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Duan T, Cao Z, Huang X, Wang X, Sun T, Xu C. Association of social health with all-cause mortality and cause-specific mortality: A population-based cohort study. J Affect Disord 2024; 359:49-58. [PMID: 38768818 DOI: 10.1016/j.jad.2024.05.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Previous studies only focused on the individual social factors, without considering the overall social health patterns. The present study aimed to develop an integrated social health score (SHS) and investigate its associations with all-cause, cardiovascular disease (CVD), cancer mortality. METHODS A total of 330,716 participants (mean age 56.3 years; 52.4 % female) from UK Biobank was included between 2006 and 2010, and thereafter followed up to 2021. SHS was calculated by using information on social connections, social engagement and social support. Cox proportional hazards models was used to estimate the hazard ratios and 95 % confidence intervals (CIs) of the association between SHS and all-cause and cause-specific mortality and the 4-way decomposition was used to quantify the mediating effect of lifestyle factors. RESULTS During a median follow-up period of 12.4 years, 37,897 death cases were recorded, including 4347 CVD and 10,380 cancer cases. The SHS was inversely associated with the risks of all-cause, CVD and cancer mortality in a dose-dependent manner (P for trend <0.001). The association between SHS with all-cause mortality was mediated by lifestyle factors including diet score, smoking status and alcohol consumption. CONCLUSION Integrated SHS was inversely associated with risks of all-cause, CVD and cancer mortality, and the associations were partially mediated by lifestyle factors. Our study highlights the importance of maintaining high levels of social health by jointly enhancing social involvement, expanding social networks, and cultivating enduring intimate relationships across the life course.
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Affiliation(s)
- Tingshan Duan
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Zhi Cao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianhong Huang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xiaohe Wang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Tao Sun
- School of Public Health, Hangzhou Normal University, Hangzhou, China.
| | - Chenjie Xu
- School of Public Health, Hangzhou Normal University, Hangzhou, China.
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Alfieri S, Murru L, Bosisio M, Gangeri L, Monfredini M, Capri G, Lozza L, Borreani C. "Ariadne's Thread": Psycho-educational Empowerment Intervention for Patients with Metastatic Breast Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02449-2. [PMID: 38809494 DOI: 10.1007/s13187-024-02449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 05/30/2024]
Abstract
"Ariadne's thread" is a psycho-educational intervention designed by the Breast Unit and the Clinical Psychology Unit of an Italian Comprehensive Cancer Center and aims to promote empowerment in patients with metastatic breast cancer. It consists of 8 online meetings led by a psycho-oncologist in which informative sessions by patients' referring physicians alternate with moments of stress management techniques. This study aims to investigate (1) the feasibility of the "Ariadne's thread" pilot intervention and (2) the satisfaction and perceived benefits of the pilot intervention. We used a mixed method approach in which (1) it was detected: the number of acceptance to the single session of the intervention by both patients and professionals, the number of help requests by patients, and the number of change of date requests by professionals; (2) semi-structured interviews were conducted with the professionals who participated in the intervention; (3) 2 focus groups were conducted with patients, and (4) a questionnaire was submitted to each of them. The intervention is sustainable from the perspective of the organization, professionals, and patients. In particular, the patients declared perceiving benefits in many aspects: improved relationships with doctors, acceptance of their illness, learning of a relaxation technique, possibility to look at the world with trust and hope, etc. The questionnaires show an improvement in empowerment and satisfaction as a result of the intervention. "Ariadne's thread" is a psycho-educational intervention that effectively addresses the needs of patients with MBC. It can be applied to other contexts (1) if it has been confirmed that similar needs exist or (2) if it can be modified to accommodate other needs.
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Affiliation(s)
- S Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - L Murru
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Bosisio
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - L Gangeri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - M Monfredini
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Capri
- Medical Oncology 1, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - L Lozza
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - C Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Agrawal M, Richards W, Beaussant Y, Shnayder S, Ameli R, Roddy K, Stevens N, Richards B, Schor N, Honstein H, Jenkins B, Bates M, Thambi P. Psilocybin-assisted group therapy in patients with cancer diagnosed with a major depressive disorder. Cancer 2024; 130:1137-1146. [PMID: 38105655 DOI: 10.1002/cncr.35010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Depression is common in patients with cancer and is associated with lower treatment adherence and reduced quality of life. Antidepressants and psychotherapy have limited success in improving depression among patients with cancer. This study explored the safety, feasibility, and efficacy of psilocybin-assisted therapy in patients with cancer and major depressive disorder. METHODS This phase 2, open-label trial enrolled patients with curable and noncurable cancer and major depressive disorder at a single community oncology practice site. A single 25-mg dose of psilocybin was administered simultaneously to cohorts of three to four participants with individual (4.25 hours in 1:1 therapist-to-patient ratio) and group therapeutic support (3.75 hours) before, during, and after psilocybin administration. Outcomes included depression severity, anxiety, pain, demoralization, and disability. RESULTS Thirty participants completed the study. No psilocybin-related serious adverse events occurred; treatment-related adverse events (e.g., nausea, headache) were generally mild and expected. There were no laboratory or electrocardiogram abnormalities. No suicidality was reported. Efficacy was suggested with a robust reduction in depression severity scores from baseline to posttreatment of 19.1 points (95% CI, 22.3 to -16.0; p < .0001) by week 8. Eighty percent of participants demonstrated a sustained response to psilocybin treatment; 50% showed full remission of depressive symptoms at week 1, which was sustained for 8 weeks. CONCLUSIONS Psilocybin-assisted therapy in group cohort administration was safe and feasible in patients with cancer and depression. Efficacy was suggested based on clinically meaningful reductions in depressive symptoms. The novel, group-oriented format, compact delivery time, community cancer center setting, and one-to-one therapist-to-patient ratio could also add to therapeutic gains and efficiency of administration. TRIAL REGISTRATION NCT04593563. PLAIN LANGUAGE SUMMARY Depression is common in patients with cancer and associated with lower treatment adherence, reduced quality of life, and limited response to antidepressants and psychotherapy. We conducted a phase 2 trial to study a single dose of psilocybin administered in a group therapy setting with one-to-one therapist-to-participant psychological support to patients with curable and noncurable cancer and major depressive disorder. Findings of the study showed safety (no treatment-related serious adverse events or suicidality) with psilocybin and suggested efficacy, with a significant reduction in depression severity scores from baseline to posttreatment. Further investigation is warranted.
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Affiliation(s)
| | | | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sarah Shnayder
- Teachers College, Columbia University, New York, New York, USA
| | - Rezvan Ameli
- Sunstone Therapies, Rockville, Maryland, USA
- Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | - Nick Schor
- Sunstone Therapies, Rockville, Maryland, USA
| | | | | | - Mark Bates
- Sunstone Therapies, Rockville, Maryland, USA
| | - Paul Thambi
- Sunstone Therapies, Rockville, Maryland, USA
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Powers-James C, Morse M, Narayanan S, Ramondetta L, Lopez G, Wagner R, Cohen L. Integrative Oncology Approaches to Reduce Recurrence of Disease and Improve Survival. Curr Oncol Rep 2024; 26:147-163. [PMID: 38180690 DOI: 10.1007/s11912-023-01467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW After a cancer diagnosis, patients ask what they can do in addition to the recommended treatments to increase their survival. Many turn to integrative medicine modalities and lifestyle changes to improve their chances of survival. Numerous studies have demonstrated that lifestyle changes can significantly improve survival rates for cancer patients. Less support exists for the use of natural products or supplements to improve cancer survival. In this manuscript, we review key findings and evidence in the areas of healthy eating habits, physical activity, stress management and social support, and sleep quality, as well as natural products and supplements as they relate to the cancer recurrence and survival. RECENT FINDINGS While more research is needed to fully understand the mechanisms underlying the associations between lifestyle changes and cancer survival, findings suggest that lifestyle modifications in the areas of diet, physical activity, stress management and social support, and sleep quality improve clinical cancer outcomes. This is especially true for programs that modify more than one lifestyle habit. To date, outside of supplementing with vitamin D to maintain adequate levels, conflicting conclusion within the research remain regarding the efficacy of using natural products or supplement to improve cancer recurrence of disease or cancer survival. A call for further research is warranted. Lifestyle screening and counseling should be incorporated into cancer treatment plans to help improve patient outcomes. While the scientific community strives for the pursuit of high-quality research on natural products to enhance cancer survival, transparency, dialogue, and psychological safety between patients and clinicians must continue to be emphasized. Proactive inquiry by clinicians regarding patients' supplement use will allow for an informed discussion of the benefits and risks of natural products and supplements, as well as a re-emphasis of the evidence supporting diet and other lifestyle habits to increase survival.
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Affiliation(s)
- Catherine Powers-James
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Meroë Morse
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Santhosshi Narayanan
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lois Ramondetta
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Richard Wagner
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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Amemiya R, Takada I, Kanzawa H, Ono S, Morishita Y, Ikeda N, Furukawa K. Metachronous Primary Lung Cancer Occurring during the Spontaneous Regression of Locally Advanced Lung Cancer: A Rare Case Report. Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 36198568 PMCID: PMC10902648 DOI: 10.5761/atcs.cr.22-00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 71-year-old man was diagnosed as having right primary lung squamous cell carcinoma, clinical stage IIIA, but he refused treatment. However, the right upper lobe nodule and lymph node (LN) #4R showed gradual shrinking without treatment. Four years after the diagnosis, a new nodule was detected in the left lung field. We considered that this new nodule might be metachronous primary lung cancer, and hence resected it for diagnosis and treatment. The tumor in the left lung was diagnosed as basaloid squamous cell carcinoma, and that in LN #4R was diagnosed as squamous cell carcinoma with keratinization. Therefore, the patient was diagnosed as having metachronous primary lung cancer that developed during the spontaneous regression of locally advanced lung cancer.
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Affiliation(s)
- Ryosuke Amemiya
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ikki Takada
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroya Kanzawa
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shotaro Ono
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yukio Morishita
- Department of Diagnostic Pathology, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kinya Furukawa
- Department of Thoracic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-machi, Ibaraki, Japan
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Li Z, Laginha KJ, Boyle F, Daly M, Dinner F, Hirsch P, Hobbs K, Kirsten L, Mazariego C, McAuley R, O'Brien M, O'Reilly A, Taylor N, Tobin L, Lewis S, Smith AL. Professionally led support groups for people living with advanced or metastatic cancer: a systematic scoping review of effectiveness and factors critical to implementation success within real-world healthcare and community settings. J Cancer Surviv 2024:10.1007/s11764-023-01515-w. [PMID: 38191752 DOI: 10.1007/s11764-023-01515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To examine the effectiveness of professionally led support groups for people with advanced or metastatic cancer, and identify factors critical to implementation success within real-world settings. METHODS Databases (MEDLINE; PsychINFO; CINAHL) and grey literature were searched for empirical publications and evaluations. Articles were screened for eligibility and data systematically extracted, charted and summarised using a modified scoping review methodology. Implementation factors were mapped using Proctor's implementation framework and the Consolidated Framework for Implementation Research 2.0. RESULTS A total of 1691 publications were identified; 19 were eligible for inclusion (8 randomised controlled trials, 7 qualitative studies, 2 cohort studies, 2 mixed methods studies). Most (n=18) studies focused on tumour-specific support groups. Evidence supported professionally led support groups in reducing mood disturbances (n=5), distress (i.e. traumatic stress, depression) (n=4) and pain (n=2). Other benefits included social connectedness (n=6), addressing existential distress (n=5), information and knowledge (n=6), empowerment and sense of control (n=2), relationships with families (n=2) and communication with health professionals (n=2). Thirteen studies identified factors predicting successful adoption, implementation or sustainment, including acceptability (n=12; 63%), feasibility (n=6; 32%) and appropriateness (n=1; 5%). Key determinants of successful implementation included group leaders' skills/experience, mode of operation, travelling distance, group composition and membership and resourcing. CONCLUSIONS Professionally led tumour-specific support groups demonstrate effectiveness in reducing mood disturbances, distress and pain among patients. Successful implementation hinges on factors such as leadership expertise, operational methods and resource allocation. IMPLICATIONS FOR CANCER SURVIVORS Professionally led support groups may fill an important gap in supportive care for people with advanced or metastatic cancer.
