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Kwete XJ, Kane K, Liu YA, Krakauer EL. Frequency and duration of suffering of cervical cancer patients and caregivers: Results from an international Delphi study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001642. [PMID: 36963037 PMCID: PMC10021373 DOI: 10.1371/journal.pgph.0001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/02/2023] [Indexed: 03/11/2023]
Abstract
This paper describes a Delphi process executed between August and September, 2020, to identify types of physical, psychological, social and spiritual suffering and their severity, prevalence and duration associated with cervical cancer to enable estimation of the global and regional palliative care needs of these cervical cancer patients and their family caregivers. Patients were dichotomized into decedents (those who died of cervical cancer in any given year) and non-decedents (those who had cervical cancer in any given year but did not die in that year). A two-round web-based Delphi study was conducted using a panel of 12 experts with first-hand experience taking care of cervical cancer patients and their family caregivers, two from each World Health Organization (WHO) region. We identified thirteen types of physical suffering, six psychological types, three social types and three spiritual types. Frequencies and durations were given for each of the suffering types for a decedent, a non-decedent and a primary family caregiver. Our findings of the types, severity, frequency and duration of suffering associated with cervical cancer should inform global, regional, national and local health care strategic planning so that the health investments can be better aligned with the needs.
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Affiliation(s)
- Xiaoxiao Jiang Kwete
- Harvard School of Public Health, Boston, MA, United States of America
- Global Health Research and Consulting, Yaozhi, Yangzhou, China
| | - Khadidjatou Kane
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | | | - Eric L Krakauer
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Palliative Care, University of Medicine and Pharmacy at Ho Chi Minh, Ho Chi Minh City, Vietnam
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Tsai LY, Tsay SL, Hsu CY, Tsai MC, Liu CM, Tsai JM. Together through the valley of death: Lived experience of case managers to meet the informational needs of gynecologic cancer survivors. Taiwan J Obstet Gynecol 2022; 61:339-344. [PMID: 35361398 DOI: 10.1016/j.tjog.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Case managers are crucial providers of health education and consultation for patients with gynecologic cancer to satisfy their informational needs. The purpose of this study is to understand the experience of case managers working to meet the needs of these patients in order to further improve their overall quality of care. MATERIALS AND METHODS A qualitative study employed. Twenty case managers recruited from Taiwanese healthcare institutes using purposive sampling. Participants were interviewed in semi-structure fashion. All interviews were verbatim transcribed. The steps of Giorgi's phenomenological method were used to analyze the transcripts. RESULTS Three major themes and twelve subthemes emerged. Major themes were associated with cancer development: (1) during diagnosis, build a communication bridge and provide appropriate treatment early on, become consultants; (2) during treatment, provide comprehensive medical care for cancer, become the patient's manager; (3) during follow-ups, assist patients to comprehend and adapt to living with cancer, return to society and the original pace of life. CONCLUSION Case managers accompany patients with gynecologic cancer and address their problems to other medical professional. The informational needs of patients with gynecologic cancer differ along the course of the disease. It is important for cancer care manager to deliver the information of individualized health care in timely manner to ensure the overall quality of care for patients with gynecologic cancer.
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Affiliation(s)
- Li-Yun Tsai
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Shiow-Luan Tsay
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Chen-Yuan Hsu
- Department of Nursing, Dayeh University, Changhua, Taiwan
| | - Meng-Chuan Tsai
- Department of Sport and Health Management, Dayeh University, Changhua, Taiwan
| | - Chien-Miao Liu
- Department of Optometry, Dayeh University, Changhua, Taiwan
| | - Jung-Mei Tsai
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan; Mackay Memorial Hospital, Taipei City, Taiwan; Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei City, Taiwan; Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.
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3
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Krakauer EL, Kwete X, Kane K, Afshan G, Bazzett-Matabele L, Bien-Aimé DDR, Byrne-Martelli S, Connor S, Correa R, Devi CRB, Diop M, Gafer N, Goodman A, Grover S, Hasenburg A, Irwin K, Thanh Khanh Q, Kumar S, Nevzorova D, Truong QXN, Rajagopal MR, Randall T, Rassouli M, Sessa C, Spence D, Torode JS, Trimble T, Varghese C, Fidarova E. Cervical Cancer-Associated Suffering: Estimating the Palliative Care Needs of a Highly Vulnerable Population. JCO Glob Oncol 2021; 7:862-872. [PMID: 34115522 PMCID: PMC8457813 DOI: 10.1200/go.21.00025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration.
