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Vasa D, Guerra L, Goel MS, Harris YT, Lin JJ. The Impact of Depression on Adherence to Diabetes Self-Management Behaviors in Breast Cancer Survivors. Psychooncology 2024; 33:e9309. [PMID: 39267253 DOI: 10.1002/pon.9309] [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: 03/13/2024] [Revised: 06/28/2024] [Accepted: 08/31/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE Breast cancer survivors (BCS) have higher rates of depression which is associated with lower adherence to medications, diet, and physical activity. Managing diabetes (DM) requires adherence to several of these self-management behaviors (SMB), and BCS have an increased risk of DM. We investigated whether depressive symptoms were associated with adherence to DM SMB in a cohort of BCS. METHODS BCS with DM were surveyed semiannually for 2 years. Depression was assessed with the Hospital Anxiety and Depression Scale (HADS). Adherence to DM medication, diet, and physical activity was self-reported using the Medication Adherence Report Scale (MARS), Summary of Diabetes Self-Care Activities Assessment (SDSCA), and International Physical Activity Questionnaire (IPAQ), respectively. Using generalized linear equation modeling, the association of depressive symptoms with nonadherence to SMB was assessed, adjusting for age, race, marital status, education level, and beliefs about cancer and DM risk. RESULTS Among 244 BCS with DM, those who were nonadherent to medication, diet, and/or physical activity had higher depression scores (p < 0.01). In adjusted analyses, higher depression scores were independently associated with dietary (OR = 1.16, p < 0.001) and physical activity nonadherence (OR = 1.18, p < 0.001) but not with medication nonadherence. Concerns about medications was independently associated with medication nonadherence (OR = 1.17, p = 0.024). CONCLUSIONS Higher depression scores are associated with nonadherence to DM SMB in this cohort of BCS. These findings highlight the importance of addressing depressive symptoms in BCS to help improve adherence to DM medications, diet, and physical activity.
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Affiliation(s)
- Devarshi Vasa
- Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren Guerra
- Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mita S Goel
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yael Tobi Harris
- Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jenny J Lin
- Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Vizin G, Szekeres T, Juhász A, Márton L, Dank M, Perczel-Forintos D, Urbán R. The role of stigma and depression in the reduced adherence among young breast cancer patients in Hungary. BMC Psychol 2023; 11:319. [PMID: 37814282 PMCID: PMC10561463 DOI: 10.1186/s40359-023-01355-4] [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: 04/16/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The main aim of our study was to investigate the role of depression, stigmatization, body shame and self-compassion in the adherence of young Hungarian breast cancer patients aged between 18 and 45 years. METHODS In a cross-sectional online survey, data were collected from 99 young breast cancer patients (BC). Participants completed self-report questionnaires on socio-demographic and cancer-specific parameters as well as psychological factors (adherence: 12-item Medication Adherence Scale; depression: Hospital Anxiety and Depression Scale; stigmatization: Stigma Scale for Chronic Illnesses; body shame: Experience of Shame Scale; self-compassion: Self-Compassion Scale). We tested the predictors and mediators of adherence using hierarchical regression, mediation and moderation analysis among BC patients. RESULTS We found that adherence was significantly associated with body shame and stigmatization in our BC sample. In addition, stigmatization alone was a significant predictor of lower adherence. Finally, in mediation models, where body shame was a mediator, we found a significant direct effect between stigma and adherence, in other words body shame had a significant mediating effect between these variables. According to our moderation analysis, self-compassion as a significant moderator acts as a protective factor in the linear relationship between stigma and lower adherence. CONCLUSIONS Our results highlight the importance of stigma and body shame in the development of adherence in oncological care among young Hungarian BC patients aged between 18 and 45 years. Assessment of stigma, body shame, self-compassion, and the improvement of the availability of evidence-based psychological interventions may increase the adherence of young Hungarian BC patients, leading to more favourable rates of survival.
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Affiliation(s)
- Gabriella Vizin
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, 1064, Hungary.
| | - Tamás Szekeres
- Faculty of General Medicine, Department of Clinical Psychology, Semmelweis University, Üllői út 25, Budapest, 1095, Hungary
| | - Anita Juhász
- Faculty of General Medicine, Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Üllői út 78, Budapest, 1082, Hungary
| | - Lilla Márton
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, 1064, Hungary
| | - Magdolna Dank
- Faculty of General Medicine, Department of Internal Medicine and Oncology, Oncology Profile, Semmelweis University, Tömő u. 25-29, Budapest, 1st, 1083, Hungary
| | - Dóra Perczel-Forintos
- Faculty of General Medicine, Department of Clinical Psychology, Semmelweis University, Üllői út 25, Budapest, 1095, Hungary
| | - Róbert Urbán
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, 1064, Hungary
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Bidstrup PE, Johansen C, Kroman N, Belmonte F, Duriaud H, Dalton SO, Andersen KG, Mertz B. Effect of a Nurse Navigation Intervention on Mental Symptoms in Patients With Psychological Vulnerability and Breast Cancer: The REBECCA Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2319591. [PMID: 37351885 PMCID: PMC10290249 DOI: 10.1001/jamanetworkopen.2023.19591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/08/2023] [Indexed: 06/24/2023] Open
Abstract
Importance The unmet needs regarding symptom management of psychological distress among patients with breast cancer must be addressed. However, little evidence exists on effective interventions, such as nurse navigation. Objective To compare the long-term effects of the REBECCA (Rehabilitation After Breast Cancer) nurse navigation intervention vs usual care in patients with breast cancer who were psychologically vulnerable. Design, Setting, and Participants This parallel randomized clinical trial recruited and evaluated for eligibility adult female patients with newly diagnosed breast cancer and symptoms of psychological distress (distress score of ≥7 points on Distress Thermometer) at Rigshospitalet in Copenhagen, Denmark, from August 2017 to October 2019. This study continued the work of a pilot study, extending the follow-up to 18 months. Patients who met the inclusion criteria were randomized to either standard care or the REBECCA intervention. Intention-to-treat analyses were performed from June 2021 to October 2022. Interventions Patients who were randomized to the REBECCA intervention received nurse navigation and symptom screening as well as standard care. Standard care included regular treatment, nurse support at chemotherapy and radiotherapy appointments, and municipality-based rehabilitation. Main Outcomes and Measures The primary outcome was distress, as measured using the Distress Thermometer. The secondary outcomes included symptoms of anxiety, symptoms of depression, breast cancer-specific health-related quality of life, fear of recurrence, sleep, cognitive function, patient activation, pain, health behavior, body mass index, and need for support. Long-term effects at 6, 12, and 18 months were examined using mixed-effect models, adjusting for randomization strata of age and treatment modality. Results A total of 309 female patients were included in the analysis, with 153 patients randomized to the standard care group and 156 patients randomized to the REBECCA intervention group. Mean (SD) age was 56 (11) years with only small between-group differences. Patients receiving the REBECCA intervention compared with standard care had reduced (although not significant) symptoms of distress, especially at the 12-month follow-up (estimated effect = -0.51 [95% CI, -1.05 to 0.04]; effect size [ES] = -0.49). Significant effects were seen for symptoms of depression at 6 months (estimated effect = -1.39 [95% CI, -2.33 to -0.44]; ES = -0.27), and breast cancer-specific health-related quality of life at 12 months (estimated effect = 4.03 [95% CI, 1.28- 6.77]; ES = 0.31). Nonsignificant reductions were seen for symptoms of anxiety at 6 months (estimated effect = -1.00 [95% CI, -1.95 to -0.06]; ES = -0.21) and 12 months (estimated effect = -1.01 [95% CI, -1.97 to -0.04]; ES = -0.21), and a nonsignificant increase was seen for patient activation at 18 months (estimated effect = 3.52 [95% CI, -0.09 to 7.12]; ES = 0.25). Stronger intervention effects were observed for younger age, low patient activation, less education, and low social support. Conclusions and Relevance Results of this study indicate that patients with breast cancer who were psychologically vulnerable (ie, having moderate to high psychological distress) did not experience significant reduction in distress with nurse navigation. Further research is needed to develop the intervention's framework and investigate its potential use in clinical practice. Trial Registration ClinicalTrials.gov Identifier: NCT03254875.
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Affiliation(s)
- Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Late Effect Research Unit, CASTLE, Oncology Clinic, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Danish Cancer Society, Copenhagen, Denmark
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, Denmark
| | - Federica Belmonte
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Helle Duriaud
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Kenneth Geving Andersen
- Department of Anesthesiology, Hvidovre Hospital, Copenhagen, Denmark
- Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Mertz
- Department of Breast Surgery, Herlev/Gentofte Hospital, Copenhagen, Denmark
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Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:309-318. [PMID: 36394636 PMCID: PMC9922233 DOI: 10.1007/s00127-022-02376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved. METHODS We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008-2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs. RESULTS Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78-1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01-2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population. CONCLUSION Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.
