Individual counseling is the preferred treatment for depression in breast cancer survivors

A qualitative approach in determining the patient-centered information and supportive care needs of cancer patients in Singapore

OBJECTIVES

To qualitatively interpret the information and supportive care needs perceived by cancer patients undergoing treatment in order to get a deeper appreciation of patients' needs and concerns. The intended outcome is to provide baseline knowledge for improving patient-centred strategies to better meet the information and supportive needs of patients.

DESIGN

A qualitative research approach, based on conventional content analysis, was used throughout the research process. The three open-ended questions obtained from a previous quantitative study guided the researchers to explore the information and supportive care needs of patients. Data from patients' responses were analysed and coded in themes.

PARTICIPANTS AND SETTING

Patients attending the Ambulatory Treatment Unit of the National Cancer Centre Singapore were invited to participate in the study. We determined from these subjects the type of information that cancer patients need, and to measure the extent to which these information needs are met by measuring patients' level of satisfaction. Included in the quantitative study were three open-ended questions designed to gain a deeper understanding of their needs and concerns. All subjects were aged 21 years and above and able to understand and communicate in English/Mandarin. They were also aware of their diagnosis, they were not cognitively impaired and were not at the end-of-life situation.

RESULTS

A variety of information and supportive care needs were identified, and three specific areas of concerns were identified: (1) psychosocial and supportive care needs, (2) information needs and (3) information delivery by professionals.

CONCLUSION

The information and supportive care needs expressed were consistent with issues of cancer patients undergoing treatment. The strategies to improve patients' coping abilities through patient-centred care are discussed. Further studies assessing the barriers of information provision by healthcare professionals should provide more detailed knowledge about unmet information needs.

Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Background

Collaborative care involves active engagement of primary care and hospital physicians in shared care of patients beyond usual discharge summaries. This enhances community-based care and reduces dependence on specialists and hospitals. The model, successfully implemented in chronic care management, may have utility for treatment of depression in cancer. The aim of this systematic review was to identify components, delivery and roles and responsibilities within collaborative interventions for depression in the context of cancer.

Methods

Medline, PsycINFO, CINAHL, Embase, Cochrane Library and Central Register for Controlled Trials databases were searched to identify studies of randomised controlled trials comparing a treatment intervention that met the definition of collaborative model of depression care with usual care or other control condition. Studies of adult cancer patients with major depression or a non-bipolar depressive disorder published in English between 2005 and January 2018 were included. Cochrane checklist for risk of bias was completed (Study Prospero registration: CRD42018086515).

Results

Of 8 studies identified, none adhered to the definition of ‘collaborative care’. Interventions delivered were multi-disciplinary, with care co-ordinated by nurses (n = 5) or social workers (n = 2) under the direction of psychiatrists (n = 7). Care was primarily delivered in cancer centres (n = 5). Care co-ordinators advised primary care physicians (GPs) of medication changes (n = 3) but few studies (n = 2) actively involved GPs in medication prescribing and management.

Conclusions

This review highlighted joint participation of GPs and specialist care physicians in collaborative care depression management is promoted but not achieved in cancer care. Current models reflect hospital-based multi-disciplinary models of care.

Protocol registration

The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018086515.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3946-z) contains supplementary material, which is available to authorized users.

Examining the preliminary efficacy of an intervention for fear of cancer recurrence in female cancer survivors: a randomized controlled clinical trial pilot study

PURPOSE

Among cancer survivors, fear of cancer recurrence (FCR) is the most frequently reported unmet need. Despite this, research on psychosocial interventions that target FCR is limited. To address this gap, an individual cognitive-existential psychotherapy intervention for FCR was pilot tested via small-scale RCT.

METHODS

Participants were recruited via study posters, healthcare professionals' referrals, and an electronic hospital database. Twenty-five female cancer survivors were randomized to experimental or wait-list control groups. Sessions included cognitive restructuring techniques, behavioral experiments, discussion of existential concerns, and relaxation exercises. Nineteen women completed the 6-week intervention and completed questionnaire packages at various time points. All participants completed self-administered questionnaires at pre-intervention (T1), post-intervention (T2), and at 3-month follow-up (T3). Participants in the control group also completed the same questionnaires, including at baseline (T0).

RESULTS

Statistically significant results of between-within ANOVAs included time by condition interactions in the primary outcome measure of FCR and, for the experimental group participants, time by condition interactions in the secondary outcome measures of cancer-specific distress and uncertainty in illness. Statistically significant results of repeated measures ANOVAs included reductions in FCR, cancer-specific distress, uncertainty in illness, reassurance seeking, cognitive avoidance, and intolerance of uncertainty, as well as improvements in positive reinterpretation and growth, emotional coping, and quality of life (improved mental health), when compared to the control group. Most changes were maintained at 3-month follow-up.

CONCLUSIONS

This intervention responds to a need for evidence-based individual modality interventions targeting quality of life in cancer survivors. Our results demonstrate preliminary promising results in addressing FCR in female cancer survivors. Future research could seek to replicate results with a larger sample. Further research is needed to test this intervention with patients of mixed cancer sites.

Psychosocial interventions in breast cancer survivorship care

Cancer distress screening and subsequent referral for psychosocial intervention has been mandated for continued cancer center accreditation. Increasing emphasis is being placed on the referral component of this mandate, ensuring that patient distress is not only identified but also effectively treated. Many evidence-based interventions exist for cancer distress. Specific interventions can effectively target biopsychosocial impacts of stress and promote adaptive coping, focusing on problem-solving, social support utilization, assertive communication, sexual health and intimacy, adherence to medical and supportive care recommendations, health behavior change, and emotional processing and expression. In randomized clinical trials, specific interventions have also been associated with biological improvements, including neuroendocrine and immune functioning, decreased rates of breast cancer recurrence, and improved survival rates. As cancer treatments advance and patients live longer, it is pertinent to treat the impacts of breast cancer with evidence-based interventions.

Medical comorbidity and psychotropic medication fills in older adults with breast or prostate cancer

BACKGROUND

Previous research has shown that as people age, distress decreases despite an increase in prevalence of medical comorbidity. This could be due to increased use of psychotropic medications with comorbidity. We tested this hypothesis in older adults.

METHODS

Information from medical records of older adults (65 to 99 years of age) in the following groups was collected: women with breast cancer (n = 2359), women without any cancer diagnosis (n = 27,161), men with prostate cancer (n = 2686), and men without any cancer diagnosis (n = 21,014). We collected fills of antidepressant or sedative medications, diagnosis of depression in the year of cancer diagnosis, and Charlson Comorbidity Index from the year before cancer.

RESULTS

Women with breast cancer were more likely to fill psychotropic prescriptions (both ps < 0.02) or be diagnosed with depression (p < 0.001) than women without cancer. Men with prostate cancer were more likely to fill these prescriptions or receive a diagnosis of depression than men without cancer (ps < 0.05). Charlson was related to increased odds of filling both types of medication in women with breast cancer and men with prostate cancer (ps < 0.001). Comorbidity was related to greater odds of receiving a depression diagnosis in men with prostate cancer (p < 0.001) but not women with breast cancer (p > 0.15).

CONCLUSIONS

Older adults with breast or prostate cancer are more likely to fill psychotropic medication prescriptions and receive a depression diagnosis than those without cancer. Comorbidity increased the likelihood of medication fills in older adults with cancer. As this population experiences polypharmacy, nonpharmacologic treatments for depression may need to be considered.