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Baik SH, Clark K, Sanchez M, Loscalzo M, Celis A, Razavi M, Yang D, Dale W, Haas N. Usability and Preliminary Efficacy of an Adaptive Supportive Care System for Patients With Cancer: Pilot Randomized Controlled Trial. JMIR Cancer 2024; 10:e49703. [PMID: 38986134 PMCID: PMC11269963 DOI: 10.2196/49703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/22/2023] [Accepted: 03/21/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Using an iterative user-centered design process, our team developed a patient-centered adaptive supportive care system, PatientCareAnywhere, that provides comprehensive biopsychosocial screening and supportive cancer care to patients across the continuum of care adaptively. The overarching goal of PatientCareAnywhere is to improve health-related quality of life (HRQOL) and self-efficacy of patients with cancer by empowering them with self-management skills and bringing cancer care support directly to them at home. Such support is adaptive to the patient's needs and health status and coordinated across multiple sources in the forms of referrals, education, engagement of community resources, and secure social communication. OBJECTIVE This study aims to assess the usability of the new web-based PatientCareAnywhere system and examine the preliminary efficacy of PatientCareAnywhere to improve patient-reported outcomes compared with usual care. METHODS For phase 1, usability testing participants included patients with cancer (n=4) and caregivers (n=7) who evaluated the software prototype and provided qualitative (eg, interviews) and quantitative (eg, System Usability Scale) feedback. For phase 2, participants in the 3-month pilot randomized controlled trial were randomized to receive the PatientCareAnywhere intervention (n=36) or usual care control condition (n=36). HRQOL and cancer-relevant self-efficacy were assessed at baseline (preintervention assessment) and 12 weeks from baseline (postintervention assessment); mean differences between pre- and postintervention scores were compared between the 2 groups. RESULTS Participants were highly satisfied with the prototype and reported above-average acceptable usability, with a mean System Usability Scale score of 84.09 (SD 10.02). Qualitative data supported the overall usability and perceived usefulness of the intervention, with a few design features (eg, "help request" function) added based on participant feedback. With regard to the randomized controlled trial, patients in the intervention group reported significant improvements in HRQOL from pre- to postintervention scores (mean difference 6.08, SD 15.26) compared with the control group (mean difference -2.95, SD 10.63; P=.01). In contrast, there was no significant between-group difference in self-efficacy (P=.09). CONCLUSIONS Overall, PatientCareAnywhere represents a user-friendly, functional, and acceptable supportive care intervention with preliminary efficacy to improve HRQOL among patients diagnosed with cancer. Future studies are needed to further establish the efficacy of PatientCareAnywhere as well as explore strategies to enhance user engagement and investigate the optimal intensity, frequency, and use of the intervention to improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02408406; https://clinicaltrials.gov/study/NCT02408406.
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Affiliation(s)
- Sharon H Baik
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Karen Clark
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Marisol Sanchez
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Ashley Celis
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Marianne Razavi
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | | | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Niina Haas
- BrightOutcome, Buffalo Grove, IL, United States
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HaGani N, Surkalim DL, Clare PJ, Merom D, Smith BJ, Ding D. Health Care Utilization Following Interventions to Improve Social Well-Being: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2321019. [PMID: 37382954 PMCID: PMC10311391 DOI: 10.1001/jamanetworkopen.2023.21019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/16/2023] [Indexed: 06/30/2023] Open
Abstract
Importance It has been suggested that interventions that aim to improve social well-being may contribute to decreased health care use; however, such evidence has not been fully systematically synthesized. Objective To systematically review and meta-analyze available evidence on the associations between psychosocial interventions and health care utilization. Data Sources Medline, Embase, PsycInfo, Cumulated Index to Nursing and Allied Health Literature, Cochrane, Scopus, Google Scholar, and reference lists of systematic reviews were searched from inception until November 31, 2022. Study Selection Included studies were randomized clinical trials reporting on both health care utilization and social well-being outcomes. Data Extraction and Synthesis The reporting of the systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Full-text and quality assessments were conducted by 2 reviewers independently. Multilevel random-effects meta-analyses were used to synthesize the data. Subgroup analyses were conducted to examine the characteristics associated with decreased health care use. Main Outcomes and Measures The outcome of interest was health care utilization, including primary, emergency, inpatient, and outpatient care services. Social well-being was measured as social support, social participation, social relationships, community support, social integration, or loneliness. Results A total of 41 studies were retrieved from 18 969 citations; 37 studies were eligible for meta-analysis. Data were analyzed for 7842 participants, including 2745 older adults, 1579 young women considered to be at risk of social and mental health disadvantages, 1118 people with chronic illnesses, 1597 people with mental illnesses, and 803 caregivers. The odds ratio (OR) random-effects model showed an overall reduction in health care use (OR, 0.75; 95% CI, 0.59 to 0.97), but the standardized mean difference (SMD) random effect model showed no association. An improvement in health care utilization was observed in association with social support interventions (SMD, 0.25; 95% CI, 0.04 to 0.45) but not in loneliness interventions. Subgroup analysis indicated a reduced length of inpatient visits (SMD, -0.35; 95% CI, -0.61 to -0.09) and number of emergency care visits (OR, 0.64; 95% CI, 0.43 to 0.96) following the intervention. However, an increase in outpatient care associated with psychosocial interventions was observed (SMD, 0.34; 95% CI, 0.05 to 0.62). The largest reductions in health care use were associated with interventions among caregivers (OR, 0.23; 95% CI, 0.07 to 0.71) and individuals with mental illnesses (OR, 0.31; 95% CI, 0.13 to 0.74). Conclusions These findings suggest that psychosocial interventions were associated with most measures of health care utilization. As the association differed by participant and intervention delivery characteristics, these characteristics should be considered in the design of future interventions.
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Affiliation(s)
- Neta HaGani
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, Australia
| | - Daniel L. Surkalim
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, Australia
| | - Philip J. Clare
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, Australia
| | - Dafna Merom
- School of Health Science, Western Sydney University, Sydney, Australia
| | - Ben J. Smith
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, Australia
| | - Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, the University of Sydney, Sydney, Australia
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Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
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Sansoni M, Scarzello G, Serino S, Groff E, Riva G. Mitigating negative emotions through virtual reality and embodiment. Front Hum Neurosci 2022; 16:916227. [PMID: 35992949 PMCID: PMC9381836 DOI: 10.3389/fnhum.2022.916227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Oncological treatments are responsible for many of the physical changes (aesthetic and functional) associated with cancer. Because of this, cancer patients are at high risk of developing mental health problems. The aim of this study is to propose an innovative Virtual Reality (VR) training that uses a somatic technique (i.e., embodiment) to create a bridge with the bodily dimension of cancer. After undergoing a psycho-educational procedure, a combination of exposure, out-of-body experience, and body swapping will gradually train the patient to cope with cancer-related difficulties, increasing stress tolerance, and patient empowerment. The most engaging step of this advanced form of Stress Inoculation Training is the body swapping experience, which will guide the patient in embodying a resilient cancer patient who is facing similar difficulties. Through the VR ability to simulate the human brain functioning, and the potential of embodiment to hook to the somatic dimension of illness, we expect that once the concepts endured through the patient’s experience of resilience are triggered, the patient will be more prone to implement functional coping strategies in real life, reaching empowerment and adjusting to the post-treatment difficulties. When the scenarios are built and the training tested, our intervention could be used to support patients with different oncological diseases and who are treated in different cancer hospitals, as well as patients with other non-oncological problems (e.g., social anxiety). Future research should focus on using our paradigm for other clinical populations, and supporting cancer patients in coping with different distressing situations.
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Affiliation(s)
- Maria Sansoni
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
- *Correspondence: Maria Sansoni
| | | | - Silvia Serino
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Elena Groff
- Radiotherapy, Veneto Institute of Oncology - IOV IRCCS, Padua, Italy
| | - Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
- Technology for Neuro-Psychology Lab, Istituto Auxologico, Milan, Italy
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Toffolutti V, Stuckler D, McKee M, Wolsey I, Chapman J, J Pimm T, Ryder J, Salt H, M Clark D. The employment and mental health impact of integrated Improving Access to Psychological Therapies: Evidence on secondary health care utilization from a pragmatic trial in three English counties. J Health Serv Res Policy 2021; 26:224-233. [PMID: 33771070 DOI: 10.1177/1355819621997493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients with a combination of long-term physical health problems can face barriers in obtaining appropriate treatment for co-existing mental health problems. This paper evaluates the impact of integrating the improving access to psychological therapies services (IAPT) model with services addressing physical health problems. We ask whether such services can reduce secondary health care utilization costs and improve the employment prospects of those so affected. METHODS We used a stepped-wedge design of two cohorts of a total of 1,096 patients with depression and/or anxiety and comorbid long-term physical health conditions from three counties within the Thames Valley from March to August 2017. Panels were balanced. Difference-in-difference models were employed in an intention-to-treat analysis. RESULTS The new Integrated-IAPT was associated with a decrease of 6.15 (95% CI: -6.84 to -5.45) [4.83 (95% CI: -5.47 to -4.19]) points in the Patient Health Questionnaire-9 [generalized anxiety disorder-7] and £360 (95% CI: -£559 to -£162) in terms of secondary health care utilization costs per person in the first three months of treatment. The Integrated-IAPT was also associated with an 8.44% (95% CI: 1.93% to 14.9%) increased probability that those who were unemployed transitioned to employment. CONCLUSIONS Mental health treatment in care model with Integrated-IAPT seems to have significantly reduced secondary health care utilization costs among persons with long-term physical health conditions and increased their probability of employment.