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Affiliation(s)
- Zhicheng Li
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Rm 111b, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia
| | - Kitty-Jean Laginha
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michele Daly
- Cancer Institute NSW, Consumer Advisory Panel, Sydney, NSW, Australia
| | | | - Pia Hirsch
- Advanced Breast Cancer Group, Brisbane, Qld, Australia
| | - Kim Hobbs
- Westmead Centre for Gynaecological Cancers, Westmead, NSW, Australia
| | | | - Carolyn Mazariego
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Mary O'Brien
- Advanced Breast Cancer Group, Brisbane, Qld, Australia
| | | | - Natalie Taylor
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Tobin
- Breast Cancer Network Australia, Camberwell, VIC, Australia
| | - Sophie Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrea L Smith
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Rm 111b, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia.
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Kissane DW, Bobevski I, Appleton J, Murphy G, Laverty-Wilson A, Kessel P, Michael N, Chye R, Lethborg C. Meaning and Purpose (MaP) therapy in advanced cancer patients: a randomised controlled trial. Support Care Cancer 2023; 31:734. [PMID: 38051407 DOI: 10.1007/s00520-023-08189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE We aimed to examine the efficacy of Meaning and Purpose (MaP) Therapy in promoting posttraumatic growth and meaningful life attitudes (choices and goal seeking) in people living with advanced cancer. METHODS Patients with a prognosis ≥ 1 year were stratified across two sites and randomised to receive MaP therapy and regular oncology/palliative care (Intervention) or usual care (Control). They completed measures at baseline (t0), post-intervention (12 weeks, t1) and 12 weeks later (t2). Our primary outcome was posttraumatic growth (PTGI); secondary outcome measures included life attitudes (LAPR), spiritual wellbeing (FACIT-Sp), anxiety, demoralization and depression. TRIAL REGISTRATION NUMBER ACTRN12618001751268, 7 January 2019. RESULTS We consented 107 from 404 eligible patients (26.5%) and randomised 55 to MaP Invention (35 completing t1, 25 t2) and 52 to Control (32 completing t1, 25 t2). Fidelity of the intervention was sustained. PTGI mean scores were significantly higher post-intervention on analysis by covariance (Cohen's d = 0.7 at t1 & d = 0.5 at t2). Secondary measures were significant, including LAPR (d = 0.4) and FACIT-Sp (meaning subscale d = 0.4; total d = 0.4). Participants completing six sessions achieved more noteworthy effect sizes. CONCLUSION This brief, structured individual intervention shows promise for sustaining sense of coherence, meaning and choices in life despite living with advanced cancer.
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Affiliation(s)
- David W Kissane
- School of Medicine, University of Notre Dame Australia, Sydney, Australia.
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia.
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia.
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia.
| | - Irene Bobevski
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Jane Appleton
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Genevieve Murphy
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Anna Laverty-Wilson
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Pauley Kessel
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Natasha Michael
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Richard Chye
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Carrie Lethborg
- Centre for Rural Health, University of Tasmania, Launceston, Australia
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Sırlıer Emir B, Yıldız S, Kurt O, Emre E, Aydın S. Relationships between Anxiety, Depression, and Illness Perceptions in Lung and Breast Cancer Patients throughout the Cancer Continuum. Healthcare (Basel) 2023; 11:2794. [PMID: 37893868 PMCID: PMC10606067 DOI: 10.3390/healthcare11202794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Cancer is a devastating disease that has significant psychological and biological impacts. Generally, lung cancer primarily affects men while breast cancer primarily affects women. Thus, this study aimed to investigate the levels of anxiety and depression in patients with these prevalent cancer types, as well as their perceptions of the illness and any potential connections between them. The study included a total of 252 participants, consisting of 110 breast cancer patients, 112 lung cancer patients, and 30 healthy individuals as controls. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to assess mood, while the Illness Perception Questionnaire (IPQ) was used to evaluate cancer perceptions. Results revealed that both breast cancer and lung cancer patients had significantly higher BDI and BAI scores compared to the control group. Furthermore, the BDI and BAI scores were lower in breast cancer patients compared to lung cancer patients. The IPQ causal representation-immunity score was significantly higher in lung cancer patients than in breast cancer patients (p = 0.01). Positive correlations were found between BDI scores and BAI scores, as well as between BDI scores and certain subscale scores of the IPQ related to illness representation and causal representation. Additionally, a positive correlation was observed between BAI scores and the IPQ illness representation-timeline acute/chronic subscale, while a negative correlation was found between BAI scores and the IPQ causal representation-accident or chance scores. Overall, the study findings demonstrated that breast and lung cancer patients possess negative perceptions of their disease and experience high levels of anxiety and depression. To enhance the quality of life and promote resilience in these patients, it is recommended to incorporate psychological interventions that consider anxiety, depression, and disease perception.
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Affiliation(s)
- Burcu Sırlıer Emir
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
| | - Sevler Yıldız
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
| | - Osman Kurt
- Department of Public Health, Adıyaman Provincial Health Directorate, 02100 Adıyaman, Turkey;
| | - Elif Emre
- Department of Anatomy, Faculty of Medicine, University of Fırat, 23119 Elazığ, Turkey;
| | - Süleyman Aydın
- Department of Biochemistry, Faculty of Medicine, University of Fırat, 23119 Elazığ, Turkey;
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9
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Nakao S, Kamo T, Someko H, Okamura M, Tsujimoto Y, Ogihara H, Sato S, Maniwa S. Peer Support for Patients With Heart Failure: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e46751. [PMID: 38021950 PMCID: PMC10630709 DOI: 10.7759/cureus.46751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 12/01/2023] Open
Abstract
Peer support, which is given by people with similar life experiences and experiential knowledge, has been shown to be effective for patients with diabetes and mental illness. However, the impact of such peer support on patients coping with heart failure remains indeterminate. The objective of this systematic review and meta-analysis is to scrutinize the potential benefits of peer support for patients with heart failure. We included randomized controlled trials (RCTs) evaluating the effectiveness of peer support for patients with heart failure in contrast to those without peer support. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov until October 2022. We pooled the data on mortality, readmission rate, and quality of life (QoL) as primary outcomes. The certainty of evidence was evaluated by the grading of recommendations assessment, development, and evaluation (GRADE) approach. We included three studies with 390 patients with heart failure. Peer support may have resulted in a slight increase in mortality (risk ratio (RR)=1.16, 95% confidence interval (CI)=0.61-2.21; low certainty of the evidence) and in a reduction in the readmission rate (RR=0.93, 95% CI=0.74-1.17; low certainty of the evidence). The evidence was very uncertain about the effect of peer support on QoL (standardized mean difference 2.03 higher in the intervention group, 95% CI=1.79 lower to 5.84 higher; very low certainty of the evidence). Despite that the certainty is low or very low, the extant data available evidence suggests that peer support may not yield substantial improvements in critical outcomes for patients with heart failure. Consequently, endorsing peer support for patients with heart failure currently seems unjustifiable.
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Affiliation(s)
- Shuri Nakao
- Division of Rehabilitation Medicine, Shimane University Hospital, Izumo, JPN
| | - Tomohiko Kamo
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Takasaki, JPN
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
| | - Hidehiro Someko
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
- Department of General Internal Medicine, Asahi General Hospital, Asahi, JPN
| | - Masatsugu Okamura
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, DEU
- Department of Rehabilitation Medicine, School of Medicine, Yokohama City University, Yokohama, JPN
| | - Yasushi Tsujimoto
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
- Department of Internal and Family Medicine, Oku Medical Clinic, Osaka, JPN
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, JPN
| | - Hirofumi Ogihara
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, JPN
| | - Shinya Sato
- Division of Rehabilitation Medicine, Shimane University Hospital, Izumo, JPN
| | - Sokichi Maniwa
- Department of Rehabilitation Medicine, Faculty of Medicine, Shimane University Hospital, Izumo, JPN
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Hassan MZO, Tawakol A, Wang Y, Alvi RM, Awadalla M, Jones-O’Connor M, B. Bakar R, Banerji D, Rokicki A, Zhang L, Mulligan CP, Osborne MT, Zarif A, Hammad B, Chan AW, Wirth LJ, Warner ET, Pitman RK, Armstrong KA, Addison D, Neilan TG. Amygdalar activity measured using FDG-PET/CT at head and neck cancer staging independently predicts survival. PLoS One 2023; 18:e0279235. [PMID: 37540647 PMCID: PMC10403142 DOI: 10.1371/journal.pone.0279235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/03/2022] [Indexed: 08/06/2023] Open
Abstract
IMPORTANCE The mechanisms underlying the association between chronic stress and higher mortality among individuals with cancer remain incompletely understood. OBJECTIVE To test the hypotheses that among individuals with active head and neck cancer, that higher stress-associated neural activity (ie. metabolic amygdalar activity [AmygA]) at cancer staging associates with survival. DESIGN Retrospective cohort study. SETTING Academic Medical Center (Massachusetts General Hospital, Boston). PARTICIPANTS 240 patients with head and neck cancer (HNCA) who underwent 18F-FDG-PET/CT imaging as part of initial cancer staging. MEASUREMENTS 18F-FDG uptake in the amygdala was determined by placing circular regions of interest in the right and left amygdalae and measuring the mean tracer accumulation (i.e., standardized uptake value [SUV]) in each region of interest. Amygdalar uptake was corrected for background cerebral activity (mean temporal lobe SUV). RESULTS Among individuals with HNCA (age 59±13 years; 30% female), 67 died over a median follow-up period of 3 years (IQR: 1.7-5.1). AmygA associated with heightened bone marrow activity, leukocytosis, and C-reactive protein (P<0.05 each). In adjusted and unadjusted analyses, AmygA associated with subsequent mortality (HR [95% CI]: 1.35, [1.07-1.70], P = 0.009); the association persisted in stratified subset analyses restricted to patients with advanced cancer stage (P<0.001). Individuals within the highest tertile of AmygA experienced a 2-fold higher mortality rate compared to others (P = 0.01). The median progression-free survival was 25 months in patients with higher AmygA (upper tertile) as compared with 36.5 months in other individuals (HR for progression or death [95%CI], 1.83 [1.24-2.68], P = 0.001). CONCLUSIONS AND RELEVANCE AmygA, quantified on routine 18F-FDG-PET/CT images obtained at cancer staging, independently and robustly predicts mortality and cancer progression among patients with HNCA. Future studies should test whether strategies that attenuate AmygA (or its downstream biological consequences) may improve cancer survival.
