Trajectories of Depressed Mood and Anxiety During Chemotherapy for Breast Cancer

Higher Levels of Multiple Types of Stress Are Associated With Worse State Anxiety and Morning Fatigue Profiles in Patients Receiving Chemotherapy

BACKGROUND

Anxiety and fatigue are common problems in patients receiving chemotherapy. Unrelieved stress is a potential cause for the co-occurrence of these symptoms.

OBJECTIVES

The aims of this study were to identify subgroups of patients with distinct state anxiety and morning fatigue profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as measures of global, cancer-specific, and cumulative life stress and resilience and coping.

METHODS

Patients (n = 1335) completed measures of state anxiety and morning fatigue 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was used to identify the state anxiety and morning fatigue profiles.

RESULTS

Three distinct joint profiles were identified: Low Anxiety and Low Morning Fatigue (59%), Moderate Anxiety and Moderate Morning Fatigue (33.4%), and High Anxiety and High Morning Fatigue (7.6%). Patients in the 2 highest classes were younger, were less likely to be married/partnered, and had a higher comorbidity burden. All of the stress scores demonstrated a dose-response effect (ie, as anxiety and morning fatigue profiles worsened, stress increased). Patients in the 2 highest classes reported higher rates of emotional abuse, physical neglect, physical abuse, and sexual harassment.

CONCLUSIONS

More than 40% of these patients experienced moderate to high levels of both anxiety and morning fatigue. Higher levels of all 3 types of stress were associated with the 2 highest profiles.

IMPLICATIONS FOR PRACTICE

Clinicians need to perform comprehensive evaluations of patients' levels of stress and recommend referrals to psychosocial services.

Effects of Yoga on Cancer-Related Fatigue, Psychological Distress, and Quality of Life Among Patients With Cancer Undergoing Chemotherapy and/or Radiotherapy: A Systematic Review and Meta-analysis

BACKGROUND

Yoga can be considered supportive therapy for patients with cancer to alleviate cancer-related symptoms. However, there has been no meta-analysis examining yoga's effects among patients with cancer undergoing chemotherapy and/or radiotherapy.

OBJECTIVE

To synthesize the evidence regarding the effects of yoga on improving cancer-related fatigue, psychological distress, and quality of life among patients with cancer undergoing chemotherapy and/or radiotherapy.

METHODS

Ten English databases and 2 Chinese databases were searched from inception to December 2022. Two independent reviewers screened studies and extracted the data. Randomized controlled trials examining the effects of yoga on cancer-related fatigue, psychological distress, and quality of life were included. Meta-analysis was conducted, and narrative synthesis was performed when meta-analysis was not applicable.

RESULTS

Fourteen studies from 16 articles were included. The results showed that yoga reduced cancer-related fatigue (standardized mean difference [SMD], -0.75; 95% confidence interval [CI], -1.12 to -0.38; P < .001), anxiety (SMD, -0.91; 95% CI, -1.68 to -0.14; P = .02), but not depression (SMD, -0.82; 95% CI, -1.67 to 0.04; P = .06). The effects of yoga on distress and quality of life were inconclusive.

CONCLUSIONS

Yoga significantly helped reduce cancer-related fatigue and anxiety but did not reduce depression among patients with cancer undergoing chemotherapy and/or radiotherapy. Further rigorous studies are needed to identify the optimal characteristics of yoga for these patients.

IMPLICATIONS FOR PRACTICE

It is possible to recommend yoga to patients with cancer undergoing chemotherapy and/or radiotherapy for managing cancer-related fatigue and anxiety after duly considering patients' physical conditions and ensuring appropriate instructions are given.

Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life

BACKGROUND

Anxiety and sleep disturbance are frequent symptoms during chemotherapy.

OBJECTIVES

Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups.

METHODS

Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles.

RESULTS

Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life.

CONCLUSIONS

More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms.

IMPLICATIONS FOR PRACTICE

Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.

The Effect of Using Virtual Reality Glasses on Anxiety and Fatigue in Women with Breast Cancer Receiving Adjuvant Chemotherapy: A Pretest-Posttest Randomized Controlled Study

OBJECTIVE

To determine the effect of using virtual reality glasses on anxiety and fatigue in women with breast cancer receiving adjuvant chemotherapy.