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Affiliation(s)
- Veronica Toffolutti
- Advanced Research Fellow in Health Economics, Centre for Health Economics & Policy Innovation (CHEPI), Department of Economics & Public Policy, Imperial College London, UK
| | - David Stuckler
- Professor of European Public Health, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Martin McKee
- Anxiety and Depression Network Manager, Coach, Trainer and Facilitator, The Oxford Academic Health Sciences Network, UK
| | - Ineke Wolsey
- Development Director, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Judith Chapman
- Development Director, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Theo J Pimm
- Consultant Counselling Psychologist, Oxford Health NHS Foundation Trust, UK
| | - Joanne Ryder
- Consultant Clinical and Health Psychologist, Oxford Health NHS Foundation Trust; and the Oxford Academic Health Sciences Network, UK
| | - Heather Salt
- Professor and Chair of Experimental Psychology, Department of Experimental Psychology, University of Oxford, UK
| | - David M Clark
- Professor and Chair of Experimental Psychology, Department of Experimental Psychology, University of Oxford, UK
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Smith TB, Workman C, Andrews C, Barton B, Cook M, Layton R, Morrey A, Petersen D, Holt-Lunstad J. Effects of psychosocial support interventions on survival in inpatient and outpatient healthcare settings: A meta-analysis of 106 randomized controlled trials. PLoS Med 2021; 18:e1003595. [PMID: 34003832 PMCID: PMC8130925 DOI: 10.1371/journal.pmed.1003595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hospitals, clinics, and health organizations have provided psychosocial support interventions for medical patients to supplement curative care. Prior reviews of interventions augmenting psychosocial support in medical settings have reported mixed outcomes. This meta-analysis addresses the questions of how effective are psychosocial support interventions in improving patient survival and which potential moderating features are associated with greater effectiveness. METHODS AND FINDINGS We evaluated randomized controlled trials (RCTs) of psychosocial support interventions in inpatient and outpatient healthcare settings reporting survival data, including studies reporting disease-related or all-cause mortality. Literature searches included studies reported January 1980 through October 2020 accessed from Embase, Medline, Cochrane Library, CINAHL, Alt HealthWatch, PsycINFO, Social Work Abstracts, and Google Scholar databases. At least 2 reviewers screened studies, extracted data, and assessed study quality, with at least 2 independent reviewers also extracting data and assessing study quality. Odds ratio (OR) and hazard ratio (HR) data were analyzed separately using random effects weighted models. Of 42,054 studies searched, 106 RCTs including 40,280 patients met inclusion criteria. Patient average age was 57.2 years, with 52% females and 48% males; 42% had cardiovascular disease (CVD), 36% had cancer, and 22% had other conditions. Across 87 RCTs reporting data for discrete time periods, the average was OR = 1.20 (95% CI = 1.09 to 1.31, p < 0.001), indicating a 20% increased likelihood of survival among patients receiving psychosocial support compared to control groups receiving standard medical care. Among those studies, psychosocial interventions explicitly promoting health behaviors yielded improved likelihood of survival, whereas interventions without that primary focus did not. Across 22 RCTs reporting survival time, the average was HR = 1.29 (95% CI = 1.12 to 1.49, p < 0.001), indicating a 29% increased probability of survival over time among intervention recipients compared to controls. Among those studies, meta-regressions identified 3 moderating variables: control group type, patient disease severity, and risk of research bias. Studies in which control groups received health information/classes in addition to treatment as usual (TAU) averaged weaker effects than those in which control groups received only TAU. Studies with patients having relatively greater disease severity tended to yield smaller gains in survival time relative to control groups. In one of 3 analyses, studies with higher risk of research bias tended to report better outcomes. The main limitation of the data is that interventions very rarely blinded personnel and participants to study arm, such that expectations for improvement were not controlled. CONCLUSIONS In this meta-analysis, OR data indicated that psychosocial behavioral support interventions promoting patient motivation/coping to engage in health behaviors improved patient survival, but interventions focusing primarily on patients' social or emotional outcomes did not prolong life. HR data indicated that psychosocial interventions, predominantly focused on social or emotional outcomes, improved survival but yielded similar effects to health information/classes and were less effective among patients with apparently greater disease severity. Risk of research bias remains a plausible threat to data interpretation.
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Affiliation(s)
- Timothy B. Smith
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Connor Workman
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Caleb Andrews
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Bonnie Barton
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Matthew Cook
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Ryan Layton
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Alexandra Morrey
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Devin Petersen
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Julianne Holt-Lunstad
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
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Nagarkar R, Patil R, Gadade K, Paleja N, Bhamre R, Ramesh Y. Psychological burden on cancer patients and their caregivers during COVID-19 pandemic in India. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_35_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Sun H, Huang H, Ji S, Chen X, Xu Y, Zhu F, Wu J. The Efficacy of Cognitive Behavioral Therapy to Treat Depression and Anxiety and Improve Quality of Life Among Early-Stage Breast Cancer Patients. Integr Cancer Ther 2019; 18:1534735419829573. [PMID: 30791739 PMCID: PMC6432673 DOI: 10.1177/1534735419829573] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Positive results have appeared among nonmetastatic breast cancer patients with the use of cognitive behavioral therapy (CBT). However, earlier stage patient results have been mixed. This novelty of this study was the focus on stage I and II breast cancer patients. The objective of the current study was to conduct a meta-analysis of psychosocial functions in early-stage breast cancer survivors to determine its efficacy. METHODS A search of Cochrane Library, EMBASE, MEDLINE, PsycInfo, and PubMed yielded 3237 abstracts, which were independently evaluated by research pairs. Meta-analysis was conducted on 8 studies that included a total of 1053 patients. Psychosocial functions were categorized according to 3 domains: (1) anxiety, (2) depression, and (3) quality of life. RESULTS Improvement in anxiety was observed in patients treated with CBT relative to controls without CBT ( P = .04). Depression and quality of life improvement was not observed in the CBT group within or after 4 months of treatment ( P > .05). CONCLUSIONS The results indicated that observed improvements in anxiety in patients with early-stage breast cancer were moderate. The effectiveness of CBT for the improvement of patient outcomes could not be determined, given the methodological and clinical shortcomings of the included trials.
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Affiliation(s)
- Haoyao Sun
- 1 The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Hualei Huang
- 2 Community Health Service Center, Economic-Technical Development Zone, Taicang, Jiangsu, People's Republic of China
| | - Shengjun Ji
- 1 The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Xiaochen Chen
- 1 The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Yongqing Xu
- 2 Community Health Service Center, Economic-Technical Development Zone, Taicang, Jiangsu, People's Republic of China
| | - Fenglan Zhu
- 3 Taicang First People's Hospital Affiliated to Soochow University, Taicang, Jiangsu, People's Republic of China
| | - Jinchang Wu
- 1 The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
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Moghadam FS, Mahmoodi Z, Kabir K, Mirabi P, Yazdkhasti M. Effectiveness of a Multi-Dimensional Group Counseling Program Based on the GATHER Approach on the Quality of Life in Surgically Menopausal Women. J Menopausal Med 2019; 25:130-141. [PMID: 32307938 PMCID: PMC6952707 DOI: 10.6118/jmm.19200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/10/2019] [Accepted: 11/11/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Surgical menopause can influence women's quality of life in many aspects. This study was designed to assess the effectiveness of a multi-dimensional group counseling program based on the great clients, ask clients, tell clients, help clients, explain how to use, return for follow up (GATHER) approach, on quality of life in the surgically menopausal women. METHODS This randomized clinical trial was conducted using two groups. The study comprised 78 women meeting inclusion criteria who had visited 4 healthcare centers in Tehran from December 2017 to September 2018. The participants were selected through simple random sampling (39 in each group). The intervention group underwent 6 consecutive weekly group counseling sessions based on GATHER approach, whereas the control group received no interventions. Data were collected using the Menopause-specific Quality of Life questionnaire at 4 time-points (i.e., baseline, immediately after the intervention, 1 month after the intervention, and 3 months after the intervention). RESULTS The trend of changes at four time-points obtained on the basis of repeated measures test results showed significant betweengroup differences in vasomotor (P = 0.001), psychosocial (P = 0.025), and physical (P = 0.001) domains. Friedman test showed significant between-group differences in the mean score trend of changes at 4 time-points in sexual (P = 0.002) and overall quality of life (P = 0.004) domains. CONCLUSIONS On the basis of the study results, implementation of this approach with less expenditure in healthcare centers aimed at improving quality of life in surgically menopausal women is highly recommended.
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Affiliation(s)
| | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Department of Midwifery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Kourosh Kabir
- Department of Community Medicine, School of Medicine, Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Parvaneh Mirabi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mansoureh Yazdkhasti
- Social Determinants of Health Research Center, Department of Midwifery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
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Pryce H, Moutela T, Bunker C, Shaw R. Tinnitus groups: A model of social support and social connectedness from peer interaction. Br J Health Psychol 2019; 24:913-930. [PMID: 31449732 PMCID: PMC6899850 DOI: 10.1111/bjhp.12386] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/11/2019] [Indexed: 01/20/2023]
Abstract
Tinnitus is a chronic condition for which there is no medical treatment. Tinnitus groups are a widely available resource for people with tinnitus. OBJECTIVES Our objectives were to explore the active ingredients of tinnitus support groups in terms of their mechanisms for providing support, the contextual factors that elicit such mechanisms, and the outcomes in terms of coping enhancement. DESIGN We adopted a pluralist and iterative approach informed by the realist evaluation method. METHODS We conducted ethnographic data generation at tinnitus support groups involving observations (n = 160), focus groups (n = 130), and individual interviews (n = 20). Inductive analyses were conducted following the constant comparison method of grounded theory. We then interrogated the inductive themes to identify evidence of Contexts, Mechanisms, and Outcomes. We then produced a model which was tested in a survey of tinnitus group members (n = 65) in effect providing large-scale respondent validation of the data-driven model created through our inductive analysis. RESULTS We identified that tinnitus groups can facilitate social connectedness between group members. This experience appeared to build resilience among those experiencing tinnitus-related distress. Groups also played a role in building a sense of control related to knowledge and information sharing. Additionally, we identified risks associated with not accessing social support in a group environment. CONCLUSIONS Our findings contribute to the growing understanding of the power of social connectedness as building shared social identity when living with tinnitus. Statement of contribution What is already known on this subject? Tinnitus is a prevalent condition with approximately 10-15% of the population experiencing a spontaneous sound without obvious source. Tinnitus is an invisible health and chronic condition. People with tinnitus experience high levels of distress, anxiety, and depression. Group support is beneficial to people with many health problems. What does this study add? This study describes the mechanisms by which tinnitus support groups can support coping in tinnitus. This is the first study to comprehensively explore the views of those who attend tinnitus groups. The study identifies the key features of support groups that facilitate social connectedness among group members. The most valued features of groups are the knowledge and information provided, the sense of belonging communicated to group members, and the creation and maintenance of a sense of hope towards the tinnitus. This study contributes new insights to both the tinnitus field and adds to the literature on support groups in health.