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Affiliation(s)
- Malek Z. O. Hassan
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Royal Papworth Hospital, Trumpington, Cambridge, United Kingdom
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Nuclear Cardiology, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ying Wang
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Nuclear Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Raza M. Alvi
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Magid Awadalla
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maeve Jones-O’Connor
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rula B. Bakar
- Department of Medical Sciences, Oxford University, Oxford, United Kingdom
| | - Dahlia Banerji
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Adam Rokicki
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lili Zhang
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Connor P. Mulligan
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael T. Osborne
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Nuclear Cardiology, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Azmaeen Zarif
- Royal Papworth Hospital, Trumpington, Cambridge, United Kingdom
| | - Basma Hammad
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Annie W. Chan
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lori J. Wirth
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Erica T. Warner
- Clinical Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Katrina A. Armstrong
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel Addison
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiology, Department of Medicine, Ohio State University, Columbus, Ohio, United States of America
| | - Tomas G. Neilan
- Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Sharbafchi MR, Malekian A, Ahmadzadeh Z, Torkian S, Baharizadeh A, Zarean E. Evaluate the Effectiveness of a Group Psychoeducational Intervention in Reducing the Level of Cancer-Related Fatigue in Women Receiving Chemotherapy for Breast Cancer: A Randomized Controlled Trial. Adv Biomed Res 2023; 12:151. [PMID: 37564460 PMCID: PMC10410410 DOI: 10.4103/abr.abr_137_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 08/12/2023] Open
Abstract
Background One of the most debilitating symptoms in breast cancer survivors is cancer-related fatigue (CRF). CRF weakens patients' physical, cognitive, and occupational functions. It is associated with poorer quality of life and may reduce recurrence-free and overall survival. This study aimed to evaluate the efficacy of a group psychoeducational intervention in improving CRF in breast cancer patients. Materials and Methods Fifty breast cancer patients who suffered from CRF were randomly assigned to receive a group psychoeducational intervention or control group. This study was designed as an eight weeks clinical trial. The psychoeducational intervention mainly consisted of concentrative movement therapy and energy conservation strategies. Primary outcome measures were the changes in the Fatigue Visual Analogue scale, Cancer Fatigue scale, and Piper Fatigue scale at the study endpoint. Measure assessments were made on four occasions: at baseline, after the intervention, one week, and four weeks post intervention. Statistical analysis was performed using SPSS26. Results The intervention improved CRF significantly (P < 0.001). All subscales of the Cancer Fatigue scale and the sensory, affective, and cognitive subscales of the Piper Fatigue scale showed statistically significant effects (P < 0.001) at all time points. However, the behavioral subscale of the Piper Fatigue scale was different only at the end of the study (P < 0.001). Conclusions The group psychoeducational intervention improved CRF significantly. All the sensory, behavioral, physical, affective, and cognitive subscales improved. Accessible and confirmatory treatment can help patients to cope with fatigue in communities.
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Affiliation(s)
- Mohammad Reza Sharbafchi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences and Iranian Cancer Control Center (MACSA), Isfahan, Iran
| | - Azadeh Malekian
- Clinical Research Development Center (CRDC), Islamic Azad University, Najafabad Independent Branch, Najafabad, Iran
| | - Zahra Ahmadzadeh
- Cancer Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samaneh Torkian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Baharizadeh
- College of Skill and Entrepreneurship, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Elham Zarean
- Cancer Research Center and Department of Psychiatry, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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12
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Macciò A, Sanna E, Piras R, Lavra F, Vallerino V, Maricosu G, Giglio E, Mura A, Tidore M, Madeddu C. Survival as a clinical outcome and its spiritual significance in a cohort of patients with advanced central pelvic neoplastic disease undergoing total pelvic evisceration: a poorly debated issue. Front Med (Lausanne) 2023; 10:1173687. [PMID: 37359011 PMCID: PMC10288149 DOI: 10.3389/fmed.2023.1173687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background Patients with either treatment-resistant or relapsing advanced central pelvic neoplastic disease present with a condition responsible for debilitating symptoms and consequently poor quality of life (QoL). For these patients, therapeutic strategies are very limited and total pelvic evisceration is the only option for relieving the symptoms and increasing survival. Of note, taking charge of these patients cannot be limited to increasing their lifespan but must also be aimed at improving the clinical, psychological, and spiritual conditions. This study aimed to prospectively evaluate the improvement in survival and QoL, focusing on spiritual wellbeing (SWB), in patients with poor life expectancy who underwent total pelvic evisceration for advanced gynecological cancers at our center. Patients and methods The QoL and SWB were assessed using the European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30), EORTC QLQ-SWB32, and SWB scale, which were repeatedly administered: 30 days before surgery, 7 days after the procedure, 1 and 3 months after surgery, and then every 3 months until death or the last follow-up assessment. Operative outcomes (blood loss, operative time, hospitalization, and incidence of complications) were evaluated as secondary endpoints. The patients and their families were included in a dedicated psycho-oncological and spiritual support protocol, which was managed by specifically trained and specialized personnel who accompanied them during all phases of the study. Results A total of 20 consecutive patients from 2017 to 2022 were included in this study. Of these patients, 7 underwent total pelvic evisceration by laparotomy and 13 underwent laparoscopy. The median survival was 24 months (range: 1-61 months). After a median follow-up of 24 months, 16 (80%) and 10 patients (50%) were alive at 1 year and 2 years after surgery, respectively. The EORTC-QLQ-C30 scores significantly improved yet at 7 days and at 1, 3, 6, and 12 months, as compared with the preoperative values. In particular, an early improvement in pain, overall QoL, and physical and emotional functions was observed. With respect to the SWB, the global SWB item score of the EORTC QLQ-SWB32 questionnaire significantly increased after 1 month and 3 months, as compared with preoperative values (p = 0.0153 and p = 0.0018, respectively), and remained stable thereafter. The mean SWB scale score was 53.3, with a sense of low overall SWB in 10 patients, a sense of moderate SWB in eight patients, and a sense of high SWB in two patients. The SWB scale score significantly increased after 7 days, 1 month, and 3 months, as compared with the preoperative value (p = 0202, p = 0.0171, and p = 0.0255, respectively), and remained stable thereafter. Conclusion Total pelvic evisceration is a valid approach for improving both survival and QoL in selected patients with advanced pelvic neoplasms and poor life expectancy. Our results particularly underline the importance of accompanying the patients and their families during the journey with dedicated psychological and spiritual support protocols.
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Affiliation(s)
- Antonio Macciò
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Elisabetta Sanna
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Roberta Piras
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Fabrizio Lavra
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Valerio Vallerino
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Giovanni Maricosu
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Emanuela Giglio
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | | | | | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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13
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Kirkegaard AM, Dalton SO, Boesen EH, Karlsen RV, Flyger H, Johansen C, von Heymann A. Effects on long-term survival of psychosocial group intervention in early-stage breast cancer: follow-up of a randomized controlled trial. Acta Oncol 2023; 62:422-428. [PMID: 37102368 DOI: 10.1080/0284186x.2023.2203329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND The promise of prolonged survival after psychosocial interventions has long been studied, but not convincingly demonstrated. This study aims to investigate whether a psychosocial group intervention improved long-term survival in women with early-stage breast cancer and investigate differences in baseline characteristics and survival between study participants and non-participants. METHODS A total of 201 patients were randomized to two six-hour psychoeducation sessions and eight weekly sessions of group psychotherapy or care as usual. Additionally, 151 eligible patients declined to participate. Eligible patients were diagnosed and treated at Herlev Hospital, Denmark, and followed for vital status up to 18 years after their primary surgical treatment. Cox's proportional hazard regressions were used to estimate hazard ratios (HRs) for survival. RESULTS The intervention did not significantly improve survival in the intervention group compared with the control group (HR, 0.68; 95% confidence interval (CI), 0.41-1.14). Participants and non-participants differed significantly in age, cancer stage, adjuvant chemotherapy, and crude survival. When adjusted, no significant survival difference between participants and non-participants remained (HR, 0.77; 95% CI, 0.53-1.11). CONCLUSIONS We could not show improved long-term survival after the psychosocial intervention. Participants survived longer than nonparticipants, but clinical and demographic characteristics, rather than study participation, seem accountable for this difference.
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Affiliation(s)
- Anne Marie Kirkegaard
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | | | - Randi V Karlsen
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Henrik Flyger
- Department of Breast Surgery, University Hospital Herlev, Denmark Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects - a Danish Cancer Society National Research Center, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Psychosocial Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
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14
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Cox-Martin E, Phimphasone-Brady P, Hoffecker L, Glasgow RE. Psychosocial Interventions for Pain Management in Breast Cancer Survivors: A RE-AIM Evaluation. J Clin Psychol Med Settings 2023; 30:182-196. [PMID: 35562602 DOI: 10.1007/s10880-022-09874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 12/24/2022]
Abstract
Psychosocial interventions for breast-cancer-related pain are effective, yet over 45% of survivors continue to struggle with this often-chronic side effect. This study evaluated multilevel indicators that can influence successful translation of interventions into clinical practice. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was applied to evaluate reporting of individual and setting/staff-level intervention indicators. A systematic search and multi-step screening process identified 31 randomized controlled trials for psychosocial interventions for breast cancer-related pain. Average reporting of indicators for individual-level dimensions (Reach and Effectiveness) were 65.2% and 62.3%, respectively. Comparatively, indicators for setting/staff-level dimensions were reported at a lower average frequency (Implementation, 46.8%; Adoption, 15.2%; Maintenance, 7.7%). Low reporting of setting/staff-level dimensions suggests gaps in the sustained implementation of psychosocial interventions. Implementation science methods and frameworks could improve trial design and accelerate the translation of psychosocial interventions for breast cancer-related pain into clinical practice.
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Affiliation(s)
- Emily Cox-Martin
- VA Puget Sound Health Care System, 9600 Veterans Dr SW, Tacoma, WA, 98493, USA.
| | | | - Lilian Hoffecker
- Strauss Health Sciences Library, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Russell E Glasgow
- Department of Family Medicine, and ACCORDS Center, University of Colorado School of Medicine, Aurora, CO, USA
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Hughes D, Yardley S, Greenfield P, Rolph M. Delivering mental healthcare to patients with a depressive disorder alongside a life-limiting illness. BJPsych Bull 2023; 47:43-48. [PMID: 34994340 PMCID: PMC10028549 DOI: 10.1192/bjb.2021.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The concurrent assessment and treatment of mental health disorders and palliative illnesses is complex. Affective disorders are more prevalent in people who need palliative care. Identifying the most suitable place of care and multi-professional multidisciplinary teams to provide support can be challenging and bewildering for professionals and patients. Mental health clinicians may be left with a sense of therapeutic nihilism, while palliative care teams can feel limited by the mental health resources available for treating those living with significant physical and mental health needs. We discuss the fictional case of a gentleman with metastatic bowel cancer who has developed symptoms of depressive disorder and identify how taking a pragmatic patient-centred approach can offer a route through potential dilemmas when seeking to provide individualised care based on needs. We used lay person experience alongside our own experiences of novel mechanisms for cross-specialty working in order to direct psychiatric trainees' approaches to such cases.
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Antoni MH, Moreno PI, Penedo FJ. Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors. Annu Rev Psychol 2023; 74:423-455. [PMID: 35961041 PMCID: PMC10358426 DOI: 10.1146/annurev-psych-030122-124119] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.