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Affiliation(s)
- Eric L Krakauer
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA.,Deparment of Palliative Care, University of Medicine and Pharmacy at Ho Chi Minh, Vietnam
| | | | - Khadidjatou Kane
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA
| | - Gauhar Afshan
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT
| | - Danta Dona Ruthnie Bien-Aimé
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA.,Université Episcopale d'Haiti, Port-au-Prince, Haiti, Faculté des Sciences Infirmières de Leogane, Leogane, Haiti
| | - Sarah Byrne-Martelli
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Mamadou Diop
- Cancer Institute of Cheikh Anta Diop University, Dakar, Senegal
| | - Nahla Gafer
- Radiation and Isotope Centre, Khartoum, Oncology Hospital, Sudan.,Comboni College of Science and Technology, Khartoum, Sudan
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA.,Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | - Surbhi Grover
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Botswana-UPenn Partnership, Gaborone, Botswana
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Kelly Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Suresh Kumar
- Institute of Palliative Medicine, Medical College, Kerala, India
| | - Diana Nevzorova
- Federal Center for Palliative Care, Sechenov 1st Moscow State Medical University, Moscow, Russian Federation.,Ministry of Health of the Russian Federation, Moscow, Russia.,Hospice Care Professionals Association of the Russian Federation, Moscow, Russia
| | - Quynh Xuan Nguyen Truong
- College of Public Health Science, Chulalongkorn University, Bangkok, Thailand.,School of Social Work, Boston College, Newton, MA.,University Medical Center of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Tom Randall
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA.,Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | - Maryam Rassouli
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cristiana Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica.,University of the West Indies, Kingston, Jamaica
| | - Julie S Torode
- Union for International Cancer Control, Geneva, Switzerland
| | | | - Cherian Varghese
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Elena Fidarova
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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4
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Krakauer EL, Kane K, Kwete X, Afshan G, Bazzett-Matabele L, Ruthnie Bien-Aimé DD, Borges LF, Byrne-Martelli S, Connor S, Correa R, Devi CRB, Diop M, Elmore SN, Gafer N, Goodman A, Grover S, Hasenburg A, Irwin K, Kamdar M, Kumar S, Nguyen Truong QX, Randall T, Rassouli M, Sessa C, Spence D, Trimble T, Varghese C, Fidarova E. Augmented Package of Palliative Care for Women With Cervical Cancer: Responding to Refractory Suffering. JCO Glob Oncol 2021; 7:886-895. [PMID: 34115537 PMCID: PMC8457849 DOI: 10.1200/go.21.00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/18/2021] [Accepted: 05/12/2021] [Indexed: 01/24/2023] Open
Abstract
The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an augmented package of palliative care for cervical cancer with which even suffering refractory to the EPPCCC often can be relieved. The package consists of medicines, radiotherapy, surgical procedures, and psycho-oncologic therapies that require advanced or specialized training. Each item in this package should be made accessible whenever the necessary resources and expertise are available.