DATA SOURCES

A total of 66 women with breast cancer receiving adjuvant chemotherapy. The intervention group watched and listened to beach and nature content with virtual reality glasses for 30 minutes. The control group also received standard care. An Introductory Information Form, the State Anxiety Scale, and the Cancer Fatigue Scale were used for data collection. The scales were administered to the groups before the intervention, followed by practice or standard care, and then the scales were re-administered. All patients were evaluated for each cycle over four cycles.

CONCLUSION

In the intervention group, the mean post-application anxiety scores decreased compared with the mean pretest scores, and the mean posttest anxiety scores decreased from the first cycle to the last cycle. In addition, the mean post-test anxiety scores of the intervention group were found to be lower in all four cycles than the mean post-test anxiety scores of the control group. In the intervention group, the mean post-test fatigue and subscales scores decreased in all cycles compared with the mean pre-test scores.

IMPLICATIONS FOR NURSING PRACTICE

This research has shown that the use of virtual reality glasses is effective in reducing anxiety and fatigue scale scores and their subscales in patients with breast cancer. For this reason, it is recommended to introduce the use of virtual reality glasses to patients and to present their use according to patients' preferences.

Psychoneurological symptom cluster trajectories in individuals treated for early-stage breast cancer

BACKGROUND/PURPOSE

The psychoneurological (PN) symptom cluster has been defined in the literature as anxiety, depression, fatigue, sleep disturbance, and pain. PN symptoms are influenced by cancer and its treatment as well as biological and psychosocial factors. The purpose of this analysis was to describe temporal patterns of the PN symptom cluster severity in breast cancer survivors over the year following initial surgical intervention and investigate the time-dependent effect of treatment modality on symptom severity.

METHODS

In a prospective longitudinal study, symptom data were collected from individuals with early-stage breast cancer 48 h after initial surgery and at monthly intervals for the subsequent 12 months using the PROMIS®-29 subscales for anxiety, depression, fatigue, sleep disturbance, and pain. Applying group-based trajectory modeling, we classified participants into subgroups with similar temporal patterns of PN symptom cluster severity and included treatment modality as a time-dependent covariate.

RESULTS

Across 353 participants (mean age 60.10 ± 11.9 years, 88.95% white, 66.57% undergoing segmental mastectomies), four distinct trajectory subgroups (mild [47.6%; n = 168], moderate [28.3%; n = 100], severe [15.9%; n = 56], and most severe increasing [8.2%; n = 29]) were revealed for PN symptom cluster severity. Chemotherapy was associated with greater severity in all symptom severity subgroups, while radiation was associated with greater symptom severity in the mild and most severe increasing subgroups.

CONCLUSIONS AND IMPLICATIONS

A subgroup of individuals with early-stage breast cancer experienced persistent severe PN symptoms. Future research should focus on psychosocial, biological, and disease-related characteristics of individuals in the most severe symptom group to inform preventative treatments and effective interventions.

Mental health care use and related factors in adolescents and young adults with cancer

PURPOSE

The actual state of mental health care use and related factors in adolescent and young adult (AYA) patients with cancer is not well understood in Japan. This study aimed to (1) examine the actual state of mental health care use among AYA patients with cancer and (2) describe socio-demographic and related factors associated with mental health care use.

METHODS

We retrospectively reviewed the medical records of AYA patients with cancer aged 15-39 who first visited the National Cancer Center Hospital in Japan (NCCH) between January 2018 and December 2020. Logistic regression was used to analyze the association between social background characteristics and mental health care use. The association between the patient's course of cancer treatment and mental health care use was analyzed to help identify which patients might benefit from early mental health intervention.

RESULTS

Among 1,556 patients, 945 AYA patients with cancer were registered. The median age at the time of the study was 33 years (range, 15-39 years). The prevalence of mental health care use was 18.0% (170/945). Age 15-19 years, female gender, urogenital cancer, gynecological cancer, bone or soft tissue cancer, head and neck cancer, and stage II-IV disease were associated with mental health care use. Regarding treatment, palliative treatment, chemotherapy, and hematopoietic stem cell transplantation were associated with mental health care use.