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Affiliation(s)
- Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA;
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Patricia I Moreno
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, Florida, USA;
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
- Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
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Abstract
This article provides an overview of the fields of psychosocial and integrative oncology, highlighting common psychological reactions to being diagnosed with and treated for cancer, including distress, anxiety, depression, fear of cancer recurrence and caregiver burden, as well as symptoms of fatigue, pain, and sleep disturbance. Patterns of symptomatology across the disease continuum are also discussed. Interventions targeted at treating these symptoms are reviewed, including acceptance-based and mindfulness therapies, mind-body therapies, and meaning-based approaches designed for people with advanced stages of disease, including psychedelic therapy. Common methodological issues and shortcomings of the evidence base are summarized with design recommendations, and a discussion of trends in future research including pragmatic research design, digital health interventions, and implementation science completes the article.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada;
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McGarrah P, Hubbard J, Novotny PJ, Branda ME, Sargent DS, Morton RF, Fuchs CS, Benson AB, Williamson SK, Findlay BP, Alberts SR, Goldberg RM, Sloan JA. Baseline Quality of Life is a Strong and Independent Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer. Cancer Control 2023; 30:10732748231185047. [PMID: 37339926 PMCID: PMC10286175 DOI: 10.1177/10732748231185047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Previous studies have established that higher baseline quality of life (QOL) scores are associated with improved survival in patients with metastatic colorectal cancer (mCRC). We examined the relationship between overall survival (OS) and baseline QOL. PATIENTS AND METHODS A total of 1 247 patients with mCRC participating in N9741 (comparing bolus 5-FU/LV, irinotecan [IFL] vs infusional 5-FU/leucovorin [LV]/oxaliplatin [FOLFOX] vs. irinotecan/oxaliplatin [IROX]) provided data at baseline on overall QOL using a single-item linear analogue self-assessment (LASA) 0-100 point scale. The association of OS according to clinically deficient (defined as CD-QOL, score 0-50) vs not clinically deficient (nCD-QOL, score 51-100) baseline QOL scores was tested. A multivariable analysis using Cox proportional hazards modeling was performed to adjust for the effects of multiple baseline factors. An exploratory analysis was performed evaluating OS according to baseline QOL status among patients who did or did not receive second-line therapy. RESULTS Baseline QOL was a strong predictor of OS for the whole cohort (CD-QOL vs nCD-QOL: 11.2 months vs 18.4 months, P < .0001), and in each arm IFL 12.4 vs 15.1 months, FOLFOX 11.1 months vs 20.6 months, and IROX 8.9 months vs 18.1 months. Baseline QOL was associated with baseline performance status (PS) (P < .0001). After adjusting for PS and treatment arm, baseline QOL was still associated with OS (P = .017). CONCLUSIONS Baseline QOL is an independent prognostic factor for OS in patients with mCRC. The demonstration that patient-assessed QOL and PS are independent prognostic indicators suggests that these assessments provide important complementary prognostic information.
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Affiliation(s)
| | - Joleen Hubbard
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Paul J. Novotny
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Megan E. Branda
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Daniel S. Sargent
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Roscoe F. Morton
- North Central Cancer Treatment Group, Iowa Oncology Research Association, Des Moines, IA, USA
| | | | - Al B. Benson
- Division of Hematology and Medical Oncology, Northwestern University, Chicago, IL, USA; and ECOG-ACRIN Cancer Research Group, Philadelphia, PA, USA
| | - Stephen K. Williamson
- SWOG Cancer Research Network, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | - Jeff A. Sloan
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
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Pyrzak A, Foley OW, Grace AK, Barber EL. Effect of Centering Preoperative Counseling on Patient-Reported Anxiety in Patients with Gynecologic Malignancies. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Adam Pyrzak
- The Southeastern Permanente Medical Group, Atlanta, Georgia, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Olivia W. Foley
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
- Northwestern Hospital Obstetrics and Gynecology, Division of Gynecologic Oncology and Prentice Women's Hospital, Chicago, Illinois, USA
| | - Anne K. Grace
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emma L. Barber
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
- Surgical Outcomes and Quality Improvement Center, Institute for Public Health in Medicine, Chicago, Illinois, USA
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20
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Wu Y, Zhou L, Zhang X, Yang X, Niedermann G, Xue J. Psychological distress and eustress in cancer and cancer treatment: Advances and perspectives. SCIENCE ADVANCES 2022; 8:eabq7982. [PMID: 36417542 PMCID: PMC9683699 DOI: 10.1126/sciadv.abq7982] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/03/2022] [Indexed: 05/31/2023]
Abstract
Facing cancer diagnosis, patients with cancer are prone to psychological stress and consequent psychological disorders. The association between psychological stress and cancer has long been a subject of high interest. To date, preclinical studies have gradually uncovered the promotive effects of psychological distress on tumor hallmarks. In contrast, eustress may exert suppressive effects on tumorigenesis and beneficial effects on tumor treatment, which brings a practicable means and psychosocial perspective to cancer treatment. However, the underlying mechanisms remain incompletely understood. Here, by focusing on the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, as well as stress-related crucial neurotransmitters and hormones, we highlight the effects of distress and eustress on tumorigenesis, the tumor microenvironment, and tumor treatment. We also discuss the findings of clinical studies on stress management in patients with cancer. Last, we summarize questions that remain to be addressed and provide suggestions for future research directions.
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Affiliation(s)
- Yuanjun Wu
- Thoracic Oncology Ward, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Laiyan Zhou
- Thoracic Oncology Ward, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xuanwei Zhang
- Thoracic Oncology Ward, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xue Yang
- Thoracic Oncology Ward, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Gabriele Niedermann
- Department of Radiation Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany, German Cancer Consortium, partner site Freiburg, and German Cancer Research Center, Heidelberg, Germany
| | - Jianxin Xue
- Thoracic Oncology Ward, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Laboratory of Clinical Cell Therapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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21
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Riccetti N, Hempler I, Hermes-Moll K, Heidt V, Walawgo T, Singer S. Experience of office-based haematologists and oncologists with outpatient psycho-social support services for cancer patients with and without migration background in Germany. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04313-6. [PMID: 36053325 DOI: 10.1007/s00432-022-04313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/18/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE We compared the perception of office-based haematologists and oncologists regarding the availability of outpatient psycho-social support services (PSSS) for patients with cancer and a migration background, as well as their different experiences with these services. METHODS Data were collected via an online survey addressing the doctors' socio-demographic characteristics and their perception of-and experience with PSSS. The association between socio-demographic characteristics of the doctors and their experiences with PSSS was tested using Pearson's chi-squared test and Kruskal-Wallis test. RESULTS A total of 55 doctors were included in this study. More than three doctors in four reported non-sufficient presence of PSSS in foreign languages in their region; one in two reported that the services for patients with migration background should be improved. Most doctors reported missing PSSS in Turkish and Arabic in their region. Doctors with less experience referred patients more often to PSSS hosted in patients' associations (75% vs 25%; p = 0.02), than doctors with more experience. Doctors working in larger cities referred patients less often to PSSS in cancer counselling centres (12% vs 88%; p = 0.01), than doctors working in small or middle-large cities. Male doctors were more satisfied with the network of PSSS' providers, than female doctors (mean score = 2.8 vs 2.2; p = 0.05). CONCLUSIONS Our results suggest that efforts should be made for a higher regional availability of overall and specific PSSS for non-German speaking patients (especially for Turkish- and Arabic-speaking patients). The experience with PSSS was associated with the doctors' work experience and gender, as well as the location of the practice.
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Affiliation(s)
- Nicola Riccetti
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Obere Zahlbacher Str. 69, 55131, Mainz, Germany. .,University Cancer Centre Mainz, Mainz, Germany.
| | - Isabelle Hempler
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Kerstin Hermes-Moll
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Vitali Heidt
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Thomas Walawgo
- Scientific Institute of Office-Based Haematologists and Oncologists (WINHO GmbH), Cologne, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Obere Zahlbacher Str. 69, 55131, Mainz, Germany.,University Cancer Centre Mainz, Mainz, Germany
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22
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Wu Y, Pan J, Lu Y, Chao J, Yu H. Psychotherapy for advanced cancer patients: A meta-analysis of the quality of life and survival assessments. Palliat Support Care 2022; 21:1-7. [PMID: 35678169 DOI: 10.1017/s1478951522000694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES A meta-analysis has explored the effect of psychotherapy on the quality of life (QOL) but has not explored the effect on advanced cancer patients' survival, which is highly debated. Therefore, we consider the survival days and QOL as the primary outcomes in our analysis. METHODS Eligible studies were collected from four databases (PubMed, Embase, Cochrane Library, and Web of Science) until February 20, 2021. The pooled effect sizes were presented as weighted mean difference (WMD) or relative risk (RR) with 95% confidence intervals (CIs). Publication bias was evaluated by Egger's test, and I2 statistics was used to assess the heterogeneity. RESULTS Thirty-three studies were finally included, containing 2,159 patients in the psychotherapy group and 2,170 patients in the control group. McGill Quality of Life Questionnaire (MQOL) and European Organization for Research and Treatment of Cancer Quality of Life-C15-Palliative (EORTC-QLQ-C15-Pal) supported that QOL of the psychotherapy group was significantly higher than that of the control group, and WMD value was 0.42 (95% CI: 0.12-0.71) and 17.26 (95% CI: 11.08-23.44), respectively. No significant difference was observed between the two groups regarding to the survival time (WMD: 17.85, 95% CI: -8.79, 44.49, P = 0.189). Moreover, the levels of anxiety, depression, confusion, pain, and suffering were lowered in psychotherapy group (all P < 0.05). SIGNIFICANCE OF RESULTS Psychotherapy could improve the QOL of advanced cancer patients but not affect the survival time.
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Affiliation(s)
- Yanqian Wu
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Jiajia Pan
- Finance Section, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Yan Lu
- Department of Encephalopathy, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Jianqian Chao
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, P.R. China
| | - Heming Yu
- Department of Encephalopathy, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, P.R. China
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23
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Ganju R, Neeranjun R, Morse R, Lominska C, TenNapel M, Chen AM. Incidence and Predictors of Persistent Opioid Use in Survivors of Head and Neck Cancer Treated With Curative Radiation. Am J Clin Oncol 2022; 45:161-167. [PMID: 35131971 DOI: 10.1097/coc.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to characterize the incidence of chronic opioid dependence among head and neck cancer survivors treated by radiation, as well as to identify patient and treatment factors associated with persistent use. MATERIALS AND METHODS The medical records of patients with head and neck cancer who received radiation therapy from January 2012 to July 2016 were reviewed. All patients received 60 to 70 Gy with curative intent. Patients who progressed or died within 1 year were intentionally excluded. Opioid doses were calculated in morphine equivalent daily doses in milligrams (mg). Univariate and multivariate regression models were used to identify associations between demographic, medical, disease, and persistent opioid use. RESULTS Two hundred and sixty-one patients were included. The median follow-up was 39 months (range: 12 to 83 mo). Two hundred and eleven patients (80%) received opioids for pain control during radiation. The median morphine equivalent daily dose during treatment was 73.8 mg (range: 5 to 561 mg). Rates of persistent opioid use at 6 months, 1 year, and 2 years from completion of radiation were 41.8%, 30.1%, and 26.0%, respectively. On multivariate analysis, only preradiation opioid use correlated with persistent opioid use at all 3 time points (P<0.05). Smoking history and a Charlson comorbidity index ≥2 predicted for persistent opioid use at some time points, but not all. CONCLUSIONS High rates of persistent opioid use exist in patients with head and neck cancer after radiation therapy. Early interventions to appropriately wean patients should be further investigated.