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Xue D, Li N, Li L, Huang Y, Men K, Meng Q, Zhang S. Sarcopenia is an independent risk factor for depression in patients with advanced lung cancer. Support Care Cancer 2022; 30:9659-9665. [PMID: 36203065 DOI: 10.1007/s00520-022-07384-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: 06/08/2022] [Accepted: 10/02/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Depression is the most prevalent psychological issue among cancer patients and can seriously affect patients' life and disease prognosis and even lead to suicide. Sarcopenia is a manifestation of cancer cachexia, a chronic progressive process. It is accompanied by a sustained decrease in skeletal muscle mass, muscle strength, and physical function and likewise has various negative effects on the patient. This study aimed to evaluate sarcopenia and other factors that may affect depression in patients with lung cancer and to further analyze and discuss. METHODS A total of 104 eligible patients were enrolled in this cross-sectional study, using the Hamilton Depression Scale to assess depression, obtaining the psoas muscle index (PMI) by computed tomography (CT), and performing the diagnosis of sarcopenia. Clinical and personal characteristics were collected by electronic medical records. RESULTS We evaluated a total of 104 hospitalized cancer patients in this analysis, with mean age = 57.8 ± 11.0 years, and 65.38% (68) were female. We found that up to 31.7% (33) of the participants had depression and 61.5% (64) of the participants had sarcopenia, and no statistical differences were found among depressed and non-depressed patients in relation to age, smoking, gender, performance status, and pathology. Patients with sarcopenia have more than four times the risk of suffering from depression than patients without sarcopenia (OR = 4.133, 95%CI = 1.390-12.287; p = 0.011). Similarly, the possibility of depression in patients with PD (progressive disease) as efficacy evaluation increased by 13.482 times (95%CI = 2.121-85.679, p = 0.006). CONCLUSION In individuals with terminal lung cancer, depression and sarcopenia are prevalent. A strong association between the two is now thought to exist. Sarcopenia and efficacy evaluation are independent risk factors for depression. The correlation between sarcopenia and depression underscores the need for early intervention by our clinicians.
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Affiliation(s)
- Dinglong Xue
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ning Li
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lijun Li
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yaru Huang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Kaiya Men
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qingwei Meng
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
| | - Shuai Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
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Gil-Guillen VF, Balsa A, Bernárdez B, Valdés y Llorca C, Márquez-Contreras E, de la Haba-Rodríguez J, Castellano JM, Gómez-Martínez J. Medication Non-Adherence in Rheumatology, Oncology and Cardiology: A Review of the Literature of Risk Factors and Potential Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12036. [PMID: 36231341 PMCID: PMC9564665 DOI: 10.3390/ijerph191912036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Medication adherence is directly associated with health outcomes. Adherence has been reviewed extensively; however, most studies provide a narrow scope of the problem, covering a specific disease or treatment. This project's objective was to identify risk factors for non-adherence in the fields of rheumatology, oncology, and cardiology as well as potential interventions to improve adherence and their association with the risk factors. The project was developed in three phases and carried out by a Steering Committee made up of experts from the fields of rheumatology, oncology, cardiology, general medicine, and hospital and community pharmacy. In phase 1, a bibliographic review was performed, and the articles/reviews were classified according to the authors' level of confidence in the results and their clinical relevance. In phase 2, 20 risk factors for non-adherence were identified from these articles/reviews and agreed upon in Steering Committee meetings. In phase 3, potential interventions for improving adherence were also identified and agreed upon. The results obtained show that adherence is a dynamic concept that can change throughout the course of the disease, the treatments, and other factors. Educational interventions are the most studied ones and have the highest level of confidence in the authors' opinion. Information and education are essential to improve adherence in all patients.
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Affiliation(s)
- Vicente F. Gil-Guillen
- Department of Clinical Medicine, Miguel Hernandez University, 03550 San Juan, Spain
- Research Unit, Hospital General Universitario de Elda, 30600 Elda, Spain
| | - Alejandro Balsa
- Rheumatology Department, La Paz University Hospital, 28046 Madrid, Spain
- Institute for Health Research Hospital La Paz (IdiPaz), 28046 Madrid, Spain
| | - Beatriz Bernárdez
- Department of Oncologic Pharmacy, Santiago de Compostela University Hospital, 15706 Santiago de Compostela, Spain
- Medicine Department, Santiago de Compostela University, 15706 Santiago de Compostela, Spain
- Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15782 Santiago de Compostela, Spain
- Adherence Group of the Sociedad Española de Farmacia Hospitalaria (ADHEFAR-SEFH), 28001 Madrid, Spain
| | - Carmen Valdés y Llorca
- Fuencarral Health Center, 28034 Madrid, Spain
- Observatorio de Adherencia al Tratamiento (OAT), 28231 Madrid, Spain
- Treatment Adherence Chair, San Juan de Alicante University, 03550 Alicante, Spain
| | | | | | - Jose M. Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Centro Integral de Enfermedades Cardiovasculares, Monteprincipe University Hospital, 28660 Madrid, Spain
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Beisel C, Poretta T, Sheppard VB, Hurtado-de Mendoza A, Sipsma H, Fuqua E, Stwalley B, Salvatore A, Yang M. Adherence to Adjuvant Therapy in Patients with Resected Melanoma: An Application of the Theory of Planned Behavior. Adv Ther 2022; 39:4061-4075. [PMID: 35776398 PMCID: PMC9402483 DOI: 10.1007/s12325-022-02221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Adherence to adjuvant therapy is crucial for effective disease management in patients with resected melanoma. This study assessed patient-reported adherence to adjuvant therapy and identified behavioral/belief constructs associated with adherence in patients with resected melanoma. METHODS Patients with resected stage III/IV melanoma were recruited through the Melanoma Research Foundation and a patient panel to complete an online survey. Patient characteristics, medical history, and adherence to therapy were captured. In accordance with the theory of planned behavior (TPB), the survey measured behavioral, normative, and control beliefs, and intention to adhere to therapy. Structural equation modeling (SEM) examined their relationships with adherence. RESULTS Among all patients who received adjuvant therapy and completed the survey (n = 184), 69% received intravenous and 31% received oral therapy; the majority (85.3%) were somewhat involved in deciding to start therapy. Mean age was 45 years, 44% of patients were female, and 83% had stage III/IV disease at diagnosis. Patients had a mean disease duration of 1.5 years, a time since complete resection of 10 months, and an adjuvant therapy duration of 8 months. Adherence to adjuvant therapy was high overall and higher with intravenous than with oral therapy (98.4% versus 91.2%, P = 0.002). All underlying TPB constructs were significant in the SEM model, which explained 60.3% of the variance in intention to adhere. Control beliefs had the strongest association with intention to adhere (standardized estimate = 0.47, P < 0.001) and intravenous therapy was associated with greater adherence than oral therapy (standardized estimate = 0.26, P < 0.001). CONCLUSIONS This study found that patients with resected melanoma are highly engaged in the decision to initiate systemic adjuvant therapy, with an overall high adherence rate to prescribed adjuvant treatment. Enhancing patients' view of their capability to adhere to treatments may further improve the adherence rate to melanoma adjuvant therapy.
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Affiliation(s)
| | - Tayla Poretta
- Bristol Myers Squibb, Princeton, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA.
| | - Vanessa B Sheppard
- Virginia Commonwealth University School of Medicine, Richmond and Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | | | | | | | - Brian Stwalley
- Bristol Myers Squibb, Princeton, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA
| | - Anthony Salvatore
- Bristol Myers Squibb, Princeton, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA
| | - Min Yang
- Analysis Group, Inc., Boston, MA, USA
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Haller K, Fritzsche S, Kruse I, O’Malley G, Ehrenthal JC, Stamm T. Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study. Front Psychol 2022; 13:913081. [PMID: 35814056 PMCID: PMC9260657 DOI: 10.3389/fpsyg.2022.913081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAlthough treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence.Methods194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale.ResultsNon-adherence correlated significant with personality functioning (r = 0.325), childhood trauma (r = 0.204) and depressiveness (r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R2 = 0.149, F(3,190) = 12.225, p < 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model.ConclusionIn cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.
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Affiliation(s)
- Karl Haller
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department of Hematology, Oncology, and Tumor Immunology, Charité – University Medicine Berlin, Berlin, Germany
- *Correspondence: Karl Haller, ,
| | | | - Irina Kruse
- Cardiology Department, Schlosspark-Klinik, Berlin, Germany
| | - Grace O’Malley
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – University Medicine Berlin, Berlin, Germany
| | | | - Thomas Stamm
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Schloss Luetgenhof Hospital, Centre for Personal Medicine, Psychosomatics and Psychotherapy, Dassow, Germany
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Eziefula C, Shah FT, Anie KA. Promoting Adherence to Iron Chelation Treatment in Beta-Thalassemia Patients. Patient Prefer Adherence 2022; 16:1423-1437. [PMID: 35698633 PMCID: PMC9188463 DOI: 10.2147/ppa.s269352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/29/2022] [Indexed: 01/19/2023] Open
Abstract
Thalassaemia is one of the commonest inherited genetic disorders world-wide with around 25,000 births of the most severely affected transfusion dependent children annually. Patients with transfusion dependent thalassaemia require regular blood transfusions to maintain life but because of this will develop iron overload. To remove the excess iron, patients are required to take iron chelation therapy (ICT). ICT requires lifelong adherence to treatment to prevent end organ damage from developing. Many of these preventable complications make adherence to therapy more complex for patients. In this review, we focus on two commonly encountered patient scenarios and discuss how different psychological models and a relational theory can be used to understand and support adherence to treatment.
