Quality of Life and Symptoms of Anxiety and Depression of Patients Receiving Cancer Chemotherapy: Longitudinal Study

Knowledge, practice and communication barriers for oncology doctors in Chile when addressing the sexuality of their patients

Introduction

Communication in a doctor-patient relationship constitutes a crucial aspect in medicine, and its multiple dimensions encompass a wide variety of ethical issues. Communication is particularly relevant in oncology, because it requires continually dealing with sensitive topics in one of the most highly vulnerable situations as a human: illness and proximity to death. Sexuality is one of these topics because it constitutes an area that is frequently affected by cancer and cancer treatment, which may include causing significant distress, the reinforcement of a negative self-image, relationship conflicts and a permanent memory of having cancer. The objective of this research is to describe the perception of knowledge and communications practices used by oncology doctors with respect to sexual health in the care of their patients, as well as the barriers found when it comes to confronting the topic.

Methods

An exploratory quantitative, descriptive and cross-sectional study was carried out, in which a self-administered questionnaire was given to oncology doctors who practise in Chile. This questionnaire had 41 closed questions with answers on a Likert scale and was previously validated by being reviewed and applied to a pilot group of five professionals (one medical bioethics expert and four doctors in the field of oncology). The data were analysed with the SPSS statistical program v. 20, using descriptive statistics.

Results

The main results show that the surveyed doctors consider sexuality to be an important part of patients' quality of life. However, this finding does not align with the practices given for including it as part of clinical care. The professionals refer as the main barriers those that are attributed to the structural functioning of the institution, giving little value to those barriers related to personal aspects or those associated with patient characteristics and/or behaviors.

Conclusion

The results of this study show that, despite oncology doctors seeing sexuality as an important aspect of the quality of life of their patients, they do not include the topic in clinical care. Given that one of the main barriers is obstacles relating to the institution, it is necessary to create political institutions that create the conditions for including this area as a relevant part of cancer patient care.

Anxiety in oncology outpatients is associated with perturbations in pathways identified in anxiety focused network pharmacology research

PURPOSE

Evaluate for perturbed signaling pathways associated with subgroups of patients with low versus high levels of state anxiety. These pathways were compared to the pathways identified across eight network pharmacology studies of the anxiolytic effect(s) of a variety of compounds.

METHODS

Adult outpatients 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. Latent profile analysis was used to identify subgroups of patients with distinct anxiety profiles based on Spielberger State Anxiety Inventory scores that were obtained six times over two cycles of chemotherapy. Blood samples were processed using RNA sequencing (i.e., RNA-seq sample, n = 244) and microarray (i.e., microarray sample; n = 256) technologies. Pathway perturbations were assessed using pathway impact analysis. Fisher's combined probability method was used to combine test results using a false discovery rate of 0.01.

RESULTS

In the RNA-seq sample, 62.3% and 37.7% of the patients were in the low- and high-anxiety classes, respectively. In the microarray sample, 61.3% and 38.7% were in the low and high-anxiety classes, respectively. Forty-one perturbed signaling pathways were identified. Eight of these pathways were common to those identified in the network pharmacology studies.

CONCLUSIONS

Findings increase our knowledge of the molecular mechanisms that underlie anxiety in patients receiving chemotherapy. This study provides initial insights into how anxiety in patients with cancer may share common mechanisms with anxiety in patients with other clinical conditions.

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.

Exploring the Effects of Cancer as a Traumatic Event on Italian Adolescents and Young Adults: Investigating Psychological Well-Being, Identity Construction and Coping Strategies

Cancer in adolescence is considered a family disease that can have numerous negative psychological consequences for adolescents and the entire household. The aim of this study was to investigate the impact of oncological disease in adolescence, with particular reference to the psychological and post-traumatic consequences for the adolescents themselves and the family system. An explorative case-control study was conducted with 31 adolescents (mean age 18.03 ± 2.799) hospitalised for cancer at IRCCS San Matteo Hospital in Pavia and 47 healthy adolescents (mean age 16.17 ± 2.099). The two samples completed a survey that included sociodemographic information and questionnaires assessing psychological well-being, traumatic effects of the disease, and adequacy of the relationship with parents. 56.7% of oncology adolescents scored below average in psychological well-being, and a small proportion of them fell within the range of clinical concern for anger (9.7%), PTS (12.9%), and dissociation (12.9%). Compared with peers, there were no significant differences. However, in contrast to peers, oncology adolescents showed a strong influence of the traumatic event on the construction of their identity and life perspectives. A significantly positive correlation also emerged between adolescents' psychological well-being and the relationship with their parents (mothers: r = 0.796; p < 0.01; fathers: r = 0.692; p < 0.01). Our findings highlight how cancer in adolescence could represent a central traumatic event that can shape the identity and life of teenagers who are in an intrinsically delicate and vulnerable stage of life.