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Affiliation(s)
- Rohit Ganju
- University of Kansas School of Medicine, Kansas City, KS
| | | | - Ryan Morse
- University of Kansas School of Medicine, Kansas City, KS
| | | | - Mindi TenNapel
- University of Kansas School of Medicine, Kansas City, KS
| | - Allen M Chen
- Irvine Chao Family Comprehensive Cancer Center, University of California, Irvine, CA
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24
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Miyamoto S, Yamazaki T, Shimizu K, Matsubara T, Kage H, Watanabe K, Kobo H, Matsuyama Y, Rodin G, Yoshiuchi K. Brief, manualised and semistructured individual psychotherapy programme for patients with advanced cancer in Japan: study protocol for Managing Cancer and Living Meaningfully (CALM) phase 2 trial. BMJ Open 2022; 12:e056136. [PMID: 35277407 PMCID: PMC8919444 DOI: 10.1136/bmjopen-2021-056136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Managing Cancer and Living Meaningfully (CALM) is a novel, brief and manualised psychotherapeutic intervention intended to treat and prevent depression and end-of-life distress in patients with advanced cancer. This phase 2 trial aims to assess the feasibility and preliminary efficacy of CALM in Japanese patients with cancer. METHODS AND ANALYSIS This study is a single-arm clinical trial. All patients involved in the study are ≥18 years of age, have been diagnosed with advanced or metastatic solid-tumour cancer, and their expected survival is at least 6 months. CALM comprises three to six individual therapy sessions, each lasting approximately 45-60 min, provided over 3- 6 months. The participants will be asked to complete questionnaires at baseline (t0), 3 months (t1) and 6 months (t2). The primary outcomes are rates of completion of the intervention and of the outcome measures and improvement of depressive symptoms measured using the Patient Health Questionnaire-9 between t0 and t2. The criteria for the successful rate of completion is that at least 70% participants who participate in at least three sessions will complete measures at t2. The secondary outcomes are the improvement in scores on: (1) the Quality of Life at the End of Life-Cancer Scale, (2) the Experiences in Close Relationships scale, (3) the Death and Dying Distress Scale and (4) the Clinical Evaluation Questionnaire. ETHICS AND DISSEMINATION This study was approved by the Research Ethics Committee of The University of Tokyo, Cancer Institute Hospital of Japanese Foundation for Cancer Research and Yamaguchi University. We will conduct the study in accordance with the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects. The results of this study will be submitted for peer-reviewed publication and presentation at local, national and international scientific meetings and conferences. TRAIL REGISTRATION NUMBER UMIN000040032; Pre-results.
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Affiliation(s)
- Seraki Miyamoto
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tadahiro Yamazaki
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
- Health Service Center, Yamaguchi University Organization for University Education, Yamaguchi, Japan
| | - Hidenori Kage
- Department of Respiratory Medicine, The University Tokyo Hospital, Tokyo, Japan
- Next-Generation Precision Medicine Development Laboratory, The University Tokyo Hospital, Tokyo, Japan
| | - Kousuke Watanabe
- Department of Respiratory Medicine, The University Tokyo Hospital, Tokyo, Japan
- Department of Clinical Laboratory, The University Tokyo Hospital, Tokyo, Japan
| | - Hiroshi Kobo
- Department of Psycho-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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25
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Rogers CC, Pope S, Whitfield F, Cohn WF, Valdez RS. The lived experience during the peri-diagnostic period of breast cancer: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:547-585. [PMID: 34210570 DOI: 10.1016/j.pec.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer. METHODS Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches. RESULTS A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period. CONCLUSIONS The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity. PRACTICE IMPLICATIONS Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.
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Affiliation(s)
- Courtney C Rogers
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Shannon Pope
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Francesca Whitfield
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Rupa S Valdez
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, United States; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
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26
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Utilizing a Team Kinesiology Model to Support Rehabilitative Care in Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042079. [PMID: 35206268 PMCID: PMC8872116 DOI: 10.3390/ijerph19042079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022]
Abstract
An approach that provides a standardized way of continuing rehabilitative care to help patients return to their lives and activities of daily living (ADL) in an economical and efficient manner is the Team Kinesiology Model (TKM). Many patients who are given a life-altering diagnosis (i.e., paralysis due to spinal cord injury, cerebral palsy, or cancer) are unable to return to employment, their family or a pre-diagnosis quality of life (QOL) given the current health care resources. This is a longstanding, and urgent problem as population aging and rising multi-morbidity is projected to negatively impact all regions of the world. Utilization of mid-level rehabilitation services is a proposed method to increase accessibility to all populations, including those of lower socioeconomic status or minority populations. Capitalizing on this idea, we describe two different programs that use the TKM to provide rehabilitative services to patients who were diagnosed with nervous system dysfunction or cancer. This model benefits the patient by improving physical fitness, psychosocial function, and QOL. Furthermore, we provide specific examples that show how this approach could have further-reaching impacts on society, education and research. Integrating kinesiologists and TKM in health care could assist in workflow, long-term health surveillance, rehabilitation and improvement of QOL.
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27
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Corn BW, Feldman DB, Hull JG, O'Rourke MA, Bakitas MA. Dispositional hope as a potential outcome parameter among patients with advanced malignancy: An analysis of the ENABLE database. Cancer 2022; 128:401-409. [PMID: 34613617 PMCID: PMC10008020 DOI: 10.1002/cncr.33907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/25/2021] [Accepted: 08/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hopefulness, whether inherently present (dispositional hope) or augmented (by enhancement techniques), may affect outcomes. This study was performed to determine the association of dispositional hope with survival among patients diagnosed with advanced cancer. METHODS Data from ENABLE (Educate, Nurture, Advise, Before Life Ends), a palliative care intervention, were reanalyzed to determine the association of higher dispositional hope and patient survival. This was a secondary analysis of data combined from the ENABLE II and ENABLE III randomized controlled trials (RCTs) with respect to dispositional hope and survival. A dispositional hope index was created from 3 hope items from 2 validated baseline questionnaires. Dispositional hope and survival data were collected during the 2 RCTs. In ENABLE II, participants were randomly assigned to the ENABLE intervention or to usual care. In ENABLE III, participants were randomly assigned to receive the intervention immediately or 12 weeks after enrollment. RESULTS In all, 529 persons were included in Cox proportional hazards regression analyses to model the effects of dispositional hope on survival. An initial analysis without covariates yielded a significant effect of hope (Wald statistic, 8.649; hazard ratio, 0.941; confidence interval, 0.904-0.980; P = .003), such that higher dispositional hope was associated with longer survival. In a subsequent analysis that included all covariates, the effect of dispositional hope approached statistical significance (Wald statistic, 2.96; hazard ratio, 0.933; confidence interval, 0.863-1.010; P = .085). CONCLUSIONS Higher levels of dispositional hope were associated with longer survival in patients with advanced cancer. Prospective trials are needed to determine the effects of dispositional and augmented hope on the outcomes of patients with advanced cancer.
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Affiliation(s)
- Benjamin W Corn
- Department of Oncology, Shaare Zedek Cancer Center, Jerusalem, Israel
| | - David B Feldman
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California
| | - Jay G Hull
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Mark A O'Rourke
- Prisma Health Upstate Cancer Institute, Greenville, South Carolina
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.,Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
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28
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Chang A, Sloan EK, Antoni MH, Knight JM, Telles R, Lutgendorf SK. Biobehavioral Pathways and Cancer Progression: Insights for Improving Well-Being and Cancer Outcomes. Integr Cancer Ther 2022; 21:15347354221096081. [PMID: 35579197 PMCID: PMC9118395 DOI: 10.1177/15347354221096081] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.
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Affiliation(s)
- Aeson Chang
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia
| | - Erica K Sloan
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia.,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.,Peter MacCallum Cancer Centre, Division of Surgery, Melbourne, VIC, Australia
| | - Michael H Antoni
- Departments of Psychology, Psychiatry, and Behavioral Sciences, and Cancer Control Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Jennifer M Knight
- Department of Psychiatry and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Telles
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Susan K Lutgendorf
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
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29
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Nursing, psychotherapy and advanced cancer: A scoping review. Eur J Oncol Nurs 2021; 56:102090. [PMID: 35026499 DOI: 10.1016/j.ejon.2021.102090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Many individuals with advanced cancer have unmet psychological needs and often lack access to supportive care. Psychotherapy for adults with advanced cancer is a promising way to address some of the challenges in meeting these care needs. Nurses are the largest cohort of healthcare workers who can practice as psychotherapists and are positioned ideally to integrate these interventions as part of routine care. The purpose of this scoping review is to map the literature on psychotherapeutic interventions among adults with advanced cancer and to explore the nursing role in this body of evidence. METHODS We conducted a scoping review for relevant quantitative, qualitative, and mixed methods studies. The content of included studies was analyzed and grouped based on two broad categories that describe how nursing's role was mentioned, described, and utilized: 1. Nurses are not the interventionist/psychotherapist and, 2. Nurses are mentioned as the interventionist/psychotherapist. RESULTS Eighty-six studies were included. Overall, majority of studies did not mention a role for nursing in any capacity. Some studies mentioned a non-interventionist role for nursing in the research study. Fourteen studies mentioned nurses as interventionists/psychotherapists. These studies focused on feasibility, acceptability and patient related outcomes of brief psychotherapies. Dignity therapy was the most common psychotherapy in studies where nurses were utilized as interventionists, followed by life review and supportive expressive therapies. Very few studies discussed nursing's role in this area and nursing's capacity to deliver this form of care. CONCLUSION There is paucity in nursing research focused on psychotherapy for adults with advanced cancer. It is feasible and acceptable for nurses to deliver brief psychotherapies to adults with advanced cancer, and the integration of these techniques in everyday practice has great potential that must be explored. The development of this knowledge base is needed to support future education, research, and practice policy agendas.
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30
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Mravec B. Neurobiology of cancer: Definition, historical overview, and clinical implications. Cancer Med 2021; 11:903-921. [PMID: 34953048 PMCID: PMC8855902 DOI: 10.1002/cam4.4488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022] Open
Abstract
Studies published in the last two decades have clearly demonstrated that the nervous system plays a significant role in carcinogenesis, the progression of cancer, and the development of metastases. These studies, combining oncological and neuroscientific approaches, created the basis for the emergence of a new field in oncology research, the so‐called “neurobiology of cancer.” The concept of the neurobiology of cancer is based on several facts: (a) psychosocial factors influence the incidence and progression of cancer diseases; (b) the nervous system affects DNA mutations and oncogene‐related signaling; (c) the nervous system modulates tumor‐related immune responses; (d) tumor tissues are innervated; (e) neurotransmitters released from nerves innervating tumor tissues affect tumor growth and metastasis; (f) alterations or modulation of nervous system activity affects the incidence and progression of cancers; (g) tumor tissue affects the nervous system. The aim of this review is to characterize the pillars that create the basis of cancer neurobiology, to describe recent research advances of the nervous system's role in cancer diseases, and to depict potential clinical implications for oncology.