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Affiliation(s)
- Chinea Eziefula
- Camden & Islington NHS Foundation Trust, London, UK
- Psychology Services, Whittington Health NHS Trust, London, UK
| | - Farrukh T Shah
- Department of Haematology, Whittington Health NHS Trust, London, UK
- Medical Director for Transfusion, NHSBT, London, UK
| | - Kofi A Anie
- London North West University Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
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Wu Z, Wang X, Zhang S, Ding N, Zhang G, Zhao C, Xu H, Lai X, Tu X, Yang X. Do Attitudes, Mental Health Status, and Interpersonal Factors Predict COVID-19 Vaccine Hesitancy at the Early Phase of the Pandemic? A Longitudinal Study in Chinese College Students. Front Psychol 2022; 13:876116. [PMID: 35664204 PMCID: PMC9161085 DOI: 10.3389/fpsyg.2022.876116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The present study examined whether and how attitudes toward the COVID-19 vaccine (i.e., safety, efficacy, and price), mental health statuses (i.e., perceived stress and depression), and interpersonal factors (i.e., online social support, perceived social support) would predict COVID-19 vaccine hesitancy. Patients and methods The two-wave longitudinal surveys were conducted in December 2019 and 2020 in Chinese medical college students (N = 194). Well- validated measures were used, including the Perceived Stress Scale, the Center for Epidemiologic Studies Depression Scale, the Online Social Support Questionnaire, and the Perceived Social Support Scale. Perceived safety, efficacy, price of COVID-19 vaccine, vaccine hesitancy, and actual intake were also measured. Results Only 2.1% of participants had been vaccinated against COVID-19 in the early stages of the pandemic; 13.4% intended to get vaccinated in the next 3 months, and 66% intended to have it in the next 12 months upon follow-up. Multiple regression analyses revealed that perceived stress (βm = -0.15, p < 0.05) and depression (βm = -0.15, p < 0.05) were risk factors for positive attitudes toward the COVID-19 vaccine; online social support (ORm = 1.41, p < 0.01) and positive attitudes toward the COVID-19 vaccine (ORm = 1.83, p < 0.01) were protective factors of intention to get vaccinated in future. Conclusion Findings suggest that intervention efforts should be made to reduce negative attitudes toward the COVID-19 vaccine among people with poor mental health and enhance online social support to promote COVID-19 vaccination.
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Affiliation(s)
- Zhipeng Wu
- School of Educational Science, Gannan Normal University, Ganzhou, China
| | - Xin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sha Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Nani Ding
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Guohua Zhang
- The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chengjia Zhao
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Huihui Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xinyi Lai
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xiaolian Tu
- Renji College, Wenzhou Medical University, Wenzhou, China
| | - Xue Yang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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The association between handgrip strength and depression in cancer survivors: a cross-sectional study. BMC Geriatr 2022; 22:111. [PMID: 35144536 PMCID: PMC8829989 DOI: 10.1186/s12877-022-02795-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background The association between handgrip strength and depression in cancer survivors has been unexplored until now. We aim to examine the association between handgrip strength and depression in cancer survivors by using publicly available data (National Health and Nutrition Examination Survey). Methods Two waves of data from the National Health and Nutrition Examination Survey, from 2011–2012 and 2013–2014, were extracted and combined to explore this important issue. We extracted maximum patient handgrip strength value (from both hands). The Patient Health Questionnaire (PHQ-9) was used to evaluate depression with a cut-off > = 10 points indicating that patients had depressive symptoms. Other basic characteristics and health-related variables were also collected. We used Least Absolute Shrinkage and Selection Operator (LASSO) regression to select potential confounding factors. Multivariable linear or logistic regression models were adopted to explore whether handgrip strength as a continuous variable, or low handgrip strength, was associated with depressive symptoms. Results There were 876 cancer survivors in our present total sample, with 403 (46.0%) males and 473 females (54.0%). The mean (SD) age of the entire group was 64.67 (13.81) years. The prevalence of depression and low handgrip strength was 12.90% and 16.7%, respectively. The results showed that handgrip strength was negatively associated with depressive symptoms in cancer survivors (OR = 0.95, 95%CI:0.92–0.99; P = 0.024). In addition, after adjusting for age, gender, race; marital status, polypharmacy, sleep disorder, arthritis, congestive heart failure, history of stroke, type of cancer, chronic coronary bronchitis and being overweight, cancer survivors with low handgrip strength had a 2.02-fold risk of depression, compared to those with normal handgrip strength (OR = 2.02,95%CI:1.07–3.81; P = 0.028). Conclusions Our present study suggests that low handgrip strength, as a simple and modifiable parameter, is associated with a higher risk of depression in cancer survivors. Therefore, future larger-scale prospective cohort studies are warranted to determine this association. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02795-0.
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McCusker J, Jones JM, Li M, Faria R, Yaffe MJ, Lambert SD, Ciampi A, Belzile E, de Raad M. CanDirect: Effectiveness of a Telephone-Supported Depression Self-Care Intervention for Cancer Survivors. J Clin Oncol 2021; 39:1150-1161. [PMID: 33555912 DOI: 10.1200/jco.20.01802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Depression in post-treatment cancer survivors is common and can impair quality of life. CanDirect is a novel, telephone-delivered depression self-care intervention for cancer survivors. We conducted a randomized controlled superiority trial to compare CanDirect with usual care (UC) in this population. METHODS Participants completing cancer treatment within the past 10 years who had mild-moderate depressive symptoms with or without major depression were recruited from clinical and community settings in Quebec and Ontario. Permuted block random assignment allocated participants to CanDirect plus UC or to UC alone. Assessments of depression severity (Center for Epidemiological Studies-Depression scale [CES-D]; primary outcome) and secondary outcomes health-related quality of life (Short Form Survey-12 mental and physical component summaries), anxiety symptoms (Hospital Anxiety and Depression Scale), activation (Patient Activation Measure), depression diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV), and health services (self-report) were conducted at baseline, as well as 3 and 6 months (primary time point). Analyses of outcomes were adjusted for covariates using linear regression and missing data by inverse probability weighting. RESULTS Participants recruited between September 2016 and October 2018 were randomly assigned to CanDirect (n = 121) or UC (n = 124). Among 245 participants randomly assigned, 218 (89.0%) completed the primary outcome at 6 months. CanDirect participants reported less severe depressive symptoms on the CES-D than UC participants at 6 months, adjusted effect size (ES) 0.61 (95% CI, 0.33 to 0.88). CanDirect participants also had significantly greater quality of life, lower anxiety, more activation, and lower rates of depression diagnoses, compared with UC. Exploratory analysis suggested that sex was a modifier of the primary outcome (interaction term P value = .03); the intervention was less effective in men (ES, 0.12; 95% CI, -0.45 to 0.69). CONCLUSION The findings suggest that CanDirect is an effective method of managing mild-moderate depression symptoms in cancer survivors.
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Affiliation(s)
| | | | - Madeline Li
- Princess Margaret Cancer Centre, UHN, Toronto, ON, Canada
| | | | | | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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Becker JH, Ezratty C, Jahan N, Goel M, Harris YT, Lin JJ. The impact of cognitive impairment on self-regulatory styles in breast cancer survivors. Psychooncology 2021; 30:970-978. [PMID: 33484026 DOI: 10.1002/pon.5633] [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] [Received: 12/29/2020] [Accepted: 01/18/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive impairment (CI) is highly prevalent in breast cancer survivors (BCS), and can be a barrier to health-promoting behaviours. However, the ways in which CI may affect self-regulation or motivation to perform such behaviours have not been explored. We assessed if BCS with CI report greater extrinsic self-regulation compared to those without CI and if this relationship persists after controlling for depression. METHODS We recruited BCS with diabetes and assessed cognition and motivation to perform healthy diabetes management behaviours (e.g., diet and exercise). Participants completed a cognitive battery evaluating attention, working memory, executive functioning (EF), processing speed (PS), language and memory. The Treatment Self-Regulation Questionnaire (TSRQ) assessed intrinsic versus extrinsic motivation. Depression was determined by a score ≥16 on the Center for Epidemiological Studies Depression Scale. Wilcoxon rank-sum test compared associations between CI and TSRQ scores. RESULTS Participants were 118 older adults (mean age 65 years). Participants with CI in the following domains had higher extrinsic self-regulation scores compared to those without CI: attention (p < 0.01), PS (p = 0.01), EF (p < 0.01), language (p = 0.02; p = 0.04) and memory (p = 0.04; p = 0.03). After adjusting for depression, the relationship between CI and higher extrinsic self-regulation scores remained significant. CONCLUSIONS BCS with CI appear to rely more on external sources of motivation to perform health behaviours, regardless of depression. Future studies and interventions to improve health behaviours should consider screening for CI and involving caregivers for those with CI to improve outcomes.
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Affiliation(s)
- Jacqueline H Becker
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charlotte Ezratty
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nusrat Jahan
- Medicine, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Mita Goel
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yael Tobi Harris
- Division of Endocrinology, Diabetes & Metabolism, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Jenny J Lin
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zamanian H, Amini-Tehrani M, Jalali Z, Daryaafzoon M, Ala S, Tabrizian S, Foroozanfar S. Perceived social support, coping strategies, anxiety and depression among women with breast cancer: Evaluation of a mediation model. Eur J Oncol Nurs 2021; 50:101892. [PMID: 33583690 DOI: 10.1016/j.ejon.2020.101892] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Depression and anxiety are now considered as common adverse reactions to cancer. Prior research has shown that social support and functional coping strategies alleviate depressive and anxious symptoms of cancer patients but the exact relationship between social support and coping strategies in amelioration of the symptoms is yet to be elaborated. METHODS The current study examined the relationship between social support, coping strategies and depressive-anxious symptomatology and explored the possible role of coping strategies in mediating the relationship between social support, depression and anxiety in Iranian breast cancer patients (N = 221). Anxiety and depressive symptoms were measured using the Depression-Anxiety-Stress (DASS-21) scale, social support was measured using the Medical Outcome Survey, Social Support Scale (MOSS-SSS), and coping strategies were measured using the brief COPE. RESULTS All of the social support subscales were negatively correlated with depression and anxiety. Most of the coping strategies were negatively correlated with depressive-anxious symptoms. When controlling for covariates, mediation analysis revealed that active coping, positive reframing and acceptance partially mediated the association of social support of different types with depression. Positive reframing also partially mediated the relationship of the total social support and positive social interactions with anxiety. CONCLUSIONS High levels of social support may relieve depressive and anxious symptoms of breast cancer patients through functional coping. The management of breast cancer patients should also focus on providing patients with social support and educating them on the practice of functional coping strategies.