CONCLUSION

Factors associated with mental health care use were identified. Our findings potentially contribute to psychological support interventions for AYA patients with cancer.

Higher stress and symptom severity are associated with worse depressive symptom profiles in patients receiving chemotherapy

PURPOSE

In a sample of oncology patients, identify subgroups of patients with distinct depressive symptom profiles and evaluate for differences in demographic and clinical characteristics, levels of stress and resilience, and the severity of common co-occurring symptoms.

METHODS

Patients (n = 1327) had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Demographic and clinical characteristics, stress, resilience, and co-occurring symptoms were evaluated at enrollment. Depressive symptoms were evaluated using the Center for Epidemiological Studies-Depression (CES-D) scale a total of six times over two cycles of chemotherapy. Latent profile analysis (LPA) was used to identify subgroups of patients (i.e., latent classes) with distinct depressive symptom profiles using the six CES-D scores.

RESULTS

Based on the findings from the LPA, 47.3% of the patients were classified as "None"; 33.6% as "Subsyndromal"; 13.8% as "Moderate"; and 5.3% as "High". Compared to None class, patients in the Subsyndromal, Moderate, and High classes had a lower functional status, a higher comorbidity burden, and a self-reported diagnosis of depression or back pain. Those patients with higher levels of depressive symptoms reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms.

CONCLUSIONS

Inter-individual variability in depressive symptoms was associated with demographic and clinical characteristics, multiple types of stress and levels of resilience, as well as with the increased severity of multiple co-occurring symptoms. The risk factors associated with worse depressive symptom profiles can assist clinicians to identify high risk patients and initiate more timely supportive care interventions.

Factors Related to Anxiety, Depressive Symptoms and Quality of Life in Breast Cancer

Breast cancer (BC) is a major public health problem internationally. Although illness survival rates have improved, patients usually suffer multiple symptoms, both physical and psychological, which can affect their quality of life (QoL). The main aim of this study was to evaluate depressive symptoms, anxiety and the QoL of people with BC. An observational, cross-sectional study was carried out at Badajoz University Hospital (Spain). A total of 200 women with BC were included. EORTC QLQ-C30 and QLQ-BR23 questionnaires were used to assess QoL. Patients were screened for depressive symptoms using the Beck Depression Inventory (BDI) and for state anxiety and trait anxiety using the State Anxiety Inventory (STAI). Thirty-eight percent of the patients in the sample had moderate to severe anxiety, which was related to the time of diagnosis, advanced stage of illness and surgical treatment. We found that 28% of patients had depressive symptoms, related mainly with time of diagnosis, adjuvant therapy and number of cycles of chemotherapy (CT). Patients with the longest time since diagnosis, in stage III, and in treatment with CT, especially those with the greatest number of cycles, had the worst scores in QoL. We found a positive association between depressive symptoms and anxiety with QoL in patients with BC.

Clemastine Rescues Chemotherapy-Induced Cognitive Impairment by Improving White Matter Integrity

With the improvement of cancer treatment techniques, increasing attention has been given to chemotherapy-induced cognitive impairment through white matter injury. Clemastine fumarate has been shown to enhance white matter integrity in cuprizone- or hypoxia-induced demyelination mouse models. However, whether clemastine can be beneficial for reversing chemotherapy-induced cognitive impairment remains unexplored. In this study, the mice received oral administration of clemastine after chemotherapy. The open-field test and Morris water maze test were used to evaluate their anxiety, locomotor activity and cognitive function. Luxol Fast Blue staining and transmission electron microscopy were used to detect the morphological damage to the myelin. Demyelination and damage to the mature oligodendrocytes and axons were observed by immunofluorescence and western blotting. Clemastine significantly improved their cognitive function and ameliorated white matter injury in the chemotherapy-treated mice. Clemastine enhanced myelination, promoted oligodendrocyte precursor cell differentiation and increased the neurofilament 200 protein levels in the corpus callosum and hippocampus. We concluded that clemastine rescues cognitive function damage caused by chemotherapy through improving white matter integrity. Remyelination, oligodendrocyte differentiation and the increase of neurofilament protein promoted by clemastine are potential strategies for reversing the cognitive dysfunction caused by chemotherapy.