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Affiliation(s)
- Boris Mravec
- Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia.,Biomedical Research Center, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia
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31
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Vanstrum EB, Doherty JK, Sinha UK, Voelker CCJ, Bassett AM. An Exploration of Online Support Community Participation Among Patients With Vestibular Disorders. Laryngoscope 2021; 132:1835-1842. [PMID: 34889460 DOI: 10.1002/lary.29969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/03/2021] [Accepted: 11/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To formally document online support community (OSC) use among patients with vestibular symptoms and gain an appreciation for the perceived influence of participation on psychosocial outcomes and the impact on medical decision-making. STUDY DESIGN Self reported internet-based questionnaire. METHODS The Facebook search function was paired with a comprehensive list of vestibular diagnoses to systematically collect publicly available information on vestibular OSCs. Next, a survey was designed to gather clinicodemographic information, OSC characteristics, participation measures, perceived outcomes, and influence on medical decision-making. The anonymous instrument was posted to two OSCs that provide support for patients with general vestibular symptoms. RESULTS Seventy-three OSCs were identified with >250,000 cumulative members and >10,000 posts per month. The survey was completed by 549 participants, a cohort of primarily educated middle-aged (median = 50, interquartile range 40-60), non-Hispanic white (84%), and female (89%) participants. The participants' most cited initial motivation and achieved goal of participants was to hear from others with the same diagnosis (89% and 88%, respectively). Daily users and those who reported seeing ≥5 providers before receiving a diagnosis indicated that OSC utilization significantly influenced their requested medical treatments (72% daily vs. 61% nondaily, P = .012; 61% <5 providers vs. 71% ≥5 providers P = .019, respectively). Most participants agreed that OSC engagement provides emotional support (74%) and helps to develop coping strategies (68%). Membership of ≥1 year was associated with a higher rate of learned coping skills (61% membership <1-year vs. 71% ≥1-year P = .016). CONCLUSIONS The use of OSCs is widespread among vestibular diagnoses. A survey of two OSCs suggests these groups provide a significant source of peer support and can influence users' ability to interface with the medical system. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Erik B Vanstrum
- Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Joni K Doherty
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Uttam K Sinha
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Courtney C J Voelker
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Alaina M Bassett
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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32
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Van Den Beldt HM, Ruble AE, Welton RS, Crocker EM. Contemporary Supportive Therapy: A Review of History, Theory, and Evidence. Psychodyn Psychiatry 2021; 49:562-590. [PMID: 34870457 DOI: 10.1521/pdps.2021.49.4.562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Supportive psychotherapy interventions were developed as a part of psychodynamic psychotherapy work, and supportive psychotherapy was historically considered to be the default form of therapy only for lower-functioning patients. These roots unfortunately have resulted in supportive psychotherapy being viewed as an inferior form of treatment. In reality, supportive psychotherapy is a practical and flexible form of psychotherapy that helps patients with a wide range of psychiatric illnesses, including mood disorders, anxiety disorders, posttraumatic stress disorder, schizophrenia, personality disorders, eating disorders, body dysmorphic disorder, and substance use disorders. In addition, supportive psychotherapy can be well-suited to higher-functioning patients, as well as to patients who are chronically lower-functioning. There is also evidence to support the use of supportive psychotherapy in patients with certain medical illnesses, including coronary artery disease, some gastrointestinal illnesses, HIV infection, and certain types of cancer. The goals of supportive psychotherapy include helping patients to understand emotional experiences, improving affective regulation and reality-testing, making use of their most effective coping strategies, and engaging in collaborative problem solving to reduce stressors and increase effective engagement with support systems.
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Affiliation(s)
- Holly M Van Den Beldt
- Clinical Assistant Professor of Psychiatry and Associate Clerkship Director, University of Iowa Hospital and Clinics
| | - Anne E Ruble
- Associate Director for Residency Education and Director of Psychotherapy Training at the Johns Hopkins Department of Psychiatry and Behavioral Sciences
| | - Randon S Welton
- Margaret Clark Morgan Chair of Psychiatry and Professor of Psychiatry, Northeast Ohio Medical University
| | - Erin M Crocker
- Clinical Associate Professor and Residency Training Director, Department of Psychiatry, University of Iowa Hospitals and Clinics
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Eckerling A, Ricon-Becker I, Sorski L, Sandbank E, Ben-Eliyahu S. Stress and cancer: mechanisms, significance and future directions. Nat Rev Cancer 2021; 21:767-785. [PMID: 34508247 DOI: 10.1038/s41568-021-00395-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/08/2023]
Abstract
The notion that stress and cancer are interlinked has dominated lay discourse for decades. More recent animal studies indicate that stress can substantially facilitate cancer progression through modulating most hallmarks of cancer, and molecular and systemic mechanisms mediating these effects have been elucidated. However, available clinical evidence for such deleterious effects is inconsistent, as epidemiological and stress-reducing clinical interventions have yielded mixed effects on cancer mortality. In this Review, we describe and discuss specific mediating mechanisms identified by preclinical research, and parallel clinical findings. We explain the discrepancy between preclinical and clinical outcomes, through pointing to experimental strengths leveraged by animal studies and through discussing methodological and conceptual obstacles that prevent clinical studies from reflecting the impacts of stress. We suggest approaches to circumvent such obstacles, based on targeting critical phases of cancer progression that are more likely to be stress-sensitive; pharmacologically limiting adrenergic-inflammatory responses triggered by medical procedures; and focusing on more vulnerable populations, employing personalized pharmacological and psychosocial approaches. Recent clinical trials support our hypothesis that psychological and/or pharmacological inhibition of excess adrenergic and/or inflammatory stress signalling, especially alongside cancer treatments, could save lives.
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Affiliation(s)
- Anabel Eckerling
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Itay Ricon-Becker
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Liat Sorski
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Elad Sandbank
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shamgar Ben-Eliyahu
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
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Teranishi-Hashimoto C, Bantum EO, Conde F, Lee E, Yamada PM. Group-based Exercise Therapy Improves Psychosocial Health and Physical Fitness in Breast Cancer Patients in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:263-269. [PMID: 34765985 PMCID: PMC8571815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cancer diagnosis and treatment often negatively impact quality of life, worsening prognosis, and long-term survival in cancer patients. Rehabilitation is effective at reversing cancer-related effects, but these services are not standardized. An implementation study was conducted to determine the usability and efficacy of group-based exercise therapy delivered from an outpatient therapy clinic. Thirty breast cancer patients (mean age ± standard deviation [SD],= 55 ± 10 years) completed 36 90-minute group-based exercise sessions in small groups. Team-based exercises were used to foster peer interaction and social support. Usability was evaluated with participant feedback, adherence, and occurrence of adverse events. Effectiveness was measured with the Revised Piper Fatigue, the City of Hope Quality of Life (QOL), and the Beck Depression Inventories. Paired t-tests and 2-way ANOVAs were used to detect significance (P<.05); Cohen's d was used to measure effect size. Twenty-five patients completed the program; they reported that they liked the program design. One anticipated, moderate adverse event occurred. The intervention improved fatigue and QOL, where significant main effects of time were detected [Fatigue: (F(1,76)=29.78, P <.001); QOL: (F(1,80)=24.42, P<.0001)]. Improvements in the fatigue inventory's behavioral/security and sensory dimensions (Cohen's d=-0.43 and ȡ0.68, respectively) and the physical dimension of the QOL inventory were detected (Cohen's d=0.92). There were no significant changes in depression (P=.0735). Seven patients continued to participate in exercise classes for 2.5-years post-intervention, demonstrating achievability of program maintenance. Providing group-based exercise therapy services at an outpatient clinic is an effective and practical approach to improve cancer patients' QOL.
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Affiliation(s)
| | | | - Francisco Conde
- Department of Oncology, Straub Medical Center, Honolulu, HI (FC)
| | - Eugene Lee
- Rehabilitation Hospital of the Pacific, Honolulu, HI (CT, EL)
| | - Paulette M. Yamada
- Department of Kinesiology and Rehabilitative Services, University of Hawai‘i at Manoa, Honolulu, HI (PMY)
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Bellinger DL, Dulcich MS, Molinaro C, Gifford P, Lorton D, Gridley DS, Hartman RE. Psychosocial Stress and Age Influence Depression and Anxiety-Related Behavior, Drive Tumor Inflammatory Cytokines and Accelerate Prostate Cancer Growth in Mice. Front Oncol 2021; 11:703848. [PMID: 34604038 PMCID: PMC8481826 DOI: 10.3389/fonc.2021.703848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/09/2021] [Indexed: 01/20/2023] Open
Abstract
Prostate cancer (PCa) prevalence is higher in older men and poorer coping with psychosocial stressors effect prognosis. Yet, interactions between age, stress and PCa progression are underexplored. Therefore, we characterized the effects of age and isolation combined with restraint (2 h/day) for 14 days post-tumor inoculation on behavior, tumor growth and host defense in the immunocompetent, orthotopic RM-9 murine PCa model. All mice were tumor inoculated. Isolation/restraint increased sympathetic and hypothalamic-pituitary-adrenal cortical activation, based on elevated serum 3-methoxy-4-hydroxyphenylglycol/norepinephrine ratios and corticosterone levels, respectively. Elevated zero maze testing revealed age-related differences in naïve C57Bl/6 mice, and increased anxiety-like behavior in tumor-bearing mice. In open field testing, old stressed mice were less active throughout the 30-min test than young non-stressed and stressed, and old non-stressed mice, suggesting greater anxiety in old stressed mice. Old (18 month) mice demonstrated more depression-like behavior than young mice with tail suspension testing, without effects of isolation/restraint stress. Old mice developed larger tumors, despite similar tumor expression of tumor vascular endothelial growth factor or transforming growth factor-beta1 across age. Tumor chemokine/cytokine expression, commonly prognostic for poorer outcomes, were uniquely age- and stress-dependent, underscoring the need for PCa research in old animals. Macrophages predominated in RM-9 tumors. Macrophages, and CD4+ and CD4+FoxP3+ T-cell tumor infiltration were greater in young mice than in old mice. Stress increased macrophage infiltration in old mice. Conversely, stress reduced intratumoral CD4+ and CD4+FoxP3+ T-cell numbers in young mice. CD8+ T-cell infiltration was similar across treatment groups. Our findings support that age- and psychological stress interacts to affect PCa outcomes by interfering with neural-immune mechanisms and affecting behavioral responses.
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Affiliation(s)
- Denise L Bellinger
- Department of Pathology & Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Melissa S Dulcich
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, United States
| | - Christine Molinaro
- Department of Pathology & Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Peter Gifford
- Department of Pathology & Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Dianne Lorton
- Department of Psychology, Kent State University and the Kent Summa Initiative for Clinical and Translational Research, Summa Health System, Akron, OH, United States
| | - Daila S Gridley
- Departments of Radiation Medicine and Biochemistry and Microbiology, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Richard E Hartman
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, United States
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Deshields TL, Wells-Di Gregorio S, Flowers SR, Irwin KE, Nipp R, Padgett L, Zebrack B. Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work. CA Cancer J Clin 2021; 71:407-436. [PMID: 34028809 DOI: 10.3322/caac.21672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization-inner setting (the context of the clinic, hospital, or health care system); and 5) organization-outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges.