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Affiliation(s)
- Eric L. Krakauer
- Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital, Boston, MA
- Departments of Medicine and of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Department of Palliative Care, University of Medicine & Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Khadidjatou Kane
- Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | | | - Gauhar Afshan
- Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT
| | - Danta Dona Ruthnie Bien-Aimé
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Université Episcopale d'Haiti, Port-au-Prince, Haiti
- Faculté des Sciences Infirmières de Leogane, Léogâne, Haiti
| | - Lawrence F. Borges
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Sarah Byrne-Martelli
- Division of Palliative Care & Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Raimundo Correa
- Gynecologic Oncology Unit & Palliative Care Service, Clínica Las Condes, Santiago, Chile
| | | | - Mamadou Diop
- Cancer Institute of Cheikh Anta Diop University, Dakar, Senegal
| | - Shekinah N. Elmore
- Department of Radiation Oncology University of North Carolina School of Medicine, Chapel Hill, NC
| | - Nahla Gafer
- Radiation and Isotope Centre, Khartoum Oncology Hospital, Khartoum, Sudan
- Comboni College of Science and Technology, Khartoum, Sudan
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | - Surbhi Grover
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, Johannes Gutenberg University Medical Center, Maine, Germany
| | - Kelly Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Mihir Kamdar
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Palliative Care and Geriatric Medicine, Department of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Suresh Kumar
- Institute of Palliative Medicine, Medical College, Kerala, India
| | - Quynh Xuan Nguyen Truong
- College of Public Health Science, Chulalongkorn University, Bangkok, Thailand
- School of Social Work, Boston College, Newton, MA
- University Medical Center of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tom Randall
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA
| | - Maryam Rassouli
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cristiana Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica
- University of the West Indies, Kingston, Jamaica
| | | | - Cherian Varghese
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Elena Fidarova
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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5
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Hacker KE, Reynolds RK, Uppal S. Ongoing strategies and updates on pain management in gynecologic oncology patients. Gynecol Oncol 2018; 149:410-419. [DOI: 10.1016/j.ygyno.2018.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 12/23/2022]
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Klügel S, Lücke C, Meta A, Schild-Suhren M, Malik E, Philipsen A, Müller HH. Concomitant psychiatric symptoms and impaired quality of life in women with cervical cancer: a critical review. Int J Womens Health 2017; 9:795-805. [PMID: 29133983 PMCID: PMC5669786 DOI: 10.2147/ijwh.s143368] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Our aim was to summarize the current relevant literature on concomitant psychiatric symptoms with a focus on anxiety/depression in a population with gynecologic cancer; to identify the predictors, associated factors, and prevention strategies of psychiatric disorders; to examine psychiatric disorders in a population with recurrent gynecologic cancer; and to describe the limitations of the literature and future research areas. Little is known about attending psychiatric disorders in patients with gynecologic and other malignant diseases like cervical or breast cancer. However, patients suffering from other types of gynecologic cancer (eg, genital/cervical cancer) may also have an increased risk of psychiatric symptoms. In this review, we identify the potential information deficits in this field. A two-rater independent literature search was conducted using the PubMed/Google Scholar search engines to systematically evaluate the literature on the research objectives, followed by a critical reflection on the results. Of the 77 screened studies, 15 met the criteria for inclusion in this review. Patients with gynecologic malignancies, especially cervical cancer, had a very high prevalence of psychiatric symptoms including depression (33%-52%). Additionally, the risk groups facing higher rates of concomitant reduced quality of life and increased psychiatric symptoms such as depression were identified. Specifically, low socioeconomic status, sexual inactivity, absence of a partner, and physical symptoms were correlated with an increased risk. Patients suffering from recurrent gynecologic cancer should receive particular attention because of their significantly increased risk of depressive symptoms. Screening programs are needed to detect psychiatric symptoms in cervical cancer patients and the associated high-risk groups. Regular screening should be implemented, and psychosocial care should be provided during follow-up.