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Affiliation(s)
- Hadi Zamanian
- Department of Health Education and Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran; Health Psychology and Behavior Medicine Research Group, Students' Scientific Research center, Exceptional Talents Development Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammadali Amini-Tehrani
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran; Students' Scientific Research center, Exceptional Talents Development Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Jalali
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mona Daryaafzoon
- Department of Health Psychology, Karaj Branch, Islamic Azad University, Alborz, Iran.
| | - Sara Ala
- Students' Scientific Research center, Exceptional Talents Development Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Samira Tabrizian
- Students' Scientific Research center, Exceptional Talents Development Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sahar Foroozanfar
- Department of Clinical Psychology, Karaj Branch, Islamic Azad University, Alborz, Iran.
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Siegel S, Unger N, Streetz-van der Werf C, Karges W, Schilbach K, Schröder B, Szybowicz J, Sauerwald J, Zopf K, Grzywotz A, Bidlingmaier M, Kirstein C, Sommer H, Strasburger CJ, Kreitschmann-Andermahr I. Adults' Adherence to Growth Hormone Replacement in Relation to Medication-Related Beliefs, Coping and Quality of Life - An Exploratory Analysis. Front Endocrinol (Lausanne) 2021; 12:680964. [PMID: 34108940 PMCID: PMC8181747 DOI: 10.3389/fendo.2021.680964] [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] [Received: 03/15/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Little is known about psychological reasons associated with adherence to growth hormone (GH) replacement therapy (GHRx) in adults. As in other chronic diseases, medication-related beliefs, coping strategies and disease impact on quality of life (QoL) might play an important role. We thus explored these psychological factors in relation to adherence in patients with GH deficiency (GHD) in order to find leverage points for the improvement of adherence. PATIENTS AND METHODS Cross-sectional analysis including 107 adult GHD patients on GHRx who completed self-assessment inventories on health-related QoL (Short-Form SF-36), coping style (Freiburg questionnaire on coping with illness, FKV-LIS) and medication beliefs (Beliefs about Medicine questionnaire, BMQ). Results were correlated to general and GH-specific adherence to medication. RESULTS In the BMQ, 92.5% of the patients (n=99) reported a strong belief in the need for their medication, which correlated significantly with general adherence (rs = 0.325). Active coping was significantly related to general (rs = 0.307) and GH-specific adherence (rs = 0.226). Better mental QoL (rs = 0.210) but worse physical QoL (rs = -0.198; all p < 0.05) were related to higher GH-specific adherence. Older age was associated with a higher degree of active coping, a higher belief in the necessity of medication and worse physical QoL. CONCLUSION We provide preliminary data that most GHD patients on GHRx are strongly convinced of their need for medication and that adherence to GHRx is influenced by coping strategies and QoL. Patients with impaired psychological QoL are less able to translate their convictions into good adherence, a phenomenon to be addressed in future research.
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Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Christine Streetz-van der Werf
- Division of Endocrinology and Diabetes, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität (LMU) Klinikum, Munich, Germany
| | - Bernadette Schröder
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Janine Szybowicz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Janina Sauerwald
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Kathrin Zopf
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität (LMU) Klinikum, Munich, Germany
| | - Cedric Kirstein
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | | | - Christian J. Strasburger
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
- *Correspondence: Ilonka Kreitschmann-Andermahr,
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Potentially Modifiable Factors Associated with Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: A Systematic Review. Cancers (Basel) 2020; 13:cancers13010107. [PMID: 33561076 PMCID: PMC7794693 DOI: 10.3390/cancers13010107] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 01/01/2023] Open
Abstract
Adjuvant endocrine therapy (AET) reduces risk of breast cancer recurrence. However, suboptimal adherence and persistence to AET remain important clinical issues. Understanding factors associated with adherence may help inform efforts to improve use of AET as prescribed. The present systematic review examined potentially modifiable factors associated with adherence to AET in accordance with PRISMA guidelines (PROSPERO registration ID: CRD42019124200). All studies were included, whether factors were significantly associated with adherence or results were null. This review also accounted for the frequency with which a potentially modifiable factor was examined and whether univariate or multivariate models were used. This review also examined whether methodological or sample characteristics were associated with the likelihood of a factor being associated with AET adherence. A total of 68 articles were included. Potentially modifiable factors were grouped into six categories: side effects, attitudes toward AET, psychological factors, healthcare provider-related factors, sociocultural factors, and general/quality of life factors. Side effects were less likely to be associated with adherence in studies with retrospective or cross-sectional than prospective designs. Self-efficacy (psychological factor) and positive decisional balance (attitude toward AET) were the only potentially modifiable factors examined ≥10 times and associated with adherence or persistence ≥75% of the time in both univariate and multivariate models. Self-efficacy and decisional balance (i.e., weight of pros vs. cons) were the potentially modifiable factors most consistently associated with adherence, and hence may be worth focusing on as targets for interventions to improve AET adherence among breast cancer survivors.
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Park C, Ma X, Park SK, Lawson KA. Association of depression with adherence to breast cancer screening among women aged 50 to 74 years in the United States. J Eval Clin Pract 2020; 26:1677-1688. [PMID: 31994268 DOI: 10.1111/jep.13356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/24/2019] [Accepted: 01/01/2020] [Indexed: 01/13/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Previous research has shown inconsistent results regarding the association of depression and screening mammography use behaviours. This study aimed to assess the relationship between women's depression and mammography adherence. METHODS This cross-sectional study used data from the 2016 Behavioural Risk Factor Surveillance System and employed the Health Belief Model (HBM). The primary independent variable was the presence of depression. The dependent variable was adherence to biennial screening mammography based on the US Preventive Services Task Force guidelines. Demographic characteristics and HBM constructs were included as covariates. Univariate and multivariate logistic regressions were used. RESULTS A total of 139 550 women were included (weighted n = 48 712 531). Among them, 23.1% reported the presence of depression (n = 32 247). The unadjusted odds ratio (OR) for mammography use in women with depression was 0.85 (95% confidence interval [CI], 0.80-0.91, P < .001) compared with women without depression, and the probability of mammography use was significantly lower in women with depression (76.3%; 95% CI, 75.4-77.3) compared with women without depression (79.1%; 95% CI, 78.5-79.6). However, the adjusted OR was not statistically significant when controlling for demographic and HBM characteristics (1.02; 95% CI, 0.93-1.11, P = .698), and the probabilities of mammography use were similar between women with depression (80.1%; 95% CI, 79.0-81.3) and without depression (79.9%; 95% CI, 79.2-80.6). CONCLUSIONS Depression itself was related to nonadherence with mammography screening guidelines. However, after controlling for demographic and HBM characteristics, depression was not associated with adherence with mammography screening guidelines.
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Affiliation(s)
- Chanhyun Park
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Xiaojing Ma
- College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Sun-Kyeong Park
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Kenneth A Lawson
- College of Pharmacy, The University of Texas at Austin, Austin, Texas
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18
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Brown SL, Fisher PL, Hope‐Stone L, Hussain RN, Heimann H, Damato B, Cherry MG. Predictors of long‐term anxiety and depression in uveal melanoma survivors: A cross‐lagged five‐year analysis. Psychooncology 2020; 29:1864-1873. [DOI: 10.1002/pon.5514] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/12/2020] [Accepted: 07/30/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Stephen L. Brown
- Department of Psychological Sciences University of Liverpool Liverpool UK
| | - Peter L. Fisher
- Department of Psychological Sciences University of Liverpool Liverpool UK
- Clinical Health Psychology Service, Linda McCartney Centre Royal Liverpool and Broadgreen University Hospital NHS Trust UK
| | - Laura Hope‐Stone
- Department of Psychological Sciences University of Liverpool Liverpool UK
- Clinical Health Psychology Service, Linda McCartney Centre Royal Liverpool and Broadgreen University Hospital NHS Trust UK
- Liverpool Ocular Oncology Centre Royal Liverpool and Broadgreen University Hospital NHS Trust UK
| | - Rumana N. Hussain
- Liverpool Ocular Oncology Centre Royal Liverpool and Broadgreen University Hospital NHS Trust UK
| | - Heinrich Heimann
- Liverpool Ocular Oncology Centre Royal Liverpool and Broadgreen University Hospital NHS Trust UK
| | - Bertil Damato
- Liverpool Ocular Oncology Centre Royal Liverpool and Broadgreen University Hospital NHS Trust UK
| | - M. Gemma Cherry
- Department of Psychological Sciences University of Liverpool Liverpool UK
- Clinical Health Psychology Service, Linda McCartney Centre Royal Liverpool and Broadgreen University Hospital NHS Trust UK
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19
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Krok-Schoen JL, Naughton MJ, Young GS, Moon J, Poi M, Melin SA, Wood ME, Hopkins JO, Paskett ED, Post DM. Increasing Adherence to Adjuvant Hormone Therapy Among Patients With Breast Cancer: A Smart Phone App-Based Pilot Study. Cancer Control 2020; 26:1073274819883287. [PMID: 31736324 PMCID: PMC6862779 DOI: 10.1177/1073274819883287] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study tested the feasibility and efficacy of using a text-based intervention to increase initiation, decrease discontinuation, and improve adherence as prescribed to adjuvant hormone therapy (AHT) among hyphenate post-menopausal breast cancer survivors. METHODS The 3-month intervention consisted of daily text message reminders to take medication, coupled with a dynamic (eg, feedback on progress) tailored intervention using weekly interactive surveys delivered by a smartphone app. Five clinic sites within the Alliance for Clinical Trials in Oncology participated. Hormone levels were measured prior to AHT initiation and at study exit. RESULTS Of the 39 patients recruited to the pilot study, 27 (69.2%) completed all study requirements (completed both the baseline and the exit surveys, both blood draws, and did not miss more than 2 weekly surveys). Significant improvements were observed pre- to postintervention for self-reported medication adherence (P = .015), mental health functioning (P = .007), and perceived stress (P = .04). Significant decreases in estradiol, estrogen, and estrone hormone levels were observed from baseline to study exit (P < .001), indicating the accuracy of self-reported AHT adherence. Participants (91.9%) and physicians (100%) agreed that participant participation in the intervention was beneficial. CONCLUSIONS The results of this pilot study established the general feasibility and efficacy of an app-based intervention to support patient AHT adherence. Larger controlled, randomized trials are needed to examine the effectiveness of the app-based intervention in improving AHT and quality of life among breast cancer survivors.