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Affiliation(s)
- Teresa L Deshields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus, Ohio
| | - Stacy R Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lynne Padgett
- Department of Psychology, Veterans Affairs Medical Center, Washington, District of Columbia
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
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Psycho-Oncology: A Bibliometric Review of the 100 Most-Cited Articles. Healthcare (Basel) 2021; 9:healthcare9081008. [PMID: 34442145 PMCID: PMC8393329 DOI: 10.3390/healthcare9081008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/25/2022] Open
Abstract
(1) Background: A bibliometric review of psycho-oncology research is overdue. (2) Methods: The 100 most-cited journal articles were compiled and ranked according to Scopus. (3) Results: The total citation count for the results ranged from 488-8509 (Mean = 940.27; SD = 1015.69). A significant correlation was found between years since publication and number of citations (p = 0.039). The majority of research originated from the United States (66%). The vast majority of research publications were original articles (80%). Observational research study designs represented the majority of studies (37%). Mixed cancer population research studies represented the largest cancer research population (36%). Positive psychology topics represented the most prolific proportion of studies (30%). Findings were reported in line with PRISMA-ScR guidelines. (4) Conclusions: This analysis offers a comprehensive account of seminal journal articles in psycho-oncology, identifying landmark contributions and areas for future research developments within the field, namely highlighting a need for more RCT studies. This analysis serves as an educational tool for interdisciplinary researchers and clinicians to support compassionate cancer care.
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Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews. BMC Palliat Care 2021; 20:89. [PMID: 34162377 PMCID: PMC8223342 DOI: 10.1186/s12904-021-00782-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings. METHODS Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions. RESULTS A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers' outcomes. The evidence of interventions delivered across other settings was generally inconsistent. CONCLUSIONS Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.
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Giri PC, Stevens GJ, Merrill-Henry J, Oyoyo U, Balasubramanian VP. Participation in pulmonary hypertension support group improves patient-reported health quality outcomes: a patient and caregiver survey. Pulm Circ 2021; 11:20458940211013258. [PMID: 34035896 PMCID: PMC8132099 DOI: 10.1177/20458940211013258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Support group participation has been shown to be effective in many chronic medical conditions. The evidence for integrating support group into pulmonary hypertension care and its effect on quality of life, physical and psychological well-being is limited. We sought to assess the effect of support group participation on quality of life in patients diagnosed with pulmonary hypertension and their caregivers. The emPHasis-10 questionnaire (a tool validated for quality of life assessment in pulmonary hypertension) was used to evaluate the effect of support group participation. Additional demographic and health-related quality measures were examined. Results showed that 165 subjects were enrolled in the study; 122 (74.4%) were patients with pulmonary hypertension, 41 (25.0%) were their caregivers, and 2 (0.02%) did not respond. The cohort was predominantly female (n = 128, 78%), Caucasian (n = 10, 61%), and the principal self-reported classification of pulmonary hypertension was World Health Organization Group 1 (n = 85, 51.8%) and the self-reported New York Heart Association Functional Class was II and III (n = 43, 57.3%). Most participants (n = 118, 71.5%) attended support groups and of them, a majority (n = 107, 90.6%) stated it helped them. There was no difference in quality of life as assessed by emPHasis-10 scores with support group participation (median score 30 vs 32, p = 0.387). There was self-reported improvement in understanding condition better including procedures such as right heart catheterization, medication compliance, and confidence in self-care (p < 0.05). Using multivariate logistic regression, baseline variables that were independently associated with emPHasis-10 scores for the entire cohort included knowledge of New York Heart Association Functional Class (odds ratio: 1.919, 95% CI: 1.004–3.67, p = 0.04) and greater distance traveled to visit pulmonary hypertension physician (odds ratio: 1.391, 95% CI: 0.998--1.94, p = 0.05). In conclusion, support group participation does not improve quality of life as assessed by emPHasis-10 scores but improves other meaningful health-related quality outcomes.
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Affiliation(s)
- Paresh C Giri
- Pulmonary and Critical Care Department, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Gizelle J Stevens
- Pulmonary and Critical Care Department, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Udochukwu Oyoyo
- Department of Dental Education Services, Loma Linda University School of Dentistry, Loma Linda, CA, USA
| | - Vijay P Balasubramanian
- Pulmonary and Critical Care Department, University of California San Francisco-Fresno, Fresno, CA, USA
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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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Lai J, Song H, Ren Y, Li S, Xiao F. Effectiveness of Supportive-Expressive Group Therapy in Women with Breast Cancer: A Systematic Review and Meta-Analysis. Oncol Res Treat 2021; 44:252-260. [PMID: 33910215 DOI: 10.1159/000515756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast cancer is the most frequently diagnosed cancer among women and ranks second in terms of global incidence. Depression, anxiety, and poor quality of life (QoL) are prevalent in women with breast cancer. Supportive-expressive group therapy (SEGT) can potentially benefit these patients. OBJECTIVE This systematic review and meta-analysis evaluated the effectiveness of SEGT for women with breast cancer, by focusing on survival, QoL, anxiety, and depression as outcomes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted. The databases PubMed, Web of Science, Cochrane Library, Embase, CINHAL, and PsycInfo in English, and Sinomed, CNKI, CQVIP, and Wanfang in Chinese, were searched from inception up to May 2020 for relevant full-text articles using "SEGT," "breast cancer," and related terms as keywords. Randomized controlled trials (RCTs) comparing SEGT with baseline conditions of patients with breast cancer were included in the analysis. RESULTS Ten studies with a total of 2,879 subjects were analyzed. Overall group differences were found for survival (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.72-0.94; p = 0.004), short-term QoL (mean difference [MD] 8.02, 95% CI 4.85-11.20; p < 0.00001), long-term QoL (MD 11.30, 95% CI 6.75-15.84; p < 0.00001), Profile of Mood States score (POMS) score (MD -0.43, 95% CI -0.72 to -0.13; p = 0.005), anxiety (standardized MD [SMD] -0.30, 95% CI -0.49 to -0.10; p = 0.003), and depression (SMD -0.47, 95% CI -0.66 to -0.29; p < 0.00001). CONCLUSIONS SEGT is effective in improving QoL and psychosocial status in breast cancer patients, but there is no convincing evidence that it has an impact on survival.
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Affiliation(s)
- Jiawei Lai
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China, .,School of Nursing, Southern Medical University, Guangzhou, China,
| | - Huijuan Song
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ying Ren
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuang Li
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Feng Xiao
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
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Clark E, Maguire H, Cannon P, Leung EY. The effects of physical activity, fast-mimicking diet and psychological interventions on cancer survival: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2021; 57:102654. [PMID: 33359756 PMCID: PMC8047871 DOI: 10.1016/j.ctim.2020.102654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health professionals are often asked if non-pharmacological interventions prolong life. This review aims to evaluate the effects of physical activity, fast-mimicking diet (FMD) and psychological interventions on survival in all cancers. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs). Only RCTs of physical activity, FMD and psychological interventions (including counselling, cognitive and other psychotherapies) in cancer patients that reported survival outcomes were included. DATA SOURCES CENTRAL, MEDLINE, Embase, CINAHL, APA PsycINFO, Web of Science, ICTRP and ClinicalTrials.gov from inception to January 2020 were searched without language restrictions. The protocol was prospectively registered at PROSPERO (CRD42019160944). RESULTS Thirty-one RCTs (9 on physical activity and 22 on psychological interventions) were included in the final analysis after evaluation of 60,207 records from our initial search. No eligible RCT on FMD was reported. RCTs on group psychological interventions (41.9 %) and in patients with breast cancer (38.7 %) were the most common. Most evaluated short-term interventions and in primary or adjuvant settings. Only one of 9 (11 %) RCTs on physical activity and 8 of 22 (36 %) RCTs on psychological interventions were associated with improved overall survival. Only group psychological interventions in breast cancer had adequate number of RCTs to allow a meta-analysis to be performed. It demonstrated a trend towards improved overall survival (HR -0.20, 95 %CI -0.49 to 0.10), particularly in RCTs that evaluated long-term (>6 months) therapies (HR -0.29, 95 %CI -0.59 to 0.01). CONCLUSION Longer term interventions starting early in the patients' care journey in primary and adjuvant settings have shown the most promise for improving survival. Better designed RCTs including survival outcomes are particularly needed in non-breast cancers.
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Affiliation(s)
- Emma Clark
- Institute of Infection, Immunity and Inflammation, Sir Graeme Davies Building, 120 University Place, University of Glasgow, Glasgow G12 8TA, United Kingdom
| | - Hannah Maguire
- Institute of Infection, Immunity and Inflammation, Sir Graeme Davies Building, 120 University Place, University of Glasgow, Glasgow G12 8TA, United Kingdom
| | - Paul Cannon
- University of Glasgow Library, University of Glasgow, Hillhead St, Glasgow G12 8QE, United Kingdom
| | - Elaine Yl Leung
- Institute of Infection, Immunity and Inflammation, Sir Graeme Davies Building, 120 University Place, University of Glasgow, Glasgow G12 8TA, United Kingdom; Institute of Cancer and Genomic Sciences, 6 Mindelsohn Way, Birmingham B15 2SY, United Kingdom.
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Abstract
This article aims to review the expanding role of group psychotherapy in the treatment of individuals with medical illnesses, an area that has expanded dramatically during the past 30 years. The fundamental principles of adaptation of group therapies for specialized clinical populations are articulated. Clarity of goals and thoughtful alignment with patient interests and needs are at the heart of building a strong therapeutic alliance and potentiate the effectiveness of group therapy. This article also discusses the conceptual underpinnings of group therapies and the ways in which group therapeutic factors gain expression with these clinical populations. This article also focuses on breast cancer, in light of its clinical prominence and the development of group therapies for individuals with the disease. These therapies address clinical concerns for women along the continuum of the disease, including familial and genetic predisposition, primary breast cancer, adaptation to illness and its treatment, metastatic disease, and dealing with mortal illness.
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Affiliation(s)
- Molyn Leszcz
- Department of Psychiatry, University of Toronto, and Sinai Health System, Toronto
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44
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Borgi M, Collacchi B, Ortona E, Cirulli F. Stress and coping in women with breast cancer:unravelling the mechanisms to improve resilience. Neurosci Biobehav Rev 2020; 119:406-421. [PMID: 33086128 DOI: 10.1016/j.neubiorev.2020.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
Breast cancer diagnosis, surgery, adjuvant therapies and survivorship can all be extremely stressful. In women, concerns about body image are common as a result of the disease and can affect interpersonal relationships, possibly leading to social isolation, increasing the likelihood for mood disorders. This is particularly relevant as women are at greater risk to develop anxiety and depressive symptoms in response to highly stressful situations. Here we address the mechanisms and the pathways activated as a result of stress and contributing to changes in the pathophysiology of breast cancer, as well as the potential of stress management factors and interventions in buffering the deleterious effects of chronic stress in a gender perspective. An improved understanding of the biological mechanisms linking stress-management resources to health-relevant biological processes in breast cancer patients could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve cancer outcomes, ultimately offering a unique opportunity to improve contemporary cancer treatments.