Prevalence and severity of anxiety in cancer patients: results from a multi-center cohort study in Germany

PURPOSE

Anxiety is an accompanying symptom in cancer patients that can have a negative impact on patients. The aim of the present analyses is to determine the prevalence of anxiety, taking into account sociodemographic and medical variables, and to determine the odds ratio for the occurrence of anxiety in cancer patients compared to general population.

METHODS

In this secondary analyses, we included 4,020 adult cancer patients during and after treatment from a multi-center epidemiological study from 5 regions in Germany in different treatment settings and a comparison group consisting of 10,000 people from the general population in Germany. Anxiety was measured with the Generalized Anxiety Disorder (GAD-7) questionnaire. In multivariate analyses adjusted for age and sex, we calculated the odds of being anxious.

RESULTS

The prevalence of anxiety was observed to be 13.8% (GAD-7 ≥ 10). The level of anxiety was significant higher for patients in rehabilitation, compared to patients during inpatient and outpatient treatment (p = .013). Comparison with the general population yielded a 2.7-fold increased risk for anxiety among cancer patients (95% CI 2.4-3.1; p < .001). Patients with bladder cancer (OR, 5.3; 95% CI 3.0-9.4) and testicular cancer (OR, 5.0; 95% CI 2.1-12.1) showed the highest risk of having high levels of anxiety.

CONCLUSION

The results highlight the importance of identifying anxiety in cancer patients.

Effects of sex, age, choice of surgical orthodontic treatment, and skeletal pattern on the psychological assessments of orthodontic patients

We aimed to examine the effects of sex, age, choice of surgical orthodontic treatment, and skeletal pattern on psychological assessment scores of orthodontic patients before edgewise treatment. They completed the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI)-II, and the psychological domain of the World Health Organization Quality of Life 26 (Psych-QOL) for assessment of anxiety, depression, and body image, respectively. No significant effects on psychological assessment scores due to sex or age differences were found. Surgical orthodontic treatment patients and patients with skeletal Class III had significantly higher STAI-Trait and/or BDI-II scores and lower Psych-QOL score. Based on the linear mixed-effects model, the choice of surgical orthodontic treatment had a significant effect on the STAI-Trait, BDI-II, and Psych-QOL scores. No significant interaction effect was found between the choice of surgical orthodontic treatment and the skeletal pattern by ANB angle. Patients with skeletal Class I or III who chose surgical orthodontic treatment had higher STAI-Trait and/or BDI-II scores and/or lower body image score, respectively. These results suggest that patients who chose surgical orthodontic treatment, particularly those with skeletal Class I and III, may be more prone to experience anxiety and depression and have body image dissatisfaction.

Acupuncture and moxibustion for cancer-related psychological disorders: A protocol for systematic review and meta-analysis

INTRODUCTION

Cancer-related psychological disorders (CRPD) with high incidence are often underdiagnosed and undertreated. Although, some studies suggested that acupuncture and moxibustion (AM) are effective and safe for CRPD, lacking strong evidence, for instance, the relevant systematic review, meta-analysis, and randomized control trial (RCT) of a large sample, multicenter, makes the effects and safety remain uncertain. The aim of protocol is to evaluating the RCTs of AM for CRPD to verify the association of AM with the improvement of CRPD.

METHODS AND ANALYSIS

Eight electric databases (4 English databases and 4 Chinese databases) will be searched from inception to Mar. 2022. There will be no restrictions on the category of the language. The RCTs of AM for CRPD unlimited to any type of cancer will be included. Depression and anxiety scores will be the primary outcome indicators. Two researchers will independently complete study selection, evaluate the risk of bias, and extract the data. The RevMan 5.2 software will be used to conduct data synthesis using the random-effects model. The weighted mean differences or standardized mean differences with 95% CIs will be used to present the results of measurement data, and the risk ratios with 95% CIs will be used to express the counting data. Additionally, we will use the Grading of Recommendations Assessment, Development, and Evaluation to assess evidence quality.

MAIN RESULTS

The results of the meta-analysis will be presented with tables and figures.

ETHICS AND DISSEMINATION

The results of this meta-analysis and meta-regression will be disseminated via publication in peer-reviewed journals and will be published at relevant conferences. The data to be used will not contain individual patient data; therefore, there is no need to worry about patient privacy.

PROSPERO REGISTRATION NUMBER

CRD42020177219.

Is women's sexual function impaired by an abnormal pap smear?

OBJECTIVE

Although the stressful psychological impact on women of an abnormal Pap smear is well documented, little research has been undertaken on its sexual impact. Our objective was to assess the impact of an abnormal Pap smear on the sexual function of affected women.