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Affiliation(s)
- Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Michelle J Naughton
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Gregory S Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Jennifer Moon
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | | | - Susan A Melin
- Department of Hematology and Oncology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Marie E Wood
- Division of Hematology and Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Judith O Hopkins
- Novant Health Oncology Specialists, Kernersville Medical Pkwy, Kernersville, NC, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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20
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Optimizing expectations about endocrine treatment for breast cancer: Results of the randomized controlled psy-breast trial. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2695. [DOI: 10.32872/cpe.v2i1.2695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background
Medication side effects are strongly determined by non-pharmacological, nocebo mechanisms, particularly patients’ expectations. Optimizing expectations could minimize side effect burden. This study evaluated whether brief psychological expectation management training (EXPECT) optimizes medication-related expectations in women starting adjuvant endocrine therapy (AET) for breast cancer.
Method
In a multisite randomized controlled design, 197 women were randomized to EXPECT, supportive therapy (SUPPORT), or treatment as usual (TAU). The three-session cognitive-behavioral EXPECT employs psychoeducation, guided imagery, and side effect management training. Outcomes were necessity-concern beliefs about AET, expected side effects, expected coping ability, treatment control expectations, and adherence intention.
Results
Both interventions were well accepted and feasible. Patients’ necessity-concern beliefs were optimized in EXPECT compared to both TAU and SUPPORT, d = .41, p < .001; d = .40, p < .001. Expected coping ability and treatment control expectations were optimized compared to TAU, d = .35, p = .02; d = .42, p < 001, but not to SUPPORT. Adherence intention was optimized compared to SUPPORT, d = .29, p = .02, but not to TAU. Expected side effects did not change significantly.
Conclusion
Expectation management effectively and partly specifically (compared to SUPPORT) modified medication-related expectations in women starting AET. Given the influence of expectations on long-term treatment outcome, psychological interventions like EXPECT might provide potential pathways to reduce side effect burden and improve quality of life during medication intake.
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21
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Exploring Medication Adherence Amongst Australian Adults Using an Extended Theory of Planned Behaviour. Int J Behav Med 2020; 27:389-399. [DOI: 10.1007/s12529-020-09862-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Brown SL, Hughes M, Campbell S, Cherry MG. Could worry and rumination mediate relationships between self‐compassion and psychological distress in breast cancer survivors? Clin Psychol Psychother 2019; 27:1-10. [DOI: 10.1002/cpp.2399] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Stephen L. Brown
- Department of Psychological Sciences University of Liverpool Liverpool UK
| | - Maria Hughes
- Department of Psychological Sciences University of Liverpool Liverpool UK
| | - Sophie Campbell
- Department of Psychological Sciences University of Liverpool Liverpool UK
| | - M. Gemma Cherry
- Department of Psychological Sciences University of Liverpool Liverpool UK
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Piazza AJ, Knowlden AP, Hibberd E, Leeper J, Paschal AM, Usdan S. Mobile device use while crossing the street: Utilizing the theory of planned behavior. ACCIDENT; ANALYSIS AND PREVENTION 2019; 127:9-18. [PMID: 30826696 PMCID: PMC10131759 DOI: 10.1016/j.aap.2019.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/11/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
Every year, thousands of pedestrians are killed and tens-of-thousands are nonfatally injured as a result of traffic crashes. The year 2016 holds the record for the most pedestrians killed in one year since 1990. Mobile device use while crossing the street has been associated with unsafe crossing behaviors and gait abnormalities, potentially increasing the risk of pedestrian injury or death. Expanding upon the small body of literature, the present study utilized the theory of planned behavior to guide the development of a questionnaire used to collect data from 480 adults on predictors of intentions to use a mobile device while crossing the street. Questionnaire development involved one round of expert panel review (N = 4), subsequent pilot testing of a revised questionnaire, and a test-retest reliability assessment. Results demonstrate that attitude toward the behavior, subjective norm, and perceived behavioral control significantly predicted the intention to use a mobile device while crossing the street in this population. Such a questionnaire can be used in the design and evaluation of TPB-based interventions to decrease distracted mobile device use while crossing the street.
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Affiliation(s)
- Andrew J Piazza
- The University of Alabama, Department of Health Science, Box 870311, Tuscaloosa, AL 35487, United States.
| | - Adam P Knowlden
- The University of Alabama, Department of Health Science, Box 870311, Tuscaloosa, AL 35487, United States
| | - Elizabeth Hibberd
- The University of Alabama, Department of Health Science, Box 870311, Tuscaloosa, AL 35487, United States
| | - James Leeper
- The University of Alabama, Department of Community Medicine and Population Health, Box 870326, Tuscaloosa, AL 35487, United States
| | - Angelia M Paschal
- The University of Alabama, Department of Health Science, Box 870311, Tuscaloosa, AL 35487, United States
| | - Stuart Usdan
- The University of Alabama, Department of Health Science, Box 870311, Tuscaloosa, AL 35487, United States
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Nursing Interventions on Medication Adherence During Hepatitis C Treatment: Application of Self-Regulation Model. Gastroenterol Nurs 2019; 41:525-531. [PMID: 30489409 DOI: 10.1097/sga.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hepatitis C virus is a common cause of liver disease nationally and globally. Medication adherence to hepatitis C treatment is important for viral eradication and the prevention of chronic disease. The purpose of this article is to identify a nursing middle-range theory to guide research on the impact of nursing interventions on medication adherence during hepatitis C treatment and to apply the theory to practice by providing examples of the theory application. A gap in the literature is identified as the lack of research using theories or models as a guide to investigate nursing interventions and hepatitis C treatment. The lack of theory-based research may contribute to medication nonadherence. The self-regulation model provides the most complete guide for nursing interventions during hepatitis C treatment. Nursing interventions and hepatitis C research, guided by theory, generate knowledge specific for nursing.
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Heiney SP, Parker PD, Felder TM, Adams SA, Omofuma OO, Hulett JM. A systematic review of interventions to improve adherence to endocrine therapy. Breast Cancer Res Treat 2018. [PMID: 30387003 DOI: 10.1007/s10549-018-5012-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Adherence to endocrine therapy for hormone positive breast cancer is a significant problem, especially in minority populations. Further, endocrine therapy reduces recurrence and thus mortality. However, little data are available on interventions to improve adherence. The authors conducted a systematic review to examine the impact of interventions, strategies, or approaches aimed to improve endocrine therapy adherence among women with breast cancer. A secondary aim was to determine if interventions had any cultural modifications. METHODS Two of the authors examined articles published between 2006 and 2017 from a wide variety of databases using Covidence systematic review platform. RESULTS In total, 16 eligible studies met criteria for review including 4 randomized controlled trials, 4 retrospective studies, and 8 with various observational designs. Eligible studies used a broad range of definitions for adherence and measured adherence by self-report, medical records, claims data, and combinations of these. All used 80% medication possession ratio as a standard for adherence. Patient information/education was the most frequent intervention strategy but did not demonstrate a significant effect except in one study. Significant results were noted when education was combined with communication strategies. CONCLUSIONS Researchers need a standard definition for adherence and a reliable measure that is feasible to use in a variety of studies. While education may be a necessary component of an intervention, when used alone, it is not a sufficient approach to change behavior.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, School of Medicine, University of South Carolina, 1601 Greene St, Columbia, 29208, SC, USA.
| | | | - Tisha M Felder
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Swann Arp Adams
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Omonefe O Omofuma
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Heiney SP, Parker PD, Felder TM, Adams SA, Omofuma OO, Hulett JM. A systematic review of interventions to improve adherence to endocrine therapy. Breast Cancer Res Treat 2018; 173:499-510. [PMID: 30387003 DOI: 10.1007/s10549-018-5012-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/15/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Adherence to endocrine therapy for hormone positive breast cancer is a significant problem, especially in minority populations. Further, endocrine therapy reduces recurrence and thus mortality. However, little data are available on interventions to improve adherence. The authors conducted a systematic review to examine the impact of interventions, strategies, or approaches aimed to improve endocrine therapy adherence among women with breast cancer. A secondary aim was to determine if interventions had any cultural modifications. METHODS Two of the authors examined articles published between 2006 and 2017 from a wide variety of databases using Covidence systematic review platform. RESULTS In total, 16 eligible studies met criteria for review including 4 randomized controlled trials, 4 retrospective studies, and 8 with various observational designs. Eligible studies used a broad range of definitions for adherence and measured adherence by self-report, medical records, claims data, and combinations of these. All used 80% medication possession ratio as a standard for adherence. Patient information/education was the most frequent intervention strategy but did not demonstrate a significant effect except in one study. Significant results were noted when education was combined with communication strategies. CONCLUSIONS Researchers need a standard definition for adherence and a reliable measure that is feasible to use in a variety of studies. While education may be a necessary component of an intervention, when used alone, it is not a sufficient approach to change behavior.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, School of Medicine, University of South Carolina, 1601 Greene St, Columbia, 29208, SC, USA.