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Affiliation(s)
- Helen Pryce
- Department of AudiologySchool of Life and Health SciencesAston UniversityBirminghamUK
| | - Tiago Moutela
- Department of AudiologySchool of Life and Health SciencesAston UniversityBirminghamUK
| | - Colette Bunker
- British Tinnitus AssociationUnit 5Acorn Business ParkSheffieldUK
| | - Rachel Shaw
- Department of PsychologySchool of Life and Health SciencesAston UniversityBirminghamUK
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11
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Fayanju OM, Yenokyan K, Ren Y, Goldstein BA, Stashko I, Power S, Thornton MJ, Marcom PK, Hwang ES. The effect of treatment on patient-reported distress after breast cancer diagnosis. Cancer 2019; 125:3040-3049. [PMID: 31120575 PMCID: PMC6690752 DOI: 10.1002/cncr.32174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) uses a 10-point scale (in which 0 indicates no distress and 10 indicates extreme distress) to measure patient-reported distress. In the current study, the authors sought to examine the relationship between treatment and NCCN DT scores in patients with breast cancer over time. METHODS The authors included women aged ≥18 years who were diagnosed with stage 0 to stage IV breast cancer (according to the seventh edition of the American Joint Commission on Cancer staging system) at a 3-hospital health system from January 2014 to July 2016. Linear mixed effects models adjusted for covariates including stage of disease, race/ethnicity, insurance, and treatment sequence (neoadjuvant vs adjuvant) were used to estimate adjusted mean changes in the DT score (MSCs) per week for patients undergoing lumpectomy, mastectomy only, and mastectomy with reconstruction (MR). RESULTS The authors analyzed 12,569 encounters for 1029 unique patients (median score, 4; median follow-up, 67 weeks). Patients treated with MR (118 patients) were younger and more likely to be married, white, and privately insured compared with patients undergoing lumpectomy (620 patients) and mastectomy only (291 patients) (all P < .01). After adjusting for covariates, distress scores were found to decline significantly across all 3 surgical cohorts, with patients undergoing MR found to have both the most preoperative distress and the greatest decline in distress prior to surgery (MSC/week: -0.073 for MR vs -0.031 for lumpectomy vs -0.033 for mastectomy only; P = .001). Neoadjuvant therapy was associated with a longitudinal decline in distress for patients treated with lumpectomy (-1.023) and mastectomy only (-0.964). Over time, ductal carcinoma in situ (-0.503) and black race (-1.198) were found to be associated with declining distress among patients treated with lumpectomy and MR, respectively, whereas divorced patients who were treated with mastectomy only (0.948) and single patients treated with lumpectomy (0.476) experienced increased distress (all P < .05). CONCLUSIONS When examined longitudinally in consecutive patients, the NCCN DT can provide patient-reported data to inform expectations and guide targeted support for patients with breast cancer.
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Affiliation(s)
- Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Women's Cancer Program, Duke Cancer Institute, Durham, North Carolina
- Department of Surgery, Durham VA Medical Center, Durham, North Carolina
| | - Karine Yenokyan
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Yi Ren
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, North Carolina
| | - Benjamin A Goldstein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Ilona Stashko
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, North Carolina
| | - Steve Power
- Department of Quality and Outcomes, Duke Cancer Institute, Durham, North Carolina
| | - Madeline J Thornton
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - P Kelly Marcom
- Women's Cancer Program, Duke Cancer Institute, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Women's Cancer Program, Duke Cancer Institute, Durham, North Carolina
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12
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Arch JJ, Mitchell JL, Genung SR, Fisher R, Andorsky DJ, Stanton AL. A randomized controlled trial of a group acceptance-based intervention for cancer survivors experiencing anxiety at re-entry ('Valued Living'): study protocol. BMC Cancer 2019; 19:89. [PMID: 30658621 PMCID: PMC6339433 DOI: 10.1186/s12885-019-5289-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/07/2019] [Indexed: 01/10/2023] Open
Abstract
Background Anxiety is a common concern of cancer survivors during the transition from active cancer treatment to cancer survivorship (the re-entry phase). This paper presents the study protocol for a novel group-based behavioral intervention to improve mental health, well-being, and medical use outcomes among anxious cancer survivors at re-entry. Methods/Design This two-armed, prospective randomized controlled trial will randomize a minimum of 100 re-entry-phase cancer survivors with moderate to high anxiety to the intervention or a usual care control condition. The intervention is delivered in a group format over 7 weeks; content is based on Acceptance and Commitment Therapy (ACT), an acceptance, mindfulness, and values-based intervention. Participants will be recruited from community cancer care centers and the intervention will be led by the onsite clinical social workers. Participants will be assessed at baseline, mid-intervention, post-intervention, and 3- and 6-month follow-up. ACT participants will complete process measures before the beginning of group sessions 2, 4, and 6; all participants will complete the process measures during the regular assessments. The primary outcome is anxiety symptoms; secondary outcomes include anxiety disorder severity, fear of recurrence, depressive symptoms, cancer-related trauma symptoms, sense of life meaning, vitality/fatigue, and medical utilization. Discussion This clinical trial will provide valuable evidence regarding the efficacy of the group ACT intervention in community oncology settings. Trial registration Clinicaltrials.gov NCT02550925.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA. .,Division of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, 80045, USA.
| | - Jill L Mitchell
- Rocky Mountain Cancer Centers, Greenwood Village, CO, 80111, USA
| | - Sarah R Genung
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA
| | - Robert Fisher
- Rocky Mountain Cancer Centers, Greenwood Village, CO, 80111, USA
| | - David J Andorsky
- Rocky Mountain Cancer Centers, Greenwood Village, CO, 80111, USA
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, 90095, USA.,Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, 90095, USA
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13
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Mausbach BT, Bos T, Irwin SA. Mental health treatment dose and annual healthcare costs in patients with cancer and major depressive disorder. Health Psychol 2018; 37:1035-1040. [PMID: 30265046 PMCID: PMC6188821 DOI: 10.1037/hea0000670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Depression in patients with cancer has been associated with increased annual health care use and costs relative to nondepressed patients. Little is known of the potential cost savings associated with receipt of mental health treatment. This study evaluated the association between number of mental health visits and annual health care costs in patients with cancer and comorbid major depression. METHOD Using a retrospective cohort study design, this study included 182 individuals with an ICD-9 chart diagnosis of cancer in 2014 and with comorbid major depressive disorder. The outcome of interest was annual health care charges 1 year from cancer diagnosis. Number of mental health visits was extracted from patients' electronic medical records for the year following cancer diagnosis. A generalized linear model with a log link function and gamma distribution was used to evaluate the association between number of mental health visits and annual health care charges, covarying for age, sex, race/ethnicity, cancer site, metastatic disease, insurance status, and severity of comorbid medical conditions. RESULTS A significant association was found between number of mental health visits and annual health care charges (exp(B) = 0.973, 95% CI [0.949, 0.999]; p = .043). Estimated annual health care costs were $99,073 for those receiving no mental health visits and $71,245 for those receiving the sample-based mean of 12 mental health visits, inclusive of mental health visits. CONCLUSIONS Greater dose of mental health visits was associated with lower annual health care costs. Improved screening and adequate treatment of depression has potential to reduce total health care costs among patients with cancer. Because this was a small study, few patients with exceptionally high costs could augment the results. Therefore, replication of these findings, particularly using a clinical trial design, is needed to confirm these effects. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Taylor Bos
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Scott A Irwin
- Department of Psychiatry, Cedars-Sinai Health System
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14
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Hamilton J, Kroska EB. Distress predicts utilization of psychosocial health services in oncology patients. Psychooncology 2018; 28:61-67. [PMID: 30286522 DOI: 10.1002/pon.4910] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The prevalence of increased distress among cancer patients has been well established and is known to be associated with negative consequences. Limited research has examined the association between distress and utilization of services, however, which is critical to understanding whether measurements of distress are being used to optimize patient care in the context of cancer. METHODS One thousand two hundred thirteen adult cancer patients completed the Distress Thermometer and Patient Needs Assessment early in their cancer care. Electronic medical record (EMR)-abstracted data included psychosocial service utilization in the 12 months following the completion of these psychosocial metrics. Logistic regressions followed by t tests were completed to assess if distress or unmet needs were affiliated with service utilization rates. RESULTS When controlling for age, distress significantly predicted service utilization rates overall. Follow-up t tests suggest that use of social work and registered dietician services was higher among those with distress scores greater than 6. When assessing unmet needs, utilization rates were positively associated with number of unmet needs, specifically for social work and dieticians. CONCLUSIONS Distress and unmet needs were related to higher rates of psychosocial service utilization during the 12 months following assessment of symptoms. These results support the continued mandate for evaluation of distress and suggest that psychosocial screening may be assisting in directing referrals and enhancing comprehensive care for patients. As psychosocial services grow, the need for continued evaluation is recommended to determine if psychology and chaplaincy services are utilized at higher rates as available providers increase.