Anxiety profiles are associated with stress, resilience and symptom severity in outpatients receiving chemotherapy

PURPOSE

The purposes of this study, in a sample of oncology patients (n = 1326) receiving chemotherapy, were to identify subgroups of patients with distinct anxiety profiles and evaluate for differences in demographic and clinical characteristics, stress and resilience measures, and severity of co-occurring symptoms (i.e., depression, sleep disturbance, attentional function, fatigue, pain).

METHODS

Patients completed self-report questionnaires a total of six times over two cycles of chemotherapy. Severity of state anxiety was evaluated using the Spielberger State Anxiety Inventory and resilience was assessed using the Connor-Davidson Resilience Scale. Symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, General Sleep Disturbance Scale, Lee Fatigue Scale, Attentional Function Index and Brief Pain Inventory.

RESULTS

Based on the findings from the latent profile analysis that utilized the six assessments of state anxiety, 47.7% of the patients were classified as "Low," 28.3% as "Moderate," 19.5% as "High," and 4.5.% as "Very High." Anxiety levels remained relatively stable across the six timepoints. Compared to the Low class, membership in the Moderate, High, and Very High classes was associated with a number of characteristics (e.g., younger age, female gender, lower functional status, more comorbidities). Those patients with higher levels of anxiety reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms.

CONCLUSION

Our findings suggest that a substantial number of oncology patients may warrant referral to psychological services. Clinicians need to perform systematic assessments of anxiety, stress, and common symptoms and initiate appropriate interventions to enhance resilience and coping.

Depressive Symptoms and Quality of Life Associated With the Use of Monoclonal Antibodies in Breast Cancer Treatment

OBJECTIVES

To assess the relationship between (a) chemotherapy and monoclonal antibody (mAb) treatments and (b) depressive symptoms and quality of life (QOL) in patients with breast cancer.

SAMPLE & SETTING

182 women with breast cancer in Spain who were undergoing chemotherapy with or without mAbs.

METHODS & VARIABLES

An observational, cross-sectional study was carried out. The European Organisation for Research and Treatment of Cancer (EORTC) QOL Questionnaire-Core 30 and the EORTC QOL Questionnaire-Breast Cancer were used to assess QOL. Patients were screened for depressive symptoms using the Beck Depression Inventory-II.

RESULTS

No relationship was found between the use of mAbs with chemotherapy and QOL, except for incidence of diarrhea. However, depressive symptoms had a negative and highly significant influence on the majority of the QOL parameters.

IMPLICATIONS FOR NURSING

The presence of depressive symptoms negatively affects QOL. Used concurrently, mAbs and chemotherapy do not negatively influence QOL, but some adverse effects, such as diarrhea, are common.

Diagnosis Disclosure Preferences of Cancer Patients in Egypt: A Multi-Institutional Cross-Sectional Study

BACKGROUND

Although diagnosis disclosure to cancer patients has important roles in cancer care, it is not a routine practice in countries like Egypt. Respecting patients' autonomy and responding to their preferences are among the factors that should guide the practice of cancer diagnosis disclosure.

OBJECTIVES

To assess the preferences of Egyptian cancer patients regarding the disclosure of cancer diagnosis and to determine factors that may affect their preferences.

METHODS

The study included 295 patients aware of their cancer diagnosis from 3 cancer care facilities in Egypt. Patients were asked if they would have preferred to be informed of the diagnosis or not, whom they would have preferred to receive the diagnosis information from, and if they would have preferred to tell their families or not.

RESULTS

The vast majority (91%) of the included patients preferred to be informed about their diagnosis, 59% preferred to disclose the diagnosis to their families and 66% preferred to receive the diagnosis information from a physician. In univariate analysis, male gender, higher education level and employment were significantly associated with the preference for disclosure. None of the studied variables associated significantly with the preferences in multivariate analysis.