| | | | - Tisha M Felder
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Swann Arp Adams
- College of Nursing, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Omonefe O Omofuma
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Drzayich Antol D, Waldman Casebeer A, Khoury R, Michael T, Renda A, Hopson S, Parikh A, Stein A, Costantino M, Stemkowski S, Bunce M. The relationship between comorbidity medication adherence and health related quality of life among patients with cancer. J Patient Rep Outcomes 2018; 2:29. [PMID: 30294709 PMCID: PMC6091619 DOI: 10.1186/s41687-018-0057-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 06/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background Studies have demonstrated that comorbidities compound the adverse influence of cancer on health-related quality of life (HRQoL). Comorbidities adversely impact adherence to cancer treatment. Additionally, adherence to medications for comorbidities is positively associated with HRQoL for various diseases. This study used the Center for Disease Control and Prevention's Healthy Days measure of HRQoL to explore the association between HRQoL and adherence to comorbidity medication for elderly patients with cancer and at least one comorbid condition. Methods We conducted a cross-sectional survey combined with retrospective claims data. Patients with metastatic breast, lung or colorectal cancer were surveyed regarding their HRQoL, comorbidity medication adherence and cancer-related symptoms. Patients reported the number of physical, mental and total unhealthy days in the prior month. The Morisky Medication Adherence 8-point scale was differentiated into moderate/high (> 6) and low (≤ 6) comorbidity medication adherence. Results Of the 1847 respondents, the mean age was 69.2 years, most were female (66.8%) and the majority of the sample had Medicare coverage (88.2%). Low comorbidity medication adherence was associated with significantly more total, mental and physical unhealthy days. Low comorbidity medication adherence was associated with the presence of patient-reported cancer-related symptoms. Patients reporting low, as compared to moderate/high, comorbidity medication adherence had 23.4% more unhealthy days in adjusted analysis, P = 0.007. Conclusion The positive association between low comorbidity medication adherence and the number of unhealthy days suggests that addressing barriers to comorbidity medication adherence during cancer treatment may be an avenue for improving or maintaining HRQoL for older patients with cancer and comorbid conditions.
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Jafari A, Goudarzian AH, Bagheri Nesami M. Depression in Women with Breast Cancer: A Systematic Review of Cross-Sectional Studies in Iran. Asian Pac J Cancer Prev 2018; 19:1-7. [PMID: 29373872 PMCID: PMC5844601 DOI: 10.22034/apjcp.2018.19.1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/14/2022] Open
Abstract
Objective: Breast cancer is one of the most common cancers in women and has more severe mental and emotional effects than other types. Depression as a mental disorder affects people’s mental well-being, physical symptoms, occupational performance, and finally quality of life. The aim of this study was to determine depression levels in Iranian women with breast cancer. Methods: A systematic review study was conducted in 2017. English and Persian databases (PubMed, SCOPUS, Web of Science, Google Scholar, SID, Magiran) were searched with key words such as Depression Or Depressive Disorders AND Women AND Breast Cancer OR Tumor OR Neoplasm OR Malignancy AND Iran. Inclusion criteria allowed for cross-sectional studies conducted in Iran (published in English or Persian language journals), studies that had key words in their keywords or their titles and standard instruments for measuring depression in patients. Of the 160 publications found, eight were selected after reviewing the title, abstract and full article. Results: Age of women with breast cancer in selected studies ranged from 43.8 (SD = 47.1) to 55.9 (SD = 14.6) years. Duration of cancer in most studies was about 1-2 years. In most studies, mild levels of depression for women with breast cancer were present. However, in one study it was stated that 69.4% of participants had serious levels of depression. Conclusions: There is increase in the risk of depression in women with breast cancer. Therefore, it seems necessary to plan preventive and therapeutic measures in order to improve the mental health and quality of life of the affected patients.
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Affiliation(s)
- Azar Jafari
- Nursing Student, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
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McCusker J, Yaffe M, Faria R, Lambert S, Li M, Poirier-Bisson J, Magalhaes M, de Raad M. Phase II trial of a depression self-care intervention for adult cancer survivors. Eur J Cancer Care (Engl) 2017; 27. [DOI: 10.1111/ecc.12763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Canada
- St. Mary's Research Centre; Montreal Canada
| | - Mark Yaffe
- St. Mary's Research Centre; Montreal Canada
- Department of Family Medicine; McGill University; Montreal Canada
- Family Medicine Centre; St. Mary's Hospital Center; Montreal Canada
| | - Rosana Faria
- Psycho-Social Oncology; St. Mary's Hospital Center; Montreal Canada
| | - Sylvie Lambert
- St. Mary's Research Centre; Montreal Canada
- Ingram School of Nursing; McGill University; Montreal Canada
| | - Madeline Li
- Department of Supportive Care; Princess Margaret Cancer Centre; Toronto Canada
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Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers. Breast Cancer Res Treat 2017; 165:247-260. [DOI: 10.1007/s10549-017-4317-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/24/2017] [Indexed: 01/31/2023]
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Irwin M. Theoretical foundations of adherence behaviors: synthesis and application in adherence to oral oncology agents. Clin J Oncol Nurs 2017; 19:31-5. [PMID: 26030390 DOI: 10.1188/15.s1.cjon.31-35] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of theory can provide structure for understanding the dynamics of adherence to oral agents for cancer (OACs) and facilitate the development of strategies for patient assessment and care planning related to oral adherence. OBJECTIVES The focus of this article is to identify common theories pertinent to medication-taking behavior, as well as their applications toward assessment and care planning regarding adherence to OACs. Approaches to apply these theories and their concepts in clinical practice are identified. METHODS Theories applied to adherence behaviors were reviewed, and their concepts were compared and synthesized. These concepts were then applied to medication adherence behavior. FINDINGS Various theories can help healthcare providers to better understand the influences and determinants of patients' adherence decisions and behaviors. They can then be used to structure assessment and plan related aspects of care.
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Abstract
Adolescents and young adults (AYAs) with cancer are at risk for depression due to disruptions in their developmental trajectory, greater physical symptom burden, and increased likelihood of developing aggressive disease. Rates of depression and other psychological disorders are substantially higher in AYAs with cancer when compared with older adults. Psychiatrists caring for these patients must consider the age-appropriate developmental context of these patients along with familial and medical factors that may influence the presentation and treatment of depression. Previous research suggests that psychosocial interventions specifically designed for AYA patients are promising, but studies of psychopharmacology treatments for depression are lacking. There is a pressing need for prospective studies and controlled clinical trials that evaluate the optimal strategies for treating depression in this patient group.
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Affiliation(s)
- Eliza M Park
- Department of Psychiatry University of North Carolina, Chapel Hill, North Carolina, USA
| | - Donald L Rosenstein
- Department of Psychiatry and Department of Medicine University of North Carolina, Chapel Hill, North Carolina, USA
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Chirico A, Lucidi F, Mallia L, D'Aiuto M, Merluzzi TV. Indicators of distress in newly diagnosed breast cancer patients. PeerJ 2015; 3:e1107. [PMID: 26244115 PMCID: PMC4517964 DOI: 10.7717/peerj.1107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/26/2015] [Indexed: 11/20/2022] Open
Abstract
Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient’s knowledge (β = − 0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping self-efficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = − 0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.
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Affiliation(s)
- Andrea Chirico
- Breast Cancer Department, National Cancer Institute Fondazione "G.Pascale," Naples , Italy ; Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Fabio Lucidi
- Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Luca Mallia
- Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Massimiliano D'Aiuto
- Breast Cancer Department, National Cancer Institute Fondazione "G.Pascale," Naples , Italy
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Wakefield CE, Butow PN, Aaronson NA, Hack TF, Hulbert-Williams NJ, Jacobsen PB. Patient-reported depression measures in cancer: a meta-review. Lancet Psychiatry 2015; 2:635-47. [PMID: 26303561 DOI: 10.1016/s2215-0366(15)00168-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 01/06/2023]
Abstract
The patient-reported depression measures that perform best in oncology settings have not yet been identified. We did a meta-review to integrate the findings of reviews of more than 50 depression measures used in adults with, or recovering from, any type of cancer. We searched Medline, PsycINFO, Embase, and grey literature from 1999 to 2014 to identify 19 reviews representing 372 primary studies. 11 reviews were rated as being of high quality (defined as meeting at least 20 criteria in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement). The Hospital Anxiety Depression Scale (HADS) was the most thoroughly evaluated measure, but was limited by cutpoint variability. The HADS had moderate screening utility indices and was least recommended in advanced cancer or palliative care. The Beck Depression Inventory was more generalisable across cancer types and disease stages, with good indices for screening and case finding. The Center for Epidemiologic Studies Depression Scale was the best-weighted measure in terms of responsiveness. This meta-review provides a comprehensive overview of the strengths and limitations of available depression measures. It can inform the choice of the best measure for specific settings and purposes.