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Affiliation(s)
- Jessica Hamilton
- Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Emily B Kroska
- Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas.,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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15
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Sanjida S, McPhail SM, Shaw J, Couper J, Kissane D, Price MA, Janda M. Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta-analyses. Psychooncology 2018; 27:2063-2076. [DOI: 10.1002/pon.4794] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/31/2018] [Accepted: 06/03/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Saira Sanjida
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
| | - Steven M. McPhail
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
- Centre for Functioning and Health Research; Metro South Health; Brisbane Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology; The University of Sydney; Sydney Australia
| | - Jeremy Couper
- Mental Health, Justice Health, Alcohol and Drug Services; Canberra Australia
- Academic Unit of Psychiatry & Addiction Medicine; Australian National University Medical School, The Canberra Hospital; Canberra Australia
| | - David Kissane
- Department of Psychiatry; Monash University; Melbourne Australia
| | - Melanie A. Price
- Psycho-oncology Co-operative Research Group, School of Psychology; The University of Sydney; Sydney Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
- Centre for Health Services Research; The University of Queensland; Brisbane Australia
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16
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Orom H, Biddle C, Underwood W, Nelson CJ. Worse Urinary, Sexual and Bowel Function Cause Emotional Distress and Vice Versa in Men Treated for Prostate Cancer. J Urol 2018; 199:1464-1469. [PMID: 29288122 PMCID: PMC7197257 DOI: 10.1016/j.juro.2017.12.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE Definitive therapy for prostate cancer (eg surgery or radiotherapy) often has side effects, including urinary, sexual and bowel dysfunction. The purpose of this study was to test whether urinary, sexual and bowel functions contribute to emotional distress during the first 2 years after treatment and whether distress may in turn decrease function. MATERIALS AND METHODS The study participants were 1,148 men diagnosed with clinically localized disease who were treated with surgery (63%) or radiotherapy (37%). Urinary, sexual and bowel functions were assessed with EPIC (Expanded Prostate Cancer Index Composite). Emotional distress was assessed with the NCCN® (National Comprehensive Cancer Network®) Distress Thermometer. Assessment time points were before treatment, and 6 weeks, and 6, 12, 18 and 24 months after treatment. We used time lagged multilevel models to test whether physical function predicted emotional distress and vice versa. RESULTS Men with worse urinary, bowel and sexual functions reported more emotional distress than others at subsequent time points. The relationships were bidirectional. Men who reported worse distress also reported worse urinary, bowel and sexual functions at subsequent time points. CONCLUSIONS Clinicians supported by practice and payer policies should screen for and facilitate the treatment of side effects and heightened emotional distress to improve well-being in survivors of prostate cancer. These interventions may be cost-effective, given that emotional distress can negatively impact functioning across life domains.
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17
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McGrady ME, Peugh JL, Brown GA, Pai ALH. Spending on Hospital Care and Pediatric Psychology Service Use Among Adolescents and Young Adults With Cancer. J Pediatr Psychol 2018; 42:1065-1074. [PMID: 28339812 DOI: 10.1093/jpepsy/jsx001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To examine the relationship between need-based pediatric psychology service use and spending on hospital care among adolescents and young adults (AYAs) with cancer. Methods Billing data were obtained from 48 AYAs with cancer receiving need-based pediatric psychology services and a comparison cohort of 48 AYAs with cancer not receiving services. A factorial analysis of covariance examined group differences in spending for hospital care. Pending significant findings, a multivariate analysis of covariance was planned to examine the relationship between need-based pediatric psychology service use and spending for inpatient admissions, emergency department (ED) visits, and outpatient visits. Results Spending for hospital care was higher among AYAs receiving need-based pediatric psychology services than in the comparison cohort (p < .001, ωPartial2 = .11). Group differences were driven by significantly higher spending for inpatient admissions and ED visits among AYAs receiving need-based pediatric psychology services. Conclusions The behavioral and psychosocial difficulties warranting need-based pediatric psychology services may predict higher health care spending.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology
| | - Gabriella A Brown
- Division of Behavioral Medicine and Clinical Psychology.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
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18
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Temple J, Salmon P, Tudur-Smith C, Huntley CD, Fisher PL. A systematic review of the quality of randomized controlled trials of psychological treatments for emotional distress in breast cancer. J Psychosom Res 2018; 108:22-31. [PMID: 29602322 DOI: 10.1016/j.jpsychores.2018.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/31/2018] [Accepted: 02/23/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Meta-analyses of trials of psychological treatments for emotional distress in breast cancer (BCa) conclude that efficacious treatments exist. Subsequently, their implementation in routine care is widely promoted by health policy. However, the methodological quality of these trials has not been systematically evaluated. The present review investigates this issue. METHOD A systematic search identified randomized controlled trials of psychological treatments for emotional distress in BCa. The Psychotherapy Outcome Study Methodology Rating Form was used to assess the quality of trials. Generic design elements, including representativeness of sample, control of concomitant treatments, reporting clinical significance outcomes, and design elements specific to psychotherapy trials, including manualisation, therapist training, and therapist adherence and competence were evaluated. RESULTS 91 trials were eligible. Overall, methodological quality was low. Generic design elements were limited in most trials: 15% specified as an inclusion criterion that participants were distressed; 10% controlled for concomitant treatments; and 11% reported the clinical significance of findings. Design elements specific to psychotherapy trials were also implemented poorly: 51% used treatment manuals; 8% used certified trained therapists; and monitoring of adherence and competence occurred in 15% and 4%, respectively. CONCLUSION The methodological quality of psychological treatment trials for emotional distress in BCa is improving. However, if relevant health policies are to be adequately empirically informed, trials of greater methodological rigour are essential. Trials should include participants with clinical levels of distress, control for concomitant treatments and report the clinical significance of findings. Trialists must also consider the specific requirements of psychotherapy trials.
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Affiliation(s)
- James Temple
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Liverpool, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Catrin Tudur-Smith
- Department of Biostatistics, Waterhouse Building, University of Liverpool, Liverpool, UK
| | - Christopher D Huntley
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Liverpool, UK
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK; Nidaros DPS, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.
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19
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Arts LPJ, Oerlemans S, Tick L, Koster A, Roerdink HTJ, van de Poll-Franse LV. More frequent use of health care services among distressed compared with nondistressed survivors of lymphoma and chronic lymphocytic leukemia: Results from the population-based PROFILES registry. Cancer 2018; 124:3016-3024. [PMID: 29698556 PMCID: PMC6055849 DOI: 10.1002/cncr.31410] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Follow-up care for a growing population of survivors of lymphoma and chronic lymphocytic leukemia (CLL) together with the adverse effects these survivors may experience as a result of their cancer and treatment have led to more pressure being placed on health care services. The objectives of the current study were to: 1) compare the use of medical care services by survivors with that of a normative population; 2) evaluate the use of medical and psychosocial care services among distressed and nondistressed survivors; and 3) identify associated sociodemographic and clinical factors. METHODS Survivors of lymphoma and CLL diagnosed between 1999 and 2012 were selected via the population-based Netherlands Cancer Registry and completed the Hospital Anxiety and Depression Scale questionnaire and questions regarding health care. Outcomes were compared with an age-matched and sex-matched normative population. RESULTS A total of 1444 survivors responded (69%). Survivors of lymphoma and CLL contacted their general practitioner (3.8 vs 2.3; P<.001) and medical specialist (5.7 vs 1.6; P<.001) more often within the last year compared with a normative population. In addition, psychologically distressed survivors had even more medical contacts and received psychosocial care more often compared with nondistressed survivors. In addition to psychological distress, comorbidity, female sex, and older age were found to be associated with a greater use of medical services, whereas younger age was associated with receiving psychosocial care. CONCLUSIONS Survivors of lymphoma and CLL, especially those who are psychologically distressed, report an increased use of health care services compared with a normative population. Further studies are needed to explore whether the use of widely applicable psychosocial interventions could reduce the frequency of medical contacts. Cancer 2018;124:3016-24. © 2018 Netherlands Comprehensive Cancer Organisation. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Lindy P J Arts
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Simone Oerlemans
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Lidwine Tick
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven and Veldhoven, the Netherlands
| | - Ad Koster
- Department of Internal Medicine, VieCuri Medical Centre, Venlo and Venray, the Netherlands
| | - Henk T J Roerdink
- Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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20
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Gonzales MJ, Gross DM, Cooke E. Psychosocial Aspects of Hematologic Disorders. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Cheng KKF, Lim YTE, Koh ZM, Tam WWS. Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database Syst Rev 2017; 8:CD011152. [PMID: 28836379 PMCID: PMC6483678 DOI: 10.1002/14651858.cd011152.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both. OBJECTIVES To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors. SEARCH METHODS In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of the review. MAIN RESULTS We included 22 RCTs and four quasi-RCTs on 2272 participants. We categorised the intervention components into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Most of the studies used usual care (routine medical follow-up services) as the comparator. A few studies used a lower level or different type of intervention (e.g. stress management or exercise) or attention control as the comparator.We used the Functional Assessment of Cancer Therapy-Breast (FACT B), European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC C30), Quality of Life (QoL) Breast Cancer, and SF36 questionnaires to assess quality of life. HBMS programmes may increase breast cancer-specific quality of life and global quality of life immediately after the intervention, as measured by FACT-B and EORTC C30 (FACT-B: mean difference (MD) 4.55, 95% confidence interval (CI) 2.33 to 6.78, 7 studies, 764 participants; EORTC: MD 4.38, 95% CI 0.11 to 8.64, 6 studies; 299 participants; moderate-quality evidence). There was no evidence of a difference in quality of life as measured by QoL-Breast Cancer or SF-36 (QoL-Breast Cancer: MD 0.42, 95% CI -0.02 to 0.85, 2 studies, 111 participants, very low-quality evidence; physical composite score SF36: MD 0.55, 95% CI -3.52 to 4.63, 2 studies, 308 participants, low-quality evidence).We observed a similar pattern at one to three months after the intervention: FACT-B (MD 6.10, 95% CI 2.48 to 9.72, 2 studies, 426 participants), EORTC-C30 (MD 6.32, 95% CI 0.61 to 12.04, 2 studies; 172 participants) and QoL-Breast Cancer (MD 0.45, 95% CI -0.19 to 1.09, 1 study, 61 participants). At four to six months and 12 months, there was no evidence of a difference in quality of life between groups (four to six months: EORTC - MD 0.08, 95% CI -7.28 to 7.44, 2 studies; 117 participants; SF-36 - MD -1.05, 95% CI -5.60 to 3.51, 2 studies, 308 participants; 12 months: EORTC - MD 2.04, 95% CI -9.91 to 13.99, 1 study; 57 participants).Functional status was incorporated into the quality of life subscale findings. HBMS programmes may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) -1.01, 95% CI -1.94 to -0.08, 5 studies, 253 participants, low-quality evidence) compared to control immediately after the intervention but the effect did not persist at four to six months. There was no evidence of improvements in depression immediately after HBMS (MD of HADS -1.36, 95% CI -2.94 to 0.22, 4 studies, 213 participants, low-quality evidence) or at follow-up. HBMS programmes may also decrease fatigue (MD -1.11, 95% CI -1.78 to -0.45, 3 studies, 127 participants; low-quality evidence) and insomnia (MD -1.81, 95% CI -3.34 to -0.27, 3 studies, 185 participants, low-quality evidence).None of the included studies reported service needs and utilisation and cost of care, and therefore the effect of HBMS programmes on healthcare utilisation and cost is unknown. Due to the variations in assessment methods of adherence among the eight studies, we could not combine the results for meta-analysis. We synthesised the results narratively, with the reported adherence rates of 58% to 100%. AUTHORS' CONCLUSIONS The results of this systematic review and meta-analysis revealed that HBMS programmes in breast cancer survivors appear to have a short-term beneficial effect of improving breast cancer-specific quality of life and global quality of life as measured by FACT-B and EORTC-C30, respectively. In addition, HBMS programmes are associated with a reduction in anxiety, fatigue and insomnia immediately after the intervention. We assessed the quality of evidence across studies as moderate for some outcomes, meaning that we are fairly confident about the results, while we assessed other outcomes as being low-quality, meaning that we are uncertain about the result.