CONCLUSION

The majority of Egyptian cancer patients in our study preferred to be informed about their diagnosis, which should be respected. The results may help in changing the diagnosis disclosure practice of health care professionals and refuting the misconception of family caregivers about cancer diagnosis disclosure in Egypt and countries with similar culture.

Effects of a Mind Map-Based Life Review Program on Anxiety and Depressive Symptoms on Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial

BACKGROUND

Cancer patients undergoing chemotherapy often experience psychological distress. The mind map-based life review program (MBLRP) offers the potential to reduce patients' negative emotions. However, its effects remain unknown.

OBJECTIVE

The objective of this study is to determine the effects of the MBLRP on anxiety and depressive symptoms in cancer patients undergoing chemotherapy.

METHODS

A randomized controlled trial with repeated measures was adopted. Eighty-four cancer patients undergoing chemotherapy were recruited from a general hospital in Fujian, China. Participants were randomly assigned to an experimental group (n = 40) or a control group (n = 44). The participants in the experimental group received the MBLRP plus routine care. The participants in the control group received routine care. Outcomes were measured at baseline, on the second day, and at 4 weeks after the MBLRP.

RESULTS

In terms of anxiety, multivariate test statistics showed significant differences in within-group (F = 11.343, P < .001), between-group (F = 8.873, P = .004), and interaction effects (group × time) (F = 19.595, P < .001). For the depressive symptoms, the results showed that the within-group effect (F = 12.385, P < .001), group effect (F = 18.000, P < .001), and group × time effect (F = 26.544, P < .001) were statistically significant, favoring the MBLRP experimental group.

CONCLUSIONS

The MBLRP has the potential to reduce anxiety and depressive symptoms in cancer patients undergoing chemotherapy. Further research is needed within larger more representative samples.

IMPLICATIONS FOR PRACTICE

The MBLRP is a nurse-led, nonpharmacological program that could be recommended for cancer patients undergoing chemotherapy and integrated into clinical practice.

Depressive Symptoms, Sleep Profiles and Serum Melatonin Levels in a Sample of Breast Cancer Patients

BACKGROUND

Chronobiological changes have been detected in various physiological functions of patients with breast cancer, suggesting dysregulation in the pineal gland and melatonin secretion. This study aimed to assess and measure serum melatonin levels pre- and postoperatively in patients who had been diagnosed for the first time with breast cancer.

METHODS

A sample of first-time breast cancer patients, consisting of 45 women aged 25-65 years, was evaluated and psychometric assessment was completed using the Beck Depression Inventory (BDI), Insomnia Severity Index (White, Weinberg et al) and the Epworth Sleepiness Scale (Cardoso, Spence et al). The Morningness-Eveningness questionnaire (MEQ) was used to assess the chronotype. Serum melatonin levels were measured by radioimmunoassay.

RESULTS

Morning and moderately morning chronotypes were prevalent among the sample (25%, 45.8%, respectively). The finding of a mean BDI score of 13.5±11.2 indicated that depressive symptoms were prevalent among the sample. Despite the finding that a mean of the participants apparently had no symptoms of daytime sleepiness (the mean and standard deviations of the ESS were 7.5±4.4), scores on the ISI (a mean of 16.7±SD 7.3) indicated that insomnia symptoms were prevalent in the sample. Melatonin levels showed an inverse relationship with insomnia severity as measured by the ISI and depression severity, as assessed by the BDI. The postoperative melatonin levels were higher than the preoperative levels. Additionally, the psychometric profile differed among various pathological types of breast cancer according to their hormone receptor profile.

CONCLUSION

Serum melatonin levels correlated significantly with self-reported sleep quality and psychometric profiles of depression in the present sample of breast cancer patients. The melatonin assay, which is relatively easy to carry out, provided a convenient, objective measure of an important biological correlate of sleep quality and depression. This assay thus represented a confirmatory alternative to the self-report instruments, which may sometimes be unreliable. Future studies should further evaluate the utility of melatonin measures in psychiatric and sleep complaints of breast cancer patients.