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Affiliation(s)
- Claire E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Randwick, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED) and the Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Neil A Aaronson
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Thomas F Hack
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Nicholas J Hulbert-Williams
- Chester Research Unit for the Psychology of Health, Department of Psychology, University of Chester, Chester, UK
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Mausbach BT, Schwab RB, Irwin SA. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2015; 152:239-46. [PMID: 26077640 DOI: 10.1007/s10549-015-3471-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/12/2015] [Indexed: 12/21/2022]
Abstract
The purpose of this meta-analysis was to analyze the available evidence concerning the effects of depression on non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer. MEDLINE and PsycInfo databases from inception through May 1, 2015 were searched using terms related to AET adherence. Articles were reviewed and selected based on predetermined selection criteria, and effect sizes from included studies were extracted. Pooled effect estimates were obtained using random-effects meta-analyses. Of the 312 articles identified, 9 met the inclusion criteria. Overall, depression was significantly associated with non-adherence to AET (Cohen's d = 0.35, 95% CI 0.19-0.52). This effect was not significantly moderated by patient age (<65 vs ≥65 years), length of study follow-up (<18 months vs ≥18 months), or method of assessing adherence (objective vs self-report). However, within these subgroups, significant effects of depression were found only for younger patients (d = 0.46; 95% CI 0.19-0.72) and in studies of shorter duration (<18 months) (d = 0.49; 95% CI 0.22-0.76). These results suggest that AET adherence may be lower among women with greater depressive symptoms, and this effect may be exacerbated in younger women during the early phases (<18 months) of AET. Management of depressive symptoms in women with breast cancer may help in enhancing adherence to AET and improve cancer treatment outcomes.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0680, USA,
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Cahir C, Guinan E, Dombrowski SU, Sharp L, Bennett K. Identifying the determinants of adjuvant hormonal therapy medication taking behaviour in women with stages I-III breast cancer: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)00234-7. [PMID: 26054455 DOI: 10.1016/j.pec.2015.05.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/05/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to identify the modifiable determinants of adjuvant hormonal therapy medication taking behaviour (MTB) in women with stage I-III breast cancer in clinical practice settings. METHODS We searched PubMed EMBASE, PsycINFO and CINAHL for articles investigating determinants of adjuvant hormonal therapy. Potentially modifiable determinants were identified and mapped to the 14 domains of the Theoretical Domains Framework (TDF), an integrative framework of theories of behavioural change. Meta-analysis was used to calculate pooled odds ratios for selected determinants. RESULTS Potentially modifiable determinants were identified in 42 studies and mapped to 9 TDF domains. In meta-analysis treatment side-effects (Domain: Beliefs about Capabilities) and follow-up care with a general practitioner (vs. oncologist) (Social Influences) were significantly negatively associated with persistence (p<0.001) and number of medications (Behaviour Regulation) was significantly positively associated with persistence (p<0.003). Studies did not examine several domains (including Beliefs about Consequences, Intentions, Goals, Social Identity, Emotion and Knowledge) which have been reported to influence MTB in other disease groups. CONCLUSIONS There is some evidence that the domains Beliefs about Capabilities, Behaviour Regulation and Social Influences influence hormonal therapy MTB. PRACTICE IMPLICATIONS Further research is needed to develop effective interventions to improve hormonal therapy MTB.
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Affiliation(s)
- Caitriona Cahir
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Ireland and Economic and Social Research Institute, Dublin 2, Ireland,.
| | - Emer Guinan
- Discipline of Physiotherapy, Trinity College Dublin, Ireland
| | | | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Ireland
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Costas-Muniz R, Leng J, Diamond L, Aragones A, Ramirez J, Gany F. Psychosocial correlates of appointment keeping in immigrant cancer patients. J Psychosoc Oncol 2015; 33:107-23. [PMID: 25574581 DOI: 10.1080/07347332.2014.992084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study aims to determine the psychosocial correlates of self-reported adherence to cancer treatment appointments and treatment delays and interruptions. The sample included 622 immigrant cancer patients from New York City. Patients completed a survey that included sociodemographic and health-related questions, questions assessing missed appointments and delays/or interruptions, and quality of life and depression scales. After controlling for sociodemographic characteristics, having a positive depression screen and poor physical and emotional well-being were significant predictors of missed appointments and delays and/or interruptions of treatment. Non-adherence to treatment appointments in immigrant cancer patients is a complex outcome related to important modifiable or treatable factors.
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Affiliation(s)
- Rosario Costas-Muniz
- a Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Immigrant Health & Cancer Disparities Service , New York , NY , USA
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Pakpour AH, Gellert P, Asefzadeh S, Updegraff JA, Molloy GJ, Sniehotta FF. Intention and planning predicting medication adherence following coronary artery bypass graft surgery. J Psychosom Res 2014; 77:287-95. [PMID: 25280826 DOI: 10.1016/j.jpsychores.2014.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 06/14/2014] [Accepted: 07/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Medication adherence rates after coronary artery bypass graft (CABG) surgery are low due to intentional (e.g., deliberately choosing not to take medication) and unintentional (e.g., forgetting to take the medication) person-related factors. There is a lack of studies examining the psychological factors related to non-adherence in CABG patients. Intentions to take medication and planning when, where, and how to take medication and to overcome unintentional forgetting to take medication were hypothesized to be independently related to medication adherence. Furthermore, planning to overcome forgetting was hypothesized to be more strongly associated with medication adherence in patients who have stronger intentions to take medication, reflecting the idea that planning is a factor that specifically helps in patients who are willing to take medication, but fail to do so. METHODS Measures of medication adherence, intention and planning were collected in a sample of (N=197) post-CABG surgery patients followed from discharge (baseline; Time 1) over a 12-month period (Time 2) in Boo-Ali Hospital in Qazvin, Iran. A series of hierarchical multiple regression analyses were performed in which medication adherence at Time 2 was regressed onto socio-demographic and clinical factors, the hypothesized psychological variables (adherence-related intention and planning), and interaction terms. RESULTS Intentions to take medication (B=.30, P<.01), action planning when, where, and how to take the medication (B=.19, P<.01), and coping planning how to avoid forgetting to take the medication (B=.16, P<.01) were independently related to medication adherence. Beyond that, action planning × intention to take medication (B=.06, P<.05) and coping planning × intention (B=.07, P<.01) interaction also significantly predicted adherence. CONCLUSION Intention to take medication was associated with better medication adherence and action and coping planning strategies to avoid forgetting to take the medication added significantly to the prediction of adherence in the year following CABG discharge. This is in line with theory and evidence about the independent roles of intentional and unintentional predictors of non-adherence. As hypothesized, planning to overcome unintentional forgetting to take the medication was more predictive of medication adherence in those patients who reported higher intentions to take medication, reflecting the idea that planning helps patients overcome unintentional reasons of being non-adherent.
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Affiliation(s)
- Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Paul Gellert
- Newcastle University, United Kingdom; Charité - Universitätsmedizin Berlin, Germany.
| | - Saeed Asefzadeh
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - John A Updegraff
- Department of Psychological Sciences, Kent State University, USA.
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Ireland.
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Raddin RS, Park EM, Hamer RM, Nelson KM, Mayer DK, Rosenstein DL, Bernard SA. A Pilot Study To Evaluate Symptom-Oriented Selection of Antidepressants in Patients with Cancer. J Palliat Med 2014; 17:167-75. [DOI: 10.1089/jpm.2013.0412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ryan S. Raddin
- Department of Medical Oncology, Bon Secours Cancer Institute, Richmond, Virginia
| | - Eliza M. Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Kelly M. Nelson
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Deborah K. Mayer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Donald L. Rosenstein
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen A. Bernard
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Pereira Dias G, Hollywood R, Bevilaqua MCDN, da Luz ACDDS, Hindges R, Nardi AE, Thuret S. Consequences of cancer treatments on adult hippocampal neurogenesis: implications for cognitive function and depressive symptoms. Neuro Oncol 2014; 16:476-92. [PMID: 24470543 DOI: 10.1093/neuonc/not321] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The human brain is capable of generating new functional neurons throughout life, a phenomenon known as adult neurogenesis. The generation of new neurons is sustained throughout adulthood due to the proliferation and differentiation of adult neural stem cells. This process in humans is uniquely located in the subgranular zone of the dentate gyrus in the hippocampus. Adult hippocampal neurogenesis (AHN) is thought to play a major role in hippocampus-dependent functions, such as spatial awareness, long-term memory, emotionality, and mood. The overall aim of current treatments for cancer (such as radiotherapy and chemotherapy) is to prevent aberrant cell division of cell populations associated with malignancy. However, the treatments in question are absolutist in nature and hence inhibit all cell division. An unintended consequence of this cessation of cell division is the impairment of adult neural stem cell proliferation and AHN. Patients undergoing treatment for cancerous malignancies often display specific forms of memory deficits, as well as depressive symptoms. This review aims to discuss the effects of cancer treatments on AHN and propose a link between the inhibition of the neurogenetic process in the hippocampus and the advent of the cognitive and mood-based deficits observed in patients and animal models undergoing cancer therapies. Possible evidence for coadjuvant interventions aiming to protect neural cells, and subsequently the mood and cognitive functions they regulate, from the ablative effects of cancer treatment are discussed as potential clinical tools to improve mental health among cancer patients.
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Affiliation(s)
- Gisele Pereira Dias
- Institute of Psychiatry, King's College London, The James Black Centre, London, UK (G.P.D., R.H., S.T.); Translational Neurobiology Unit, Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (G.P.D., M.C.N.B., A.C.D.dS.d.L., A.E.N.); MRC Centre for Developmental Neurobiology, King's College London, London, UK (M.C.N.B., R.H.)