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Affiliation(s)
- Karis Kin Fong Cheng
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Yee Ting Ethel Lim
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Zhi Min Koh
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
| | - Wilson Wai San Tam
- National University of Singapore, National University Health SystemAlice Lee Centre for Nursing StudiesSingaporeSingapore
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Carlson LE, Zelinski EL, Speca M, Balneaves LG, Jones JM, Santa Mina D, Wayne PM, Campbell TS, Giese-Davis J, Faris P, Zwicker J, Patel K, Beattie TL, Cole S, Toivonen K, Nation J, Peng P, Thong B, Wong R, Vohra S. Protocol for the MATCH study (Mindfulness and Tai Chi for cancer health): A preference-based multi-site randomized comparative effectiveness trial (CET) of Mindfulness-Based Cancer Recovery (MBCR) vs. Tai Chi/Qigong (TCQ) for cancer survivors. Contemp Clin Trials 2017; 59:64-76. [PMID: 28576734 PMCID: PMC5639905 DOI: 10.1016/j.cct.2017.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE A growing number of cancer survivors suffer high levels of distress, depression and stress, as well as sleep disturbance, pain and fatigue. Two different mind-body interventions helpful for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been evaluated in the same study or directly compared. This study will be the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors. It will also allow for secondary analyses of which program best targets specific symptoms in particular groups of survivors, based on preferences and baseline characteristics. METHODS AND SIGNIFICANCE The design is a preference-based multi-site randomized comparative effectiveness trial. Participants (N=600) with a preference for either MBCR or TCQ will receive their preferred intervention; while those without a preference will be randomized into either intervention. Further, within the preference and non-preference groups, participants will be randomized into immediate intervention or wait-list control. Total mood disturbance on the Profile of mood states (POMS) post-intervention is the primary outcome. Other measures taken pre- and post-intervention and at 6-month follow-up include quality of life, psychological functioning, cancer-related symptoms and physical functioning. Exploratory analyses investigate biomarkers (cortisol, cytokines, blood pressure/Heart Rate Variability, telomere length, gene expression), which may uncover potentially important effects on key biological regulatory and antineoplastic functions. Health economic measures will determine potential savings to the health system.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada.
| | - Erin L Zelinski
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Michael Speca
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Jones
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Janine Giese-Davis
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Peter Faris
- Centre for Advancement of Health, Alberta Health Services, AB, Canada
| | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Kamala Patel
- Department of Immunology, University of Calgary, Calgary, AB, Canada
| | - Tara L Beattie
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Steve Cole
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kirsti Toivonen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jill Nation
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Philip Peng
- Department of Anesthesia, University of Toronto, ON, Canada
| | - Bruce Thong
- Department of Athletics and Recreation, McMaster University, Hamilton, ON, Canada
| | - Raimond Wong
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine and Dentistry, Integrative Health Institute, University of Alberta, Edmonton, AB, Canada
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Watson M, Dunn J. The multidisciplinary art and science of cancer care: integrating psycho-oncology. Future Oncol 2016; 12:2775-2778. [DOI: 10.2217/fon-2016-0374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Maggie Watson
- Pastoral & Psychological Care, Compton House, The Royal Marsden NHS Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Jeffrey Dunn
- Cancer Council Queensland, Australia
- School of Public Health, Griffith University, Brisbane, Australia
- School of Social Science, University of Queensland, Australia
- Institute of Resilient Regions, USQ, Australia
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Acceptance and commitment therapy for adults with advanced cancer (CanACT): study protocol for a feasibility randomised controlled trial. Trials 2016; 17:77. [PMID: 26865162 PMCID: PMC4750179 DOI: 10.1186/s13063-016-1169-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/12/2016] [Indexed: 12/26/2022] Open
Abstract
Background One-third of people with cancer experience psychological distress and may suppress distressing thoughts, emotions, and concerns, leading to further problems. Conventional psychological treatments reduce distress by problem solving, but in advanced cancer, when ill health is progressive and death may be approaching, physical and psychological difficulties are complex and have no simple solutions. Acceptance and Commitment Therapy encourages acknowledgement and acceptance of mental experiences, increasing people’s ability to work with problems that cannot be solved. Previous pilot work in advanced cancer confirms that distress can be associated with an avoidance of experiencing uncomfortable thoughts and emotions. Methods/Design This feasibility randomised controlled trial of Acceptance Commitment Therapy aims to establish parameters for a larger trial. Fifty-four participants with advanced cancer will be randomly allocated to up to eight sessions (each 1 hour) of Acceptance Commitment Therapy or a talking control. Participants will be recruited from those attending outpatient services and hospice day care at three specialist palliative care units in North and East London, United Kingdom. The primary outcome is a measure of functioning in four areas of life (physical, social/family, emotional, and general activity) using the Functional Assessment of Cancer Therapies - General questionnaire at 3 months after randomisation. Secondary outcomes are (i) acceptance using the Acceptance and Action Questionnaire; (ii) psychological distress using the Kessler Psychological Distress Scale; (iii) physical functioning using a timed walk and sit-to-stand test; and (iv) quality of life measures including the Euroqol-5 Dimensions and ICECAP Supportive Care measures. Qualitative data will be collected at 3 months to explore the participants’ experiences of the trial and therapy. Data will be collected on the costs of care. Discussion Data generated on the recruitment, retention, and experience of the interventions and the usefulness of the outcome measures will inform the adaptations required and whether changes in function are consistent with existing data when planning for a sufficiently powered randomised controlled trial. Trial registration ISRCTN13841211 (registered 22 July 2015). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1169-8) contains supplementary material, which is available to authorized users.
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25
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Travado L, Reis JC, Watson M, Borràs J. Psychosocial oncology care resources in Europe: a study under the European Partnership for Action Against Cancer (EPAAC). Psychooncology 2015; 26:523-530. [PMID: 26685870 DOI: 10.1002/pon.4044] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/21/2015] [Accepted: 11/10/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cancer is a complex health problem requiring multidisciplinary care. There are clinical guidelines available in order to improve the process and outcomes of cancer care within Europe. However, strategic action is still needed in many European Union (EU) Member States to develop or improve national cancer control plans (NCCPs), which play a key role in cancer control and care. The current study clarifies the extent of implementation of psychosocial oncology care (PSOC) in the EU. METHOD A survey methodology was used to cover four dimensions: (1) inclusion of PSOC in NCCPs; (2) structure and resources of PSOC delivery; (3) use of NCCP clinical guidelines; and (4) education and training resources available along with determination of training needs in PSOC. RESULTS Twenty-seven (90%) countries returned questionnaires of which 21 (78%) include PSOC in their NCCP. However, only 10 (37%) reported having specific budgets for PSOC, 8 (30%) having nationally recommended PSOC clinical guidelines, and 6 countries (22%) reported having an official certification for PSOC education. CONCLUSION Although many countries seem to have integrated PSOC into their NCCP, there is still much to do in terms of allocating resources and delivering psychosocial care equitably. Also, there is a need for improving training and certification in PSOC. The findings indicate the need to develop national policies concerning PSOC with clear targets for deliverables in an appropriate timetable in order that psychosocial services and existing clinical guidelines are implemented and fully integrated into EU NCCPs. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Luzia Travado
- Psycho-oncology Unit, Clinical Centre of the Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
| | | | - Maggie Watson
- Royal Marsden Hospital NHS Trust, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Josep Borràs
- Catalan Institute of Oncology, IDIBELL, and University of Barcelona, Barcelona, Spain
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Crook B, Glowacki EM, Love B, Jones BL, Macpherson CF, Johnson RH. Hanging by a thread: exploring the features of nonresponse in an online young adult cancer survivorship support community. J Cancer Surviv 2015; 10:185-93. [PMID: 26123806 DOI: 10.1007/s11764-015-0465-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/15/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Finding helpful information can be challenging for young adult (YA) cancer survivors; thus, it is critical to examine features of online posts that successfully solicit responses and assess how these differ from posts that do not solicit responses. METHODS Using posts from an online YA cancer support community, we analyzed initial posts that did and did not receive replies utilizing Linguistic Inquiry Word Count (LIWC). RESULTS Independent t tests revealed significant differences between the sets of posts regarding content, emotions, cognitive processes, pronoun use, and linguistic complexity. More specifically, posts with replies contained fewer words per sentence, had more first-person pronouns, had more expressions of negative emotions, and contained more present tense and past tense verbs. CONCLUSIONS The findings of this study can help improve peer-exchanged support in online communities so that YA cancer survivors can more effectively receive digital support. This research also provides communication researchers, health educators, and care providers a lens for understanding the YA cancer survivorship experience. IMPLICATIONS FOR CANCER SURVIVORS This research helps survivors be strategic in how they use online forums to seek advice and support. More complete understanding of what kinds of prompts produce responses allows those in need to craft messages in ways that are most likely to elicit support from fellow cancer survivors. These implications for message design extend beyond blogging and can be applicable for text message and email exchanges between cancer patients and their care providers.