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Affiliation(s)
- Stephanie Klügel
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn
| | - Aurora Meta
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn
| | - Meike Schild-Suhren
- Department of Gynecology and Obstetrics, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Eduard Malik
- Department of Gynecology and Obstetrics, Carl von Ossietzky University Oldenburg, Oldenburg
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn
| | - Helge Ho Müller
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky University Oldenburg, Bad Zwischenahn.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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7
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Bardhoshi G, Duncan K, Erford BT. Psychometric Meta-Analysis of the English Version of the Beck Anxiety Inventory. JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12090] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gerta Bardhoshi
- Division of Counseling and Psychology; University of South Dakota
- Now at Department of Rehabilitation and Counselor Education; University of Iowa
| | - Kelly Duncan
- Division of Counseling and Psychology; University of South Dakota
- Now at School of Education; Northern State University
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8
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Stafford L, Judd F, Gibson P, Komiti A, Mann GB, Quinn M. Anxiety and depression symptoms in the 2 years following diagnosis of breast or gynaecologic cancer: prevalence, course and determinants of outcome. Support Care Cancer 2015; 23:2215-24. [PMID: 25559036 DOI: 10.1007/s00520-014-2571-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 12/15/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE The purposes of this study are to examine the course and prevalence of anxiety and depression over 24 months in women with newly diagnosed breast and gynaecologic cancer and, controlling for demographic and clinical confounders, to test the role of neuroticism and psychiatric history in determining outcome 6, 12, 18 and 24 months post-diagnosis. METHODS Participants completed the Hospital Anxiety and Depression Scale-anxiety subscale and Centre for Epidemiological Studies Depression Scale on an 8-weekly basis from diagnosis until 96 weeks. Changes over time were analyzed with repeated measures ANOVA. Hierarchical linear regression, adjusted a priori for age, chemotherapy and radiation treatment, living alone, education and tumour stream were used to predict anxiety and depression. RESULTS Participants were 105 women (66 breast, 39 gynaecologic). Rates of anxiety (18.1 %) and depression (33.3 %) were highest at diagnosis. Average rates of anxiety and depression were 5.9 and 22.4 %, respectively. Average scores of anxiety and depression were highest at diagnosis, with improvement at 8 and 40 weeks, respectively, subsequently maintained. Morbidity at diagnosis was particularly acute among women with a treatment history of anxiety/depression or with high neuroticism. These three variables were the best and only predictors over 24 months. CONCLUSIONS Women are most vulnerable to anxiety and depression at diagnosis, with improvement over time. Morbidity rates are lower than reported elsewhere. Women with high neuroticism and a psychiatric history are at greatest risk for future morbidity after adjusting for confounders. Early identification of these women plus heightened surveillance or early referral to psychosocial services may protect against longer-term morbidity.
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Affiliation(s)
- Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Locked Bag 300, Parkville, Victoria, 3052, Australia,
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9
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Pineda MJ, Singh DK. What is integrative oncology and can it help my patients? Obstet Gynecol Clin North Am 2012; 39:285-312. [PMID: 22640716 DOI: 10.1016/j.ogc.2012.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Integrative oncology lends itself to the comprehensive practice of gynecologic oncology with multiple tools and interventions that can impact on QoL and survival. However, there remains a paucity of well-designed, well-powered randomized control trials on various CAM modalities for gynecologic cancer patients. The reasons for the lack of level 1 evidence include the nascent state of integrative medicine as a science, the limitations on CAM funding, the relative lack of integration of CAM practitioners into the oncology community, and absence of strict regulation of herbs and supplements by the US FDA. The use of CAM as adjunctive therapies will likely continue given the patient-driven trends to date, and given the evidence for at least safety and potentially efficacy, our patients deserve our willingness to use all possible approaches to improving their outcomes. Continued evolution of our ability to specifically measure and describe QoL will further our ability to hone in on domains most important to patients and their survival and allow practitioners to make patient-specific recommendations. Multimodal programs that include physical activity, stress management, and diet have the potential to address demonstrated deficits in PWB and FWB in ovarian cancer patients which suggests a model of collaborative gynecologic oncology care). Integrative oncology represents a holistic approach to patient care whose goal is maximization of patient quantity and quality of life. Patients can achieve this optimal outcome through the synergy of conventional care, integrative modalities, lifestyle modifications, and supportive care. Refer to Table 4 for a listing of integrated medicine Internet resources.
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Affiliation(s)
- Mario Javier Pineda
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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10
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Nazik E, Arslan S, Nazik H, Narin MA, Karlangic H, Koc Z. Anxiety and symptom assessment in Turkish gynecologic cancer patients receiving chemotherapy. Asian Pac J Cancer Prev 2012; 13:3129-33. [PMID: 22994722 DOI: 10.7314/apjcp.2012.13.7.3129] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Diagnosis and treatment procedures in cancers and resulting anxiety negatively affect the individual and the family. Particularly treatment methods may generate psychological symptoms. The aim of this study was to determine the level of such symptoms in Turkish gynecologic cancer patients receiving chemotherapy. A total of 41 patients who were referred to our gynecologic oncology research clinic between January-March 2012, receiving 3 months or more chemotherapy and who agreed to participate were enrolled in study. All the data were collected using a personal information form, Edmonton Symptom Assesment System and State-Trait Anxiety Inventory. Patients received highest point average from fatigue symptom (6.53±2.67) and lowest point average from dyspnea (1.53±3.03) according to Edmonton Symptom Assesment System. The mean State Anxiety score of patients was 43.1±9.77 and mean Trait Anxiety score was 46.7±7.01. Comparing symptoms of patients and mean State Anxiety score it was found that there was a statistically significant corelation with symptoms like pain (p<0.05), sadness (p<0.001), insomnia (p<0.05), state of well being (p<0.001) and dyspnea (p<0.05). Similarly comparing symptoms of patients and mean Trait Anxiety score demonstrated significant correlations for fatigue (p<0.05), sadness (p<0.01), insomnia (p<0.01) and state of well-being (p<0.01). As a result, patients with gynecological cancers experienced symptoms related to chemotherapy and a moderate level of anxiety. In accordance, appropriate interventions should recommended for the evaluation and improvement of anxiety and symptoms related to treatment in cancer patients.