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Sniehotta FF, Gellert P, Witham MD, Donnan PT, Crombie IK, McMurdo MET. Psychological theory in an interdisciplinary context: psychological, demographic, health-related, social, and environmental correlates of physical activity in a representative cohort of community-dwelling older adults. Int J Behav Nutr Phys Act 2013; 10:106. [PMID: 24011129 PMCID: PMC3847689 DOI: 10.1186/1479-5868-10-106] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 08/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA) in older adults is influenced by a range of environmental, demographic, health-related, social, and psychological variables. Social cognitive psychological models assume that all influences on behaviour operate indirectly through the models constructs, i.e., via intention and self-efficacy. We evaluated direct, indirect, and moderating relationships of a broad range of external variables with physical activity levels alongside intention and self-efficacy. METHODS We performed a cross-sectional survey of a representative and stratified (65-80 and 80+ years; deprived and affluent) sample of 584 community-dwelling people, resident in Scotland. Objectively measured physical activity and questionnaire data were collected. RESULTS Self-efficacy showed unique relationships with physical activity, controlling for demographic, mental health, social, environmental, and weather variables separately, but the relationship was not significant when controlling for physical health. Overall, results indicating support for a mediation hypothesis, intention and self-efficacy statistically mediate the relationship of most domain variables with physical activity. Moderation analyses show that the relationship between social cognitions and physical activity was stronger for individuals with better physical health and lower levels of socio-economic deprivation. CONCLUSIONS Social cognitive variables reflect a range of known environmental, demographic, health-related and social correlates of physical activity, they mediate the relationships of those correlates with physical activity and account for additional variance in physical activity when external correlates are controlled for, except for the physical health domain. The finding that the social cognition-physical activity relationship is higher for participants with better health and higher levels of affluence raises issues for the applicability of social cognitive models to the most disadvantaged older people.
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Costas R, Gany F. Depressive symptoms in a sample of Afro-Caribbean and Latino immigrant cancer patients: a comparative analysis. Support Care Cancer 2013; 21:2461-8. [PMID: 23604454 PMCID: PMC3731416 DOI: 10.1007/s00520-013-1813-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aims to describe the depressive symptoms in a sample of African-Caribbean and Latino cancer patients and examine differences in specific symptoms between the two groups. METHODS The sample included immigrant Afro-Caribbean (n = 44) and Latino (n = 145) underserved cancer patients recruited from five hospitals in New York City. Participants completed a questionnaire comprised of measures of depression (Patient Health Questionnaire-9), health-related quality of life (EuroQol 5D), sociodemographic, and health-related questions. RESULTS Results of the comparison of mean scores and percentage of patients meeting the cutoff scores showed that Afro-Caribbean patients reported comparable depressive symptoms to the Latino patients. But, upon closer inspection of specific symptoms and other self-report variables, Latino patients reported more frequently depressed mood, having a history of a depressive disorder, and overall higher psychological distress than Afro-Caribbean patients. CONCLUSIONS Different presentation of symptoms associated with depression is expressed by Afro-Caribbean and Latino cancer patients. Studies analyzing in detail the presentation of psychological responses of different cultural groups with chronic medical conditions are greatly needed.
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Affiliation(s)
- Rosario Costas
- Memorial Sloan Kettering Cancer Center Department of Psychiatry & Behavioral Sciences 641 Lexington Avenue, 7 Floor New York, NY 10022 Phone Number: 646-888-0098 Fax: 212-888-2584
| | - Francesca Gany
- Memorial Sloan Kettering Cancer Center Department of Psychiatry & Behavioral Sciences 300 E. 66th Street, 15th floor, NY, NY 10065 (Phone) 646-888-4240 (Fax) 646-888-4491
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Sivell S, Elwyn G, Edwards A, Manstead ASR. Factors influencing the surgery intentions and choices of women with early breast cancer: the predictive utility of an extended theory of planned behaviour. BMC Med Inform Decis Mak 2013; 13:92. [PMID: 23962230 PMCID: PMC3849725 DOI: 10.1186/1472-6947-13-92] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 08/06/2013] [Indexed: 11/25/2022] Open
Abstract
Background Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women’s choices. An extended Theory of Planned Behaviour (TPB) could provide a basis to understand and predict women’s surgery choices. The aims of this study were to understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, examining the predictive utility of an extended TPB. Methods Sixty-two women recruited from three UK breast clinics participated in the study; 48 women, newly diagnosed with early breast cancer, completed online questionnaires both before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options using items designed to measure constructs of an extended TPB (i.e., attitudes, subjective norms, perceived behavioural control, and anticipated regret), and women’s intentions to choose mastectomy or BCS. Objective data were collected on women’s choice of surgery via the clinical breast teams. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery. Results The extended TPB accounted for 69.9% of the variance in intentions (p <.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p <.01). Conclusions These findings demonstrate the utility of an extended TPB in predicting and understanding women’s surgery intentions and choices for early breast cancer. Understanding these factors should help to identify key components of interventions to support women while considering their surgery options.
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Affiliation(s)
- Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
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Hung YP, Liu CJ, Tsai CF, Hung MH, Tzeng CH, Liu CY, Chen TJ. Incidence and risk of mood disorders in patients with breast cancers in Taiwan: a nationwide population-based study. Psychooncology 2013; 22:2227-34. [PMID: 23463734 DOI: 10.1002/pon.3277] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/21/2012] [Accepted: 02/11/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study is to assess the incidence and risk of mood disorders, including major depression, anxiety, and bipolar disorders, in Taiwanese patients after the diagnosis of breast cancer compared with a matched cohort. METHODS From January 2000 to December 2005, 26,629 newly diagnosed breast cancer patients were enrolled by the Taiwan National Health Insurance program database. The control cohort was selected randomly from 1,000,000 National Health Insurance beneficiaries from a population of 21,400,826 enrolled throughout Taiwan. Each patient was matched with one subject without breast cancer by age, sex, and presence of comorbidities with the same diagnosis index date. The diagnosis of mood disorders was defined by compatible International Classification of Diseases, 9th revision, clinical modification codes plus the prescription of antidepressants for at least 30 days. RESULTS The overall incidence rate ratio of mood disorders was 1.33 (95% CI 1.28-1.39, p < 0.001) in the breast cancer cohort compared with the matched cohort. The incidence rate ratios for specific mood disorders were 2.06 for bipolar disorder (95% CI 1.37-3.15 p = 0.0003), 1.94 for major depressive disorder (95% CI 1.76-2.13 p < 0.001), and 1.22 for anxiety (95% CI 1.16-1.27 p < 0.001). Independent risk factors for developing mood disorders included breast cancer, as well as age, hypertension, chronic obstructive pulmonary disease, autoimmune disease, ischemic heart disease, and cerebrovascular disease. CONCLUSIONS Breast cancer is a prominent risk factor for mood disorders, including major depressive disorder, anxiety, and bipolar disorder. The impact is most potent in the first year after diagnosis. Psychological support is a critical issue in these patients.
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Affiliation(s)
- Yi-Ping Hung
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Chia-Fen Tsai
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Man-Hsin Hung
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Sliwinski J, Elkins GR. Enhancing placebo effects: insights from social psychology. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2013; 55:236-48. [PMID: 23488251 DOI: 10.1080/00029157.2012.740434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Placebo effects are widely recognized as having a potent impact upon treatment outcomes in both medical and psychological interventions, including hypnosis. In research utilizing randomized clinical trials, there is usually an effort to minimize or control placebo effects. However, in clinical practice there may be significant benefits in enhancing placebo effects. Prior research from the field of social psychology has identified three factors that may enhance placebo effects, namely: priming, client perceptions, and the theory of planned behavior. These factors are reviewed and illustrated via a case example. The consideration of social-psychological factors to enhance positive expectancies and beliefs has implications for clinical practice as well as future research into hypnotic interventions.
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Aiello Bowles EJ, Boudreau DM, Chubak J, Yu O, Fujii M, Chestnut J, Buist DSM. Patient-reported discontinuation of endocrine therapy and related adverse effects among women with early-stage breast cancer. J Oncol Pract 2012; 8:e149-57. [PMID: 23598850 PMCID: PMC3500489 DOI: 10.1200/jop.2012.000543] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Approximately 20% to 50% of women diagnosed with hormone receptor-positive breast cancer discontinue endocrine therapy early; most reports come from automated pharmacy data or small self-report evaluations. We conducted a larger self-report evaluation of endocrine therapy discontinuation associated with patient characteristics and therapy-related adverse effects. METHODS We surveyed 538 women from a single health plan who were diagnosed with early-stage breast cancer from 2002 to 2008 and received endocrine therapy. Women reported adverse effects and reasons for discontinuation via mailed survey; tumor characteristics were obtained via registry linkage. We classified women as discontinuers if they self-reported stopping therapy and their self-reported duration of tamoxifen plus aromatase inhibitor (AI) use was < 5 years, and nondiscontinuers if they self-reported ≥ 5 years use or current use. We estimated odds ratios (ORs) with 95% CIs for discontinuation versus continuation by using logistic regression adjusted for age and year of diagnosis. RESULTS Among 538 women, 98 (18.2%) discontinued endocrine therapy early. Women with positive lymph nodes (v negative) were significantly less likely to discontinue therapy (odds ratio [OR] = 0.54; 95% CI, 0.31 to 0.93). Almost all women (94%) experienced adverse effects. Experiencing headaches was associated with discontinuation of AIs (OR = 4.16; 95% CI, 2.16 to 8.01) and tamoxifen (OR = 2.34; 95% CI, 1.24 to 4.41); few other individual adverse effects were related to discontinuation despite most discontinuers reporting they "did not like adverse effects" (AIs: 66.7%, tamoxifen: 59.1%). CONCLUSION Few individual adverse effects or patient characteristics were significantly associated with endocrine therapy discontinuation, yet adverse effects were prevalent and were the most common reason women reported for discontinuing therapy.
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Affiliation(s)
- Erin J Aiello Bowles
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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Sharp L, Carsin AE, Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psychooncology 2012; 22:745-55. [PMID: 22411485 DOI: 10.1002/pon.3055] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 01/06/2012] [Accepted: 01/30/2012] [Indexed: 01/06/2023]
Affiliation(s)
| | - Anne-Elie Carsin
- National Cancer Registry; Cork Ireland
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
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