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Affiliation(s)
- Brittani Crook
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin, 2504A Whitis Ave. (A1105), Austin, TX, 78712-0115,, USA. .,Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA.
| | - Elizabeth M Glowacki
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin, 2504A Whitis Ave. (A1105), Austin, TX, 78712-0115,, USA.,Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Brad Love
- Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA.,Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Barbara L Jones
- The University of Texas at Austin School of Social Work, Austin, TX, USA
| | - Catherine Fiona Macpherson
- Adolescent and Young Adult Program, Children's Center for Cancer and Blood Diases, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rebecca H Johnson
- Division of Pediatric Hematology/Oncology, Mary Bridge Hospital/MultiCare, Tacoma, WA, USA
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Bains MK, Scott S, Kellett S, Saxon D. Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults. Aging Ment Health 2015; 18:1057-65. [PMID: 24903078 DOI: 10.1080/13607863.2014.908459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES There is a dearth of older adult evidence regarding the group treatment for co-morbid anxiety and depression. This research evaluated the effectiveness of a low-intensity group psychoeducational approach. METHOD Patients attended six sessions of a manualised cognitive-behavioural group. Validated measures of anxiety, depression and psychological well-being were taken at assessment, termination and six-week follow-up from patients, who also rated the alliance and their anxiety/depression at each group session. Staff rated patients regarding their functioning at assessment, termination and six-week follow-up. Outcomes were categorised according to whether patients had recovered, improved, deteriorated or been harmed. Effect sizes were compared to extant group interventions for anxiety and depression. RESULTS Eight groups were completed with 34 patients, with a drop-out rate of 17%. Staff and patient rated outcome measures showed significant improvements (with small effect sizes) in assessment to termination and assessment to follow-up comparisons. Over one quarter (26.47%) of patients met the recovery criteria at follow-up and no patients were harmed. Outcomes for anxiety were better than for depression with the alliance in groups stable over time. CONCLUSION The intervention evaluated shows clinical and organisational promise. The group approach needs to be further developed and tested in research with greater methodological control.
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Affiliation(s)
- Manreesh Kaur Bains
- a Older Adults Psychology , Sheffield Health & Social Care NHS Trust , Sheffield , United Kingdom
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28
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Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2015:CD008729. [PMID: 26017383 DOI: 10.1002/14651858.cd008729.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. OBJECTIVES To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer. SEARCH METHODS We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women. DATA COLLECTION AND ANALYSIS Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome. MAIN RESULTS Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Adliya, Bahrain
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29
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Venter M, Venter C, Botha K, Strydom M. Cancer Patients' Illness Experiences During a Group Intervention. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2008.10820234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jiménez J, Rivera D, Benítez P, Tarrats H, Ramos A. Integrating mental health services into a general hospital in Puerto Rico. J Clin Psychol Med Settings 2014; 20:294-301. [PMID: 23543328 DOI: 10.1007/s10880-012-9352-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The prevalence of mental health problems in the general population should be carefully considered. The literature has reported a high co-morbidity of medical and mental illnesses; therefore, collaborative efforts incorporating psychological services into medical settings are imperative. In Puerto Rico, this is not a regular practice in general hospitals. Improving access to mental health services is a challenge and requires the creation of new venues within the healthcare system. This paper describes the theoretical framework, mission, and objectives of the Clinical Psychology Services Program (CPSP) implemented at Damas Hospital in Puerto Rico. From December 2002 to December 2010, a total of 13,580 visits were made to inpatients in diverse clinical units of the hospital; 61% of all inpatients evaluated met the criteria for at least one mental health disorder based on the DSM-IV-TR. The CPSP's outcomes highlight the acceptance and relevance of incorporating mental health services and clinical psychologists into general hospitals.
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Affiliation(s)
- J Jiménez
- Clinical Psychology Department, Ponce School of Medicine and Health Sciences, P.O. Box 7004, Ponce, PR 00732-7004, USA.
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Carlson LE, MacRae JH. Quality of life issues following autologous bone marrow transplantation. Expert Rev Pharmacoecon Outcomes Res 2014; 2:129-46. [DOI: 10.1586/14737167.2.2.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Stafford L, Judd F, Gibson P, Komiti A, Quinn M, Mann GB. Comparison of the hospital anxiety and depression scale and the center for epidemiological studies depression scale for detecting depression in women with breast or gynecologic cancer. Gen Hosp Psychiatry 2014; 36:74-80. [PMID: 24200105 DOI: 10.1016/j.genhosppsych.2013.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/01/2013] [Accepted: 08/28/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Depression is common in cancer patients but frequently undetected. Consensus regarding validity and optimal thresholds of screening measures is lacking. We investigated the validity of the Hospital Anxiety and Depression Scale (HADS-D) and Center for Epidemiological Studies Depression Scale (CES-D) relative to a referent diagnostic standard in women with breast or gynecologic cancer. METHOD Participants were 100 patients who completed the CES-D and HADS-D within a larger study. The Mini International Neuropsychiatric Interview was the criterion standard. Sensitivity, specificity, predictive values and likelihood ratios for various thresholds were calculated using receiver operating characteristics. Participants were assigned to two diagnostic groups: 'major depressive disorder' or 'any depressive disorder'. RESULTS Separate analyses were conducted whereby participants found to be receiving depression/anxiety treatment at the time of validation (n=28) were excluded. Both measures had good internal consistency and criterion validity. There were no statistical differences in global accuracy between the measures for detecting either group. For optimal sensitivity and specificity in both groups, generally recommended thresholds were lowered for the HADS-D. For the CES-D, the threshold was lowered for 'any depressive disorder' and raised for 'major depressive disorder'. Negative predictive values associated with our recommended cutoffs were excellent, but positive predictive values were poor. CONCLUSIONS The HADS-D and CES-D have acceptable properties and are equivalent for detecting depression in this population. Depending on the purpose of screening, the CES-D may be more suitable for identifying major depression. Threshold choice may have serious implications for screening program effectiveness, and the use of generally recommended thresholds should be cautious.
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Affiliation(s)
- Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Australia.
| | - Fiona Judd
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia; Department of Psychiatry, University of Melbourne, Australia
| | - Penny Gibson
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia
| | - Angela Komiti
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia
| | - Michael Quinn
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Oncology and Dysplasia Unit, Royal Women's Hospital, Parkville, Australia
| | - G Bruce Mann
- The Breast Service, Royal Women's and Royal Melbourne Hospitals, Parkville, Australia; Department of Surgery, University of Melbourne, Australia
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Arving C, Brandberg Y, Feldman I, Johansson B, Glimelius B. Cost-utility analysis of individual psychosocial support interventions for breast cancer patients in a randomized controlled study. Psychooncology 2013; 23:251-8. [PMID: 24115469 DOI: 10.1002/pon.3411] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 07/04/2013] [Accepted: 08/27/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim was to explore the cost-utility in providing complementary individual psychosocial support to breast cancer patients compared with standard care (SC). METHODS Patients just starting adjuvant therapy (n = 168) at Uppsala University Hospital, Sweden, were consecutively included and randomized into three groups: psychosocial support from a specially trained nurse (INS), from a psychologist (IPS), or SC. Psychological effects and healthcare utilization were monitored during a 2-year period. The hospital billing system provided cost estimates. Quality-adjusted life years (QALYs) were calculated using health-related quality of life data from the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ C-30) translated into the Euro Quality of Life- 5-Dimensional classification. On the basis of the medical cost offset, a cost-utility analysis was performed. RESULTS Health care utilization was mainly related to the breast cancer diagnosis and treatment. The intervention costs amounted to about €500 or 3% of the total costs. Total health care costs, including interventions cost, were lower in the INS (€18,670) and IPS (€20,419) groups than in the SC group (€25,800). The number of QALYs were also higher in the INS (1.52 QALY) and IPS (1.59 QALY) groups, compared with the SC group (1.43 QALY). CONCLUSIONS The cost-utility analysis revealed that, during adjuvant treatment for breast cancer, the individual psychosocial support interventions provided here was cost effective because the health care costs were lower and QALYs were higher compared to SC alone.
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Affiliation(s)
- Cecilia Arving
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden
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Carvalho AF, Hyphantis T, Sales PMG, Soeiro-de-Souza MG, Macêdo DS, Cha DS, McIntyre RS, Pavlidis N. Major depressive disorder in breast cancer: a critical systematic review of pharmacological and psychotherapeutic clinical trials. Cancer Treat Rev 2013; 40:349-55. [PMID: 24084477 DOI: 10.1016/j.ctrv.2013.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/06/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND While women with breast cancer often face varying levels of psychological distress, there is a subgroup whose symptomatology reaches a threshold for diagnosis of major depressive disorder (MDD). Major depressive disorder is known to influence patient outcomes, such as health-related quality of life and treatment adherence. There are no systematic reviews that evaluate pharmacological and psychotherapeutic treatment trials for MDD among individuals with breast cancer. METHODS Two authors independently searched MEDLINE, EMBASE, Cochrane and Clinical Trials.gov databases through February 20, 2013 without language restrictions. Core journals, reference lists and citation tracking were also searched. Articles on breast cancer patients were included if they (1) included participants with a diagnosis of MDD; (2) investigated pharmacological or psychotherapeutic treatments for MDD compared to placebo or usual care in a randomized controlled trial (RCT). RESULTS Two RCTs on antidepressant treatment met inclusion criteria. However, no RCTs investigating the effects of psychological treatments for MDD in breast cancer were identified. Notwithstanding the paucity of data investigating the effects of psychological treatments for MDD in breast cancer, numerous psychotherapeutic strategies targeting depressive symptoms were identified. Mianserin had significant antidepressant effects when compared to placebo in a 6-week, parallel-group, RCT of Stage I-II breast cancer in women with MDD. Desipramine and paroxetine were reported to be no more efficacious than placebo in a 6-week, RCT of Stage I-IV breast cancer in women with MDD. CONCLUSIONS The evidence reviewed herein underscores the paucity of data available to guide clinicians in treatment decisions for MDD in individuals with breast cancer. Therefore, the treatment of MDD in breast cancer is primarily based on clinical experience. Some antidepressants (for example, paroxetine) should be avoided in women concurrently taking tamoxifen due to relevant interactions involving the cytochrome CYP2D6.