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Affiliation(s)
- Evşen Nazik
- Department of Nursing, Adana Health School, Çukurova University, Adana, Turkey.
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11
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Jefferies H, Clifford C. All change: the lived experience of younger women with cancer of the vulva. J Clin Nurs 2012; 21:2327-35. [DOI: 10.1111/j.1365-2702.2011.04043.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Posluszny DM, Baum A, Edwards RP, Dew MA. Posttraumatic growth in women one year after diagnosis for gynecologic cancer or benign conditions. J Psychosoc Oncol 2012; 29:561-72. [PMID: 21882935 DOI: 10.1080/07347332.2011.599360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The authors sought to examine levels and predictors of posttraumatic growth over one year after surgery in women diagnosed with gynecologic cancer or benign conditions necessitating surgical intervention. Women with advanced-stage cancer (n = 16), early-stage cancer (n = 18), benign gynecologic disease (n = 21), and no disease (n = 14; postannual pelvic exam) completed questionnaires (Perceived Threat, PTSD Checklist [PCL]) 1 week prior to surgery and completed the Posttraumatic Growth Inventory (PTGI) 16 months postsurgery. The four groups' scores varied significantly on the PTGI. The three disease groups reported higher levels of posttraumatic growth than the no disease group. Higher PCL score presurgery and greater disease severity were positively related to posttraumatic growth, and higher income level was negatively related to posttraumatic growth. Women with gynecologic cancer, regardless of stage, and women with benign gynecologic conditions experience posttraumatic growth.
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Affiliation(s)
- Donna M Posluszny
- Department of Medicine, University of Pittsburgh School of Medicine and University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
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13
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Floyd A, Dedert E, Ghate S, Salmon P, Weissbecker I, Studts JL, Stetson B, Sephton SE. Depression may mediate the relationship between sense of coherence and quality of life in lung cancer patients. J Health Psychol 2010; 16:249-57. [PMID: 20929943 DOI: 10.1177/1359105310371856] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lung cancer patients generally experience high levels of physical and psychological distress and decreased quality of life (QOL). Sense of coherence (SOC) has been conceptualized as a personality orientation reflecting the degree to which an individual perceives their world as comprehensible, manageable and meaningful. The present study investigated the associations of SOC with QOL in lung cancer. It also examined potential psychological mediators by which SOC may exert its influences on QOL. Fifty-six participants with non-small cell lung cancer were administered self-report assessments of SOC, QOL and psychological distress. Results revealed that SOC was positively associated with QOL and this relationship may be mediated by depressive symptoms. The current study supports the notion that SOC may be a protective factor with regard to psychological adjustment and QOL in cancer survivors.
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14
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Mendonsa RD, Appaya P. Psychiatric morbidity in outpatients of gynecological oncology clinic in a tertiary care hospital. Indian J Psychiatry 2010; 52:327-32. [PMID: 21267366 PMCID: PMC3025158 DOI: 10.4103/0019-5545.74307] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Psychiatric morbidity in gynecological oncology patients is relatively less studied. AIMS This cross-sectional observational study was undertaken to assess the common psychiatric disorders in women who consult the gynecological oncology outpatients' department. MATERIALS AND METHODS We assessed a total of 101 outpatients who were recruited by convenience method of sampling. The main outcome measures were PRIME-MD PHQ diagnoses, gynecological and sociodemographic profiles. RESULTS Psychiatric disorders as detected by PRIME -MD PHQ were diagnosed in 44% of the patients. Mood disorders were most common. Major depression was present in 25.7% of patients. Anxiety disorders were diagnosed in 16.8% of the patients. Among 44 patients with a psychiatric diagnosis only one patient was on psychiatric treatment. Major depression was much more common (34.4%) in cancer patients than in women with benign conditions (16.6%). CONCLUSION The findings of our study reveal a high rate of psychiatric morbidity in the gynecological oncology outpatients.