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Affiliation(s)
- Marta Borgi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Barbara Collacchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Elena Ortona
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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45
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Serfaty M, King M, Nazareth I, Moorey S, Aspden T, Tookman A, Mannix K, Gola A, Davis S, Wood J, Jones L. Manualised cognitive-behavioural therapy in treating depression in advanced cancer: the CanTalk RCT. Health Technol Assess 2020; 23:1-106. [PMID: 31097078 DOI: 10.3310/hta23190] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND With a prevalence of up to 16.5%, depression is one of the commonest mental disorders in people with advanced cancer. Depression reduces the quality of life (QoL) of patients and those close to them. The National Institute for Health and Care Excellence (NICE) guidelines recommend treating depression using antidepressants and/or psychological treatments, such as cognitive-behavioural therapy (CBT). Although CBT has been shown to be effective for people with cancer, it is unclear whether or not this is the case for people with advanced cancer and depression. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of treatment as usual (TAU) plus manualised CBT, delivered by high-level Improving Access to Psychological Therapy (IAPT) practitioners, versus TAU for people with advanced cancer and depression, measured at baseline, 6, 12, 18 and 24 weeks. DESIGN Parallel-group, single-blind, randomised trial, stratified by whether or not an antidepressant was prescribed, comparing TAU with CBT plus TAU. SETTING Recruitment took place in oncology, hospice and primary care settings. CBT was delivered in IAPT centres or/and over the telephone. PARTICIPANTS Patients (N = 230; n = 115 in each arm) with advanced cancer and depression. Inclusion criteria were a diagnosis of cancer not amenable to cure, a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of depressive disorder using the Mini-International Neuropsychiatric Interview, a sufficient understanding of English and eligibility for treatment in an IAPT centre. Exclusion criteria were an estimated survival of < 4 months, being at high risk of suicide and receiving, or having received in the last 2 months, a psychological intervention recommended by NICE for treating depression. INTERVENTIONS (1) Up to 12 sessions of manualised individual CBT plus TAU delivered within 16 weeks and (2) TAU. OUTCOME MEASURES The primary outcome was the Beck Depression Inventory, version 2 (BDI-II) score at 6, 12, 18 and 24 weeks. Secondary outcomes included scores on the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, satisfaction with care, EuroQol-5 Dimensions and the Client Services Receipt Inventory, at 12 and 24 weeks. RESULTS A total of 80% of treatments (185/230) were analysed: CBT (plus TAU) (n = 93) and TAU (n = 92) for the BDI-II score at all time points using multilevel modelling. CBT was not clinically effective [treatment effect -0.84, 95% confidence interval (CI) -2.76 to 1.08; p = 0.39], nor was there any benefit for other measures. A subgroup analysis of those widowed, divorced or separated showed a significant effect of CBT on the BDI-II (treatment effect -7.21, 95% CI -11.15 to -3.28; p < 0.001). Economic analysis revealed that CBT has higher costs but produces more quality-adjusted life-years (QALYs) than TAU. The mean service costs for participants (not including the costs of the interventions) were similar across the two groups. There were no differences in EQ-5D median scores at baseline, nor was there any advantage of CBT over TAU at 12 weeks or 24 weeks. There was no statistically significant improvement in QALYs at 24 weeks. LIMITATIONS Although all participants satisfied a diagnosis of depression, for some, this was of less than moderate severity at baseline, which could have attenuated treatment effects. Only 64% (74/115) took up CBT, comparable to the general uptake through IAPT. CONCLUSIONS Cognitive-behavioural therapy (delivered through IAPT) does not achieve any clinical benefit in advanced cancer patients with depression. The benefit of CBT for people widowed, divorced or separated is consistent with other studies. Alternative treatment options for people with advanced cancer warrant evaluation. Screening and referring those widowed, divorced or separated to IAPT for CBT may be beneficial. Whether or not improvements in this subgroup are due to non-specific therapeutic effects needs investigation. TRIAL REGISTRATION Current Controlled Trials ISRCTN07622709. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Marc Serfaty
- Division of Psychiatry, University College London, London, UK.,Priory Hospital North London, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK.,Research Department of Primary Care & Population Health, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Stirling Moorey
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trefor Aspden
- Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- Marie Curie Hospice, Royal Free Hampstead NHS Trust, London, UK
| | - Kathryn Mannix
- Palliative Care Service, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Gola
- Research Department of Primary Care & Population Health, University College London, London, UK.,Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Sarah Davis
- Division of Psychiatry, University College London, London, UK.,Palliative Care Service, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Wood
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Louise Jones
- Division of Psychiatry, University College London, London, UK.,Marie Curie Hospice, Royal Free Hampstead NHS Trust, London, UK
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46
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Soto-Rubio A, Perez-Marin M, Rudilla D, Galiana L, Oliver A, Fombuena M, Barreto P. Responding to the Spiritual Needs of Palliative Care Patients: A Randomized Controlled Trial to Test the Effectiveness of the Kibo Therapeutic Interview. Front Psychol 2020; 11:1979. [PMID: 32973614 PMCID: PMC7472743 DOI: 10.3389/fpsyg.2020.01979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
Context The WHO recognizes the need to attend to patients’ spiritual needs as being fundamental to comprehensive and high-quality end-of-life care. Spiritual needs must be attended to since the resolution of biological and psychosocial issues is insufficient to reduce patients’ suffering. Associations have been found between spiritual needs and other variables of importance for patients in palliative care. Despite the consensus that exists regarding the importance of assessing and attending to spiritual needs, professionals encounter many difficulties in attempting to do so. Objectives Our study aims to demonstrate the benefits that the Kibo therapeutic interview in palliative care patients can have for spirituality, demoralization, and resilience. Methods A parallel randomized controlled trial of two groups was undertaken. Information on 60 palliative care patients during pre- and post-intervention time points was gathered. Results ANOVAs showed a statistically significant effect of the intervention on the dimension of transpersonal spirituality. The ANCOVA for the effect of the intervention on resilience also pointed to its effectiveness. When the means of demoralization were examined, a higher decrease in the levels of demoralization for patients in the intervention group was observed, when compared to patients in the control group. Conclusion Our findings point to this interview as an effective means to attend to the spiritual needs of palliative patients, reducing demoralization and increasing resilience. Future research could focus on a broader sample and on the effects of this interview on family caregivers, mourners, and health care professionals. Clinical Trial Registration Number https://clinicaltrials.gov/ct2/show/ Identifier NCT03995095.
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Affiliation(s)
- Ana Soto-Rubio
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Marian Perez-Marin
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Laura Galiana
- Department of Methodology of Experimental and Social Sciences, University of Valencia, Valencia, Spain
| | - Amparo Oliver
- Department of Methodology of Experimental and Social Sciences, University of Valencia, Valencia, Spain
| | | | - Pilar Barreto
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
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47
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Ikeda M, Tamai N, Kanai H, Osaka M, Kondo K, Yamazaki T, Sanada H, Kamibeppu K. Effects of the appearance care program for breast cancer patients receiving chemotherapy: A mixed method study. Cancer Rep (Hoboken) 2020; 3:e1242. [PMID: 32671981 DOI: 10.1002/cnr2.1242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Treatment of breast cancer entails surgery, often followed by chemotherapy. Alopecia is a major, intractable side effect with potentially profound impacts on appearance. We developed a nurse-facilitated program targeting appearance-related symptoms. AIMS This study explored the effects of the appearance care program on quality of life (QOL). The program was delivered across three sessions, each involving personal reflections on appearance concerns, short lectures on skincare and makeover techniques, and small group discussions. METHOD AND RESULTS Seventy-two women who attended the appearance care program were invited to participate. We employed a mixed-method design combining quantitative and qualitative methods. QOL instruments were used to measure effects of the program at the first and final sessions and at a one-month follow-up. The qualitative data were collected as open-ended notes regarding participants' perception of the program at the final session and at a one-month follow-up. Fifty-seven women completed all three sessions. Of them, 55 participated in this study. Their mean age was 46.4 years; 39 (70.9%) had partners, and 34 (61.8%) had children. Most participants experienced hair loss at one-month post-program; however, cancer-specific QOL improved after attending the program. Patients' experience of fatigue and weakness may explain observations of decreased physical well-being. Emotional well-being continued to increase 1 month following the program, while social and functional well-being was consistent. Participants felt empowered by the information on skincare and cosmetic techniques and valued the intimate support from the group members facing similar circumstances. CONCLUSIONS This study showed that the appearance care program increased or maintained the well-being of participants. Findings suggest the appearance care program which promoted group sharing experiences empowered participants and may have enhanced their coping strategies.
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Affiliation(s)
- Mari Ikeda
- Department of Nursing Administration, School of Nursing, Tokyo Women's Medical University, Tokyo, Japan
| | - Nao Tamai
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisako Kanai
- Breast Center/Oncology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Misato Osaka
- Breast Center/Oncology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuko Kondo
- Mothering and Life Management Institute, Tokyo, Japan
| | | | - Hiromi Sanada
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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48
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Mehl A, Reif M, Zerm R, Pranga D, Friemel D, Berger B, Brinkhaus B, Gutenbrunner C, Büssing A, Kröz M. Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study. Integr Cancer Ther 2020; 19:1534735420935618. [PMID: 32618207 PMCID: PMC7491213 DOI: 10.1177/1534735420935618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients' satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson's correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = -0.60). Qualitative feedback confirmed patients' benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients' satisfaction and qualitative feedback they help refine treatment.
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Affiliation(s)
| | - Marcus Reif
- Society for Clinical Research, Berlin, Germany
| | - Roland Zerm
- Research Institute Havelhöhe, Berlin, Germany.,Havelhöhe Hospital, Berlin, Germany
| | | | | | | | | | | | | | - Matthias Kröz
- Research Institute Havelhöhe, Berlin, Germany.,Witten/Herdecke University, Witten, Germany
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49
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Mravec B, Tibensky M, Horvathova L. Stress and cancer. Part II: Therapeutic implications for oncology. J Neuroimmunol 2020; 346:577312. [PMID: 32652364 DOI: 10.1016/j.jneuroim.2020.577312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023]
Abstract
Accumulated evidence has confirmed the ability of stress to promote the induction and progression of cancer (for review see Stress and cancer. Part I: Mechanisms mediating the effect of stressors on cancer). In support of this, data from clinical trials utilizing approaches that reduce stress-related signaling have shown prolonged survival of cancer patients. Therefore, the question has arisen as to how we can utilize this knowledge in the daily treatment of cancer patients. The main aim of this review is to critically analyze data from studies utilizing psychotherapy or treatment by β-blockers on the survival of cancer patients. Because these approaches, especially treatment by β-blockers, have been routinely used in clinical practice for decades in the treatment of non-cancer patients, their wider introduction into oncology might be realized in the near future.
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Affiliation(s)
- Boris Mravec
- Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Slovakia; Biomedical Research Center, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia.
| | - Miroslav Tibensky
- Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Slovakia
| | - Lubica Horvathova
- Biomedical Research Center, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia
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50
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Trachtenberg L, Wong J, Rennie H, Esplen MJ. Translating the Restoring Body Image After Cancer (ReBIC) Group Therapy Intervention Into an Online Version: A Successful Case Study and Recommendations. Int J Group Psychother 2020; 70:307-328. [PMID: 38449219 DOI: 10.1080/00207284.2020.1751639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A growing number of face-to-face group therapy interventions are being translated into online versions in psycho-oncology. Yet few researchers have systematically described the complex translation process or systematic approaches used to maintain the integrity of the original empirically supported interventions. In this article, we present a case study to illustrate the process of translating an evidence-based face-to-face therapy group, Restoring Body Image after Cancer (ReBIC) into an online format. We highlight how three critical therapeutic components from the original intervention (guided imagery exercises, psychoeducational reading materials, and psychotherapeutic group processes) were maintained and translated for online delivery. We provide preliminary recommendations for future translation efforts of text-based online group therapies to encourage best practices.
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