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Affiliation(s)
- André F Carvalho
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - Thomas Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece
| | - Paulo Marcelo G Sales
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Márcio G Soeiro-de-Souza
- Mood Disorders Unit (GRUDA), Institute and Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Danielle S Macêdo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicholas Pavlidis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
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Hopko DR, Funderburk JS, Shorey RC, McIndoo CC, Ryba MM, File AA, Benson K, Vitulano M. Behavioral Activation and Problem-Solving Therapy for Depressed Breast Cancer Patients. Behav Modif 2013; 37:747-67. [DOI: 10.1177/0145445513501512] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Major depressive disorder (MDD) is the most common psychiatric disorder in breast cancer patients. The prevalence of suicidal ideation in breast cancer patients is considerable, and relative to the general population, the prevalence of completed suicide is elevated, particularly in cancer patients with MDD. A major component of suicide prevention is effective treatment of MDD. Although some research has explored the utility of psychotherapy with breast cancer patients, only three trials have explored the benefits of behavior therapy in patients with well-diagnosed MDD and there has been no systematic investigation of the potential benefits of psychotherapy toward reducing suicidal ideation in breast cancer patients. As a follow-up to a recently completed randomized trial, this study examined the efficacy of 8 weeks of behavioral activation treatment for depression (BATD) and problem-solving therapy (PST) in reducing depression and suicidal ideation, as well as increasing hopefulness in breast cancer patients with MDD ( n = 80). Across both treatments, GEE analyses revealed decreased depression and suicidal ideation and increased hopefulness at posttreatment, results that were maintained at 12-month follow-up. Moreover, follow-up patient contact at approximately 2 years posttreatment yielded no indication of completed suicide. Although these data are preliminary, BATD and PST may represent practical approaches to decrease suicidal ideation in depressed breast cancer patients.
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Affiliation(s)
- D. R. Hopko
- The University of Tennessee-Knoxville, TN, USA
| | - J. S. Funderburk
- Syracuse VA Medical Center, NY, USA
- Syracuse University, NY, USA
- University of Rochester, NY, USA
| | | | | | - M. M. Ryba
- The University of Tennessee-Knoxville, TN, USA
| | - A. A. File
- The University of Tennessee-Knoxville, TN, USA
| | - K. Benson
- The University of Tennessee-Knoxville, TN, USA
| | - M. Vitulano
- The University of Tennessee-Knoxville, TN, USA
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36
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Stafford L, Judd F, Gibson P, Komiti A, Mann GB, Quinn M. Screening for depression and anxiety in women with breast and gynaecologic cancer: course and prevalence of morbidity over 12 months. Psychooncology 2013; 22:2071-8. [DOI: 10.1002/pon.3253] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/13/2013] [Accepted: 01/15/2013] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Penny Gibson
- Centre for Women's Mental Health; Royal Women's Hospital; Parkville; Australia
| | - Angela Komiti
- Centre for Women's Mental Health; Royal Women's Hospital; Parkville; Australia
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Björneklett HG, Rosenblad A, Lindemalm C, Ojutkangas ML, Letocha H, Strang P, Bergkvist L. A randomized controlled trial of support group intervention after breast cancer treatment: results on sick leave, health care utilization and health economy. Acta Oncol 2013; 52:38-47. [PMID: 23106175 DOI: 10.3109/0284186x.2012.734921] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND More than 50% of breast cancer patients are diagnosed before the age of 65. Returning to work after treatment is, therefore, of interest for both the individual and society. The aim was to study the effect of support group intervention on sick leave and health care utilization in economic terms. MATERIAL AND METHODS Of 382 patients with newly diagnosed breast cancer, 191 + 191 patients were randomized to an intervention group or to a routine control group, respectively. The intervention group received support intervention on a residential basis for one week, followed by four days of follow-up two months later. The support intervention included informative-educational sections, relaxation training, mental visualization and non-verbal communication. Patients answered a questionnaire at baseline, two, six and 12 months about sick leave and health care utilization. RESULTS There was a trend towards longer sick leave and more health care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p = 0.0036). CONCLUSION Costs to society were not reduced with intervention in its present form.
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Torres A, Pereira A, Monteiro S. Cognitive-Behavioral Group Therapy for Breast Cancer Survivors: Description of a Program and Preliminary Evaluation of its Effectiveness. PSYCHOLOGY, COMMUNITY & HEALTH 2012. [DOI: 10.5964/pch.v1i3.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Treanor C, Donnelly M. An international review of the patterns and determinants of health service utilisation by adult cancer survivors. BMC Health Serv Res 2012; 12:316. [PMID: 22973899 PMCID: PMC3465193 DOI: 10.1186/1472-6963-12-316] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 09/10/2012] [Indexed: 11/22/2022] Open
Abstract
Background There is a need to review factors related to health service utilisation by the increasing number of cancer survivors in order to inform care planning and the organisation and delivery of services. Methods Studies were identified via systematic searches of Medline, PsycINFO, CINAHL, Social Science Citation Index and the SEER-MEDICARE library. Methodological quality was assessed using STROBE; and the Andersen Behavioural Model was used as a framework to structure, organise and analyse the results of the review. Results Younger, white cancer survivors were most likely to receive follow-up screening, preventive care, visit their physician, utilise professional mental health services and least likely to be hospitalised. Utilisation rates of other health professionals such as physiotherapists were low. Only studies of health service use conducted in the USA investigated the role of type of health insurance and ethnicity. There appeared to be disparate service use among US samples in terms of ethnicity and socio-demographic status, regardless of type of health insurance provision s- this may be explained by underlying differences in health-seeking behaviours. Overall, use of follow-up care appeared to be lower than expected and barriers existed for particular groups of cancer survivors. Conclusions Studies focussed on the use of a specific type of service rather than adopting a whole-system approach and future health services research should address this shortcoming. Overall, there is a need to improve access to care for all cancer survivors. Studies were predominantly US-based focussing mainly on breast or colorectal cancer. Thus, the generalisability of findings to other health-care systems and cancer sites is unclear. The Andersen Behavioural Model provided an appropriate framework for studying and understanding health service use among cancer survivors. The active involvement of physicians and use of personalised care plans are required in order to ensure that post-treatment needs and recommendations for care are met.
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Affiliation(s)
- Charlene Treanor
- Cancer Epidemiology & Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK.
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Baker P, Beesley H, Dinwoodie R, Fletcher I, Ablett J, Holcombe C, Salmon P. 'You're putting thoughts into my head': a qualitative study of the readiness of patients with breast, lung or prostate cancer to address emotional needs through the first 18 months after diagnosis. Psychooncology 2012; 22:1402-10. [PMID: 22890719 DOI: 10.1002/pon.3156] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 07/09/2012] [Accepted: 07/20/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the readiness of patients to address emotional needs up to 18 months following a diagnosis of breast, lung or prostate cancer. METHOD Patients (N = 42) attending pre-treatment, treatment and follow-up clinics were provided with information designed to help them manage their emotional reactions to cancer. Patients were interviewed 3-4 weeks later about their emotional experience of cancer and their attitudes towards managing emotional problems. Qualitative data analysis followed a constant comparative approach. RESULTS Patients early in the cancer trajectory, who had not yet been engaged in chemotherapy or radiotherapy, described emotional distress as a temporary and understandable reaction that did not warrant professional intervention. They valued knowing that support was available, but did not want to use it, and were reluctant to acknowledge or address emotional needs. Conversely, patients currently or recently engaged in treatment readily acknowledged their emotional needs and welcomed help to address these. CONCLUSIONS Drawing on social cognitive and other theories, we suggest that engagement in physical treatment and care allows patients to address emotional needs following a cancer diagnosis. Guidance that emotional needs should routinely be assessed and addressed at key points in the cancer trajectory should therefore be implemented cautiously when patients are only recently diagnosed; psychological intervention may be less appropriate at this time than later.
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Affiliation(s)
- Paul Baker
- Division of Clinical Psychology, University of Liverpool, Liverpool, UK
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41
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A randomized controlled trial of a support group intervention on the quality of life and fatigue in women after primary treatment for early breast cancer. Support Care Cancer 2012; 20:3325-34. [DOI: 10.1007/s00520-012-1480-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 04/22/2012] [Indexed: 11/12/2022]
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Li M, Fitzgerald P, Rodin G. Evidence-Based Treatment of Depression in Patients With Cancer. J Clin Oncol 2012; 30:1187-96. [PMID: 22412144 DOI: 10.1200/jco.2011.39.7372] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Depression is a common condition in patients with cancer, although there has been a relative paucity of research on the effectiveness of treatment in this population. This review summarizes the psychosocial and pharmacologic treatment of depression in patients with cancer based on a consideration of evidence regarding etiologic factors and treatment outcomes. Methods A review of the evidence base for psychosocial and pharmacologic interventions for depression in patients with cancer was performed, including original studies, systematic reviews, and meta-analytic studies in the literature. Results Recent evidence from randomized controlled trials has demonstrated the efficacy of psychosocial and pharmacologic treatments to alleviate depression in patients with cancer. Further research is needed to establish their relative and combined efficacy and their role in the treatment of depression that is less severe and occurs in association with more advanced disease. First-line recommendations for the treatment of depression in patients with cancer are difficult to derive based on current evidence, because comparative studies have not been conducted to support the superiority of one treatment modality over another in this population. Conclusion Both psychosocial and pharmacologic interventions have been shown to be efficacious in treating depression in cancer, but further research is needed to establish their relative and combined benefit. Future research directions include the development and evaluation of novel interventions targeted to specific biologic and psychosocial risk factors.