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Posluszny DM, Edwards RP, Dew MA, Baum A. Perceived threat and PTSD symptoms in women undergoing surgery for gynecologic cancer or benign conditions. Psychooncology 2010; 20:783-7. [PMID: 20878863 DOI: 10.1002/pon.1771] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 04/05/2010] [Accepted: 04/08/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We sought to examine levels of perceived threat and traumatic stress symptoms both before and in the short- and long-term period after surgery and associated care in women diagnosed with gynecologic cancer or benign conditions. METHODS Women with advanced-stage cancer (n=22), early-stage cancer (n=31), benign gynecologic disease (n=33), and no disease (n=25; post-annual pelvic examination) completed questionnaires (Perceived Threat, Impact of Event Scale (IES), and Post-Traumatic Stress Disorder (PTSD Checklist (PCL)) on three occasions: 1 week before surgery (Time 1), 7 weeks after surgery or comparable time (Time 2), and 16 months after surgery (Time 3). RESULTS Perceived threat did not differ across disease groups at Time 1, but there were differences at both later times (F(2, 93.1)=11.83; p<0.001; group × time interaction); women with advanced cancer reported the highest levels. IES scores were consistently higher for the disease groups compared with the no-disease group (F(3,104.2)=11.19; p<0.001), but were not significantly different from one another. IES scores declined over time, most markedly for the three disease groups (group × time interaction (F(6,163.8)=2.60; p=0.02). Survival analysis indicated significant differences across the groups in risk of estimated PTSD [Wilcoxon χ(2) (3, N=96)=7.83, p=0.050] with 34% of advanced cancer, 16% of early cancer, and 15% of benign disease groups reaching estimated PTSD criteria. CONCLUSIONS Women with gynecologic cancer, regardless of stage, and women with benign conditions experience heightened traumatic stress at the time of diagnosis, and some continue to be distressed many months afterwards. Broad-based screening and intervention for traumatic stress symptoms may be warranted.
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Affiliation(s)
- Donna M Posluszny
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA.
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16
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Incorporating pelvic/vaginal reconstruction into radical pelvic surgery. Gynecol Oncol 2009; 115:154-163. [DOI: 10.1016/j.ygyno.2009.05.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 05/26/2009] [Accepted: 05/28/2009] [Indexed: 11/20/2022]
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McCorkle R, Dowd M, Ercolano E, Schulman-Green D, Williams AL, Siefert ML, Steiner J, Schwartz P. Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers. Psychooncology 2009; 18:62-70. [PMID: 18570223 PMCID: PMC4186244 DOI: 10.1002/pon.1365] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Women with gynecological cancers have reported poor health-related quality of life (QOL), with complex physical and psychological needs post-surgery and during chemotherapy treatment. There are no studies reporting interventions addressing these needs post-hospital discharge in this population. METHODS Patients were randomized into two groups. The intervention group received 6 months of specialized care by an Advanced Practice Nurse (APN); in addition, women with high distress were evaluated and monitored by a psychiatric consultation-liaison nurse (PCLN). The attention control group was assisted with symptom management by a research assistant. The effects of the 6-month intervention were evaluated using self-report questionnaires at baseline (24-48 h after surgery), 1, 3, and 6 months post- surgery. QOL assessments included the Center for Epidemiological Studies-Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale, and the Short-Form Health Survey (SF-12). The sample for the longitudinal analysis included 123 who completed QOL outcome measures across three occasions post-surgery. RESULTS The APN intervention resulted in significantly less uncertainty than the attention control intervention 6 months after surgery. When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group, the sub-group had significantly less uncertainty, less symptom distress, and better SF-12 mental and physical QOL over time. CONCLUSION Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect.
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Affiliation(s)
- Ruth McCorkle
- Yale School of Nursing, Center for Excellence in Chronic Illness Care, New Haven, Connecticut 06536-0740, USA.
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Schulman-Green D, Ercolano E, Dowd M, Schwartz P, McCorkle R. Quality of life among women after surgery for ovarian cancer. Palliat Support Care 2008; 6:239-47. [PMID: 18662417 PMCID: PMC3648854 DOI: 10.1017/s1478951508000497] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Difficulties with diagnosis and aggressive, long-term treatment may result in lower quality of life (QOL), including high levels of anxiety, depression, and uncertainty, greater symptom distress, and lower overall QOL among women with ovarian cancer. The purpose of this study was to describe demographic, clinical, and other risk factors associated with compromised QOL among women who have undergone surgery for ovarian malignancies. METHODS Subjects were recruited to participate in a clinical trial that tested a specialized nursing intervention addressing psychological and physical care among women post-surgical for ovarian cancer. QOL was measured using five standardized self-report measures: the State-Trait Anxiety Scale (SAS), the Center for Epidemiological Studies Depression Scale (CES-D), the Mishel Uncertainty in Illness Scale (MUIS), the Symptom Distress Scale (SDS), and the Short-Form Health Survey (SF-12). Baseline data were collected while women were hospitalized following surgery. RESULTS The sample (n=145) included women with ovarian cancer (58%) and other cancers metastasized to the ovaries and abdomen (42%). Mean scores on the measures were consistent with or higher than previously reported means for similar populations. Women reporting the lowest QOL were more likely to be younger, more educated, and have early stage disease. SIGNIFICANCE OF RESULTS Women who have undergone surgery for ovarian malignancies have psychological needs that are often considered secondary to physical needs. Interventions should include routine screening for distress and referral to appropriate psychological and social services, thereby facilitating quality cancer care.
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Chase DM, Monk BJ, Wenzel LB, Tewari KS. Supportive care for women with gynecologic cancers. Expert Rev Anticancer Ther 2008; 8:227-41. [PMID: 18279064 DOI: 10.1586/14737140.8.2.227] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supportive care is a multidimensional field, that involves caring for a patient's symptoms either during and/or after treatment. Ideally, once these supportive care needs are met, patients can enjoy an improved quality of life. Supportive care needs include all body systems, and are, therefore, difficult to manage, secondary to the fact that they require collaboration among multiple medical specialties. In this review, several components of supportive care are separated into two categories: tumor-related morbidities and treatment-related morbidities. Some of the themes discussed include nausea and vomiting, cancer pain, psychological distress, fatigue and anemia, small bowel obstruction and peripheral neuropathy. While all of these components are challenging to manage, it is perhaps the psychosocial realm that remains the most unmet need. Regardless, the oncologist must act as a facilitator who addresses these needs and, if unable to address the issue alone, knows how to steer the patient toward the appropriate provider. As these needs are met, the goal is for quality of life to improve; and with the improvement in quality of life we may expect to see improved survival outcomes.
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Affiliation(s)
- Dana M Chase
- University of California, Irvine Medical Center, The Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, The Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA.
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Abstract
Around one third of all patients reveal signs of stress disorder and adaptation difficulties following breast cancer or during the course of the illness, often manifested clinically as fear and depression. Supportive treatment should be made available to all patients in the form of psycho-educative group sessions introducing information and assistance to help overcome the illness. The indication for extensive treatment, e.g. psychotherapy, can be deduced from the somatopsychic disorders presented. Individual or group therapy will be offered to the patient corresponding to her diagnostics and motivation. The aim of therapy should be discussed openly with the patient, that is, an improvement in the quality of life and the possibility to overcome the situation. In general, the various intervention programmes have proved to be beneficial for patients with cancer. These include relaxation therapy and stress management as well as behavioural therapy and supportive psychotherapy. Patients have high expectations of the therapy offered and this should be taken into careful consideration by all physicians, psychologists and others responsible for administering treatment. The aim of this work is mainly to present the clinical experience gained in a breast centre.