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Affiliation(s)
- Madeline Li
- All authors: Princess Margaret Hospital, University Health Network; and University of Toronto, Toronto, Ontario, Canada
| | - Peter Fitzgerald
- All authors: Princess Margaret Hospital, University Health Network; and University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- All authors: Princess Margaret Hospital, University Health Network; and University of Toronto, Toronto, Ontario, Canada
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Heron-Speirs HA, Harvey ST, Baken DM. Moderators of psycho‐oncology therapy effectiveness: Addressing design variable confounds in meta‐analysis. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1468-2850.2012.01274.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sabariego C, Brach M, Herschbach P, Berg P, Stucki G. Cost-effectiveness of cognitive-behavioral group therapy for dysfunctional fear of progression in cancer patients. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:489-497. [PMID: 20689977 DOI: 10.1007/s10198-010-0266-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 06/28/2010] [Indexed: 05/29/2023]
Abstract
Anxiety and fear are often associated with chronic conditions such as cancer. This paper targets the cost-effectiveness analysis of a cognitive-behavioral group therapy (CBT) in comparison to a client-centered, supportive-experiential group therapy (SET) in cancer patients with dysfunctional fear of progression. An incremental cost-effectiveness analysis was performed using data from a randomized controlled trial among cancer patients receiving inpatient rehabilitation. The means, 95% confidence intervals [95% CI], incremental cost-effectiveness graphic and acceptability curve were obtained from 1,000 bootstrap replications. A total of 174 patients were included in the economic evaluation. The estimated means [95% CI] of direct costs and reduction of fear of progression were <euro>9,045.03 [6,359.07; 12,091.87] and 1.41 [0.93; 1.92] for patients in the SET and <euro>6,682.78 [4,998.09; 8,440.95] and 1.44 [1.02; 1.09] for patients in the CBT. The incremental cost-effectiveness ratio [95% CI] amounts to minus <euro>78,741.66 [-154,987.20; 110,486.32] for an additional unit of effect. Given the acceptability curve, there is a 92.4% chance that the CBT, compared with the SET, is cost-effective without the need of additional costs to payers. Our main result is the superior cost-effectiveness of the cognitive-behavioral intervention program in comparison to the non-directive encounter group for our sample of cancer patients with high levels of anxiety.
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Affiliation(s)
- C Sabariego
- Institute for Health and Rehabilitation Sciences, Ludwig-Maximilians-University, Marchioninistraße 17, 81377, Munich, Germany
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45
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Smith A. Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims. PSYCHOLOGICAL INJURY & LAW 2011. [DOI: 10.1007/s12207-011-9103-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rutledge R, Robinson L. Community-based organizations are critical partners in providing complete cancer care. ACTA ACUST UNITED AC 2011; 16:29-33. [PMID: 19370176 PMCID: PMC2669232 DOI: 10.3747/co.v16i2.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Canada people affected by cancer access psychosocial care and support from two systems. In the conventional medical system, psychosocial professionals focus mainly on screening for and treating those most distressed by their diagnosis. Many patients and family members go beyond this step to find information and support provided by community-based organizations (CBOS). This article outlines the components of complete cancer care effectively provided by CBOS and why the integration of the two systems of care is critical in delivering seamless high-quality psychosocial care for all.
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Affiliation(s)
- R Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia.
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Harrison JD, Young JM, Solomon MJ, Butow PN, Secomb R, Masya L. Randomized pilot evaluation of the supportive care intervention "CONNECT" for people following surgery for colorectal cancer. Dis Colon Rectum 2011; 54:622-31. [PMID: 21471765 DOI: 10.1007/dcr.0b013e31820bc152] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Improvements can be made in the quality of cancer care if supportive care needs are addressed; however, there are few trials of supportive care interventions to guide policy and practice. OBJECTIVE This study aimed to determine the effectiveness of a nurse-delivered telephone supportive intervention (the "CONNECT" intervention). DESIGN This study was a pilot randomized controlled trial. Intervention group patients received 5 calls from a specialist colorectal nurse in the 6 months after hospital discharge. Each call was standardized, comprising the assessment of unmet need and the provision of information and emotional support. CONNECT was in addition to standard clinical follow-up. Patients allocated to the control group received standard follow-up only. SETTING This study took place at the Royal Prince Alfred Hospital, Sydney, Australia. PARTICIPANTS Patients (n = 75) were included who had been surgically treated for colorectal cancer (any stage). MAIN OUTCOME MEASURES The main outcome measures were the unmet supportive care needs, health service utilization, and quality of life at 1, 3, and 6 months postdischarge. RESULTS Of 87 eligible patients, 75 consented (86% consent rate). Thirty-nine patients were randomly assigned to CONNECT and 36 to usual care. At 6 months, there was a clinically relevant, but nonsignificant reduction in presentations to emergency departments (21% vs 33%; χ1 = 1.41, P = .23) and readmission to the hospital (37% vs 47%; χ1 = 0.82, P = .37) among intervention compared with control group participants. Nonsignificant differences between groups were found for all unmet supportive care need and quality-of-life scores, change scores, and trends. However, at 6 months, total quality-of-life scores were higher for intervention group patients than controls (106.0 vs 98.6). This difference (7.4) was clinically relevant. Improvements in total quality-of-life change scores demonstrated that at 6 months, improvements were more than twice as large and clinically significant in the intervention compared with the control group. CONCLUSIONS CONNECT has shown promising indications on health system and patient outcomes that warrant a larger study to further investigate the potential of this intervention.
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Affiliation(s)
- James D Harrison
- Surgical Outcomes Research Centre, Sydney South West Area Health Service & School of Public Health, University of Sydney, Sydney, Australia.
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Lemieux J, Goodwin PJ, Bordeleau LJ, Lauzier S, Théberge V. Quality-of-life measurement in randomized clinical trials in breast cancer: an updated systematic review (2001-2009). J Natl Cancer Inst 2011; 103:178-231. [PMID: 21217081 DOI: 10.1093/jnci/djq508] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Quality-of-life (QOL) measurement is often incorporated into randomized clinical trials in breast cancer. The objectives of this systematic review were to assess the incremental effect of QOL measurement in addition to traditional endpoints (such as disease-free survival or toxic effects) on clinical decision making and to describe the extent of QOL reporting in randomized clinical trials of breast cancer. METHODS We conducted a search of MEDLINE for English-language articles published between May-June 2001 and October 2009 that reported: 1) a randomized clinical trial of breast cancer treatment (excluding prevention trials), including surgery, chemotherapy, hormone therapy, symptom control, follow-up, and psychosocial intervention; 2) the use of a patient self-report measure that examined general QOL, cancer-specific or breast cancer-specific QOL or psychosocial variables; and 3) documentation of QOL outcomes. All selected trials were evaluated by two reviewers, and data were extracted using a standardized form for each variable. Data are presented in descriptive table formats. RESULTS A total of 190 randomized clinical trials were included in this review. The two most commonly used questionnaires were the European Organization for Research and Treatment of Cancer QOL Questionnaire and the Functional Assessment of Cancer Therapy/Functional Assessment of Chronic Illness Therapy. More than 80% of the included trials reported the name(s) of the instrument(s), trial and QOL sample sizes, the timing of QOL assessment, and the statistical method. Statistical power for QOL was reported in 19.4% of the biomedical intervention trials and in 29.9% of the nonbiomedical intervention trials. The percentage of trials in which QOL findings influenced clinical decision making increased from 15.2% in the previous review to 30.1% in this updated review for trials of biomedical interventions but decreased from 95.0% to 63.2% for trials of nonbiomedical interventions. Discordance between reviewers ranged from 1.1% for description of the statistical method (yes vs no) to 19.9% for the sample size for QOL. CONCLUSION Reporting of QOL methodology could be improved.
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Affiliation(s)
- Julie Lemieux
- Santé des populations: Unité de recherche en santé des populations (URESP), Centre de recherche FRSQ du Centre hospitalier affilié universitaire de Québec (CHA), Service d'hémato-oncologie du CHA and Centre des Maladies du Sein Deschênes-Fabia du CHA, Quebec City, QC, Canada.
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Pedersen AE, Sawatzky JA, Hack TF. The sequelae of anxiety in breast cancer: a human response to illness model. Oncol Nurs Forum 2010; 37:469-75. [PMID: 20591806 DOI: 10.1188/10.onf.469-475] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To provide a critical review of the empirical literature on anxiety in women with breast cancer using the physiologic, pathophysiologic, behavior, and experiential perspectives of the Human Response to Illness (HRTI) Model. DATA SOURCES Research articles, clinical articles, and Internet sources on breast cancer and anxiety. Literature sources included CINAHL, PubMed, and PsycINFO, incorporating English language reports through March 2009. DATA SYNTHESIS Patients with breast cancer experience fluctuating levels of anxiety throughout their diagnosis and treatment trajectory. Anxiety may influence an individual's response to treatment, treatment decision making, and overall quality of life. CONCLUSIONS Research consistently demonstrates that anxiety in patients with breast cancer can have a negative effect on patient outcomes. IMPLICATIONS FOR NURSING The insight gained from exploring anxiety within the context of the four interrelated perspectives of the HRTI model fosters the provision of optimal care for patients suffering with anxiety throughout their breast cancer illness trajectory.
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Fors EA, Bertheussen GF, Thune I, Juvet LK, Elvsaas IKØ, Oldervoll L, Anker G, Falkmer U, Lundgren S, Leivseth G. Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review. Psychooncology 2010; 20:909-18. [PMID: 20821803 DOI: 10.1002/pon.1844] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 06/27/2010] [Accepted: 07/26/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This systematic review aimed to determine the effectiveness of psychoeducation, cognitive behavioural therapy (CBT) and social support interventions used in the rehabilitation of breast cancer (BC) patients. METHODS We conducted a systematic literature search to identify randomised controlled trials of female BC patients who underwent different psychosocial interventions during or after primary cancer treatment. The methodological quality of all studies was independently assessed by two reviewers. Studies with low quality, less than 20 participants in each group, patients with metastatic cancer, data not presented separately for BC and studies that included other cancer types were excluded. RESULTS Among 9617 identified studies, only 18 RCTs published between 1999 and 2008, including 3272 patients were finally included in this systematic evaluation. Outcome measures were categorised into quality of life (QoL), fatigue, mood, health behaviour and social function. Six trials examined psychoeducation had inconsistent results, both during and after the primary treatment. Seven trials examined the effect of CBT, four of which given after primary treatment (range 6-12 weeks) demonstrated improvements in QoL; the other three CBT studies given during primary treatment (range 9-20 weeks) had inconsistencies. Five studies addressed social support and showed no conclusive impacts of this intervention. CONCLUSIONS Limited documentation exists on the efficacy of psychosocial rehabilitation interventions among BC patients. However, we found that patients might have QoL benefits from CBT given after primary BC treatment. More documentation is needed regarding the effects of CBT during primary treatment and the effects of psychoeducation and social support.
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Affiliation(s)
- Egil A Fors
- Department of Psychiatry, St Olav University Hospital, Trondheim, Norway.
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