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Affiliation(s)
- Mechthild Neises
- Psychosomatische Frauenheilkunde, Medizinische Hochschule Hannover, Germany
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Lue BH, Huang TS, Chen HJ. Physical distress, emotional status, and quality of life in patients with nasopharyngeal cancer complicated by post-radiotherapy endocrinopathy. Int J Radiat Oncol Biol Phys 2007; 70:28-34. [PMID: 17765405 DOI: 10.1016/j.ijrobp.2007.06.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 06/07/2007] [Accepted: 06/07/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore factors affecting quality of life (QOL) among patients with nasopharyngeal cancer (NPC) complicated by post-radiotherapy endocrinopathy. METHODS AND MATERIALS This cross-sectional study was conducted in a tertiary medical center and involved a total of 43 post-radiotherapy, recurrence-free NPC patients with endocrinopathy. They performed self-assessment of their emotional status using the Beck Anxiety Inventory and Beck Depression Inventory-II, and their QoL with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire and the H&N35 cancer module. RESULTS Emotional and cognitive functioning of EORTC QLQ-C30 were the most affected. Fatigue, insomnia, and pain were the main concerns. Of the patients, 22 (51.2%) had anxiety and 19 (44.2%) had depression. Both depression and anxiety were negatively correlated with functional scales and global QoL but positively correlated with symptom scales. Multiple linear regression analysis revealed that physical distress symptoms of QLQ-C30 and physical functioning were the significant predictors of global QoL. Emotional and social functioning could predict depression, whereas emotional and physical functioning were significant predictors of anxiety. CONCLUSIONS NPC patients with post-radiotherapy endocrinopathy exhibit impaired cognitive function and negative emotions. Symptoms of physical distress play an important role in QoL perception. Measurement of EORTC QLQ-C30 can be a useful instrument for the early detection of patients' impaired cognitive function and psychological morbidity. The high psychological distress related to the endocrine disturbances or the impact of NPC itself needs further study.
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Affiliation(s)
- Bee-Horng Lue
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Steel JL, Geller DA, Gamblin TC, Olek MC, Carr BI. Depression, Immunity, and Survival in Patients With Hepatobiliary Carcinoma. J Clin Oncol 2007; 25:2397-405. [PMID: 17557953 DOI: 10.1200/jco.2006.06.4592] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PurposeThe aims of the present study were to assess the prevalence of depressive symptoms at diagnosis, test the association between depressive symptoms and survival, and preliminarily test a mediational model of depression, immunity, and survival in patients with hepatobiliary carcinoma (HBC).Patients and MethodsOne hundred one patients diagnosed with HBC were prospectively studied. Depressive symptoms were measured at diagnosis using the Center for Epidemiological Studies Depression Scale (CES-D). Sociodemographic and disease-specific data were gathered from the patients' charts. In a subsample of patients, stress; alcohol, tobacco, and drug use; sleep quality; physical activity; social support; natural killer (NK) cell number and cytotoxicity; and plasma levels of interleukin (IL) -4, IL-5, tumor necrosis factor alpha, and interferon gamma were measured. Survival was measured from date of diagnosis to death.ResultsAt diagnosis, 37% of patients reported a CES-D score of ≥ 16 (clinical range). Using Cox regression analysis, sociodemographic and disease-specific variables and CES-D score significantly predicted survival (Breslow χ2= 32.4, P = .006). Only vascular invasion (P = .001) and CES-D score ≥ 16 (P = .03) were significant predictors. In a subsample of 23 patients, patients who reported a CES-D score of ≥ 16 were found to have significantly lower NK cell numbers than patients who reported a CES-D score of less than 16 (F1,21= 9.39, P = .003). A robust trend was found in which NK cell number was associated with survival. A mediational model linking depressive symptoms and survival, with NK cell number as a mediator, was preliminarily supported.ConclusionSecondary to the high prevalence of depressive symptoms and impact on survival, psychological and pharmacologic interventions should be designed and implemented in patients diagnosed with HBC.
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Affiliation(s)
- Jennifer L Steel
- University of Pittsburgh School of Medicine, Liver Cancer Center, Department of Surgery, Starzl Transplantation Institute, Pittsburgh, PA 15213, USA.
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