METHODS

A prospective study compared the sexual function of 48 women with an abnormal Pap smear (case group) with that of 48 women with a normal Pap smear (control group). Sexual function was assessed using the Female Sexual Function Index and the Hospital Anxiety Depression Scale. The questionnaires were mailed to the participants.

RESULTS

Surprisingly, the risk of sexual dysfunction was comparable between women with and without an abnormal Pap smear (odds ratio [OR] 0.7; p = 0.4). The OR remained statistically non-significant after adjustment for risk factors. Multivariable analysis showed that only older age at first intercourse, depression and anxiety were identified as factors significantly associated with sexual dysfunction.

CONCLUSION

Contrary to our clinical experience, female sexual function is not impaired by an abnormal Pap smear. Further research is needed to better understand how sexuality in women with abnormal Pap smears may be affected.

Constructing a Predictive Model of Depression in Chemotherapy Patients with Non-Hodgkin's Lymphoma to Improve Medical Staffs' Psychiatric Care

Objectives

Depression is highly prevalent in non-Hodgkin's lymphoma (NHL) patients undergoing chemotherapy. The social stress associated with malignancy induces neurovascular pathology promoting clinical levels of depressive symptomatology. The purpose of this study was to establish an effective depressive symptomatology risk prediction model to those patients.

Methods

This study included 238 NHL patients receiving chemotherapy, 80 of whom developed depressive symptomatology. Different types of variables (sociodemographic, medical, and psychosocial) were entered in the models. Three prediction models (support vector machine-recursive feature elimination model, random forest model, and nomogram prediction model based on logistic regression analysis) were compared in order to select the one with the best predictive power. The selected model was then evaluated using calibration plots, ROC curves, and C-index. The clinical utility of the nomogram was assessed by the decision curve analysis (DCA).

Results

The nomogram prediction has the most efficient predictive ability when 10 predictors are included (AUC = 0.938). A nomogram prediction model was constructed based on the logistic regression analysis with the best predictive accuracy. Sex, age, medical insurance, marital status, education level, per capita monthly household income, pathological stage, SSRS, PSQI, and QLQ-C30 were included in the nomogram. The C-index was 0.944, the AUC value was 0.972, and the calibration curve also showed the good predictive ability of the nomogram. The DCA curve suggested that the nomogram had a strong clinical utility.

Conclusions

We constructed a depressive symptomatology risk prediction model for NHL chemotherapy patients with good predictive power and clinical utility.

Social enrichment attenuates chemotherapy induced pro-inflammatory cytokine production and affective behavior via oxytocin signaling

Breast cancer survivors receiving chemotherapy often report increased anxiety and depression. However, the mechanism underlying chemotherapy-induced changes in affect remains unknown. We hypothesized that chemotherapy increases cytokine production, in turn altering exploratory and depressive-like behavior. To test this hypothesis, female Balb/C mice received two injections, separated by two weeks, of vehicle (0.9% saline) or a chemotherapeutic cocktail [9 mg/kg doxorubicin (A) and 90 mg/kg cyclophosphamide (C)]. Peripheral and central cytokine concentrations were increased one and seven days, respectively, after AC. Because of the beneficial effects of social enrichment on several diseases with inflammatory components, we examined whether social enrichment could attenuate the increase in peripheral and central cytokine production following chemotherapy administration. Socially isolated mice receiving AC therapy demonstrated increased depressive-like and exploratory behaviors with a concurrent increase in hippocampal IL-6. Whereas, group housing attenuated AC-induced IL-6 and depressive-like behavior. Next, we sought to determine whether central oxytocin may contribute to the protective effects of social housing after AC administration. Intracerebroventricular administration of oxytocin to socially isolated mice recapitulated the protective effects of social enrichment; specifically, oxytocin ameliorated the AC-induced effects on IL-6 and depressive-like behavior. Furthermore, administration of an oxytocin antagonist to group housed mice recapitulated the responses of socially isolated mice; specifically, AC increased depressive-like behavior and central IL-6. These data suggest a possible neuroprotective role for oxytocin following chemotherapy, via modulation of IL-6. This study adds to the growing literature detailing the negative behavioral effects of chemotherapy and provides further evidence that social enrichment may be beneficial to health.

Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study

BACKGROUND

Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems.

OBJECTIVE

This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app.

METHODS

After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients' quality of life, nursing care needs, and acceptance of the mHealth app.

RESULTS

The physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (-7.24 vs -4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05).

CONCLUSIONS

Compared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients' need for physiological care and improving their quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968.

Psychological Wellbeing in Adolescents with Leukaemia: A Comparative Study with Typical Development Peers

There is still little research on psychological wellbeing, life satisfaction and reported problems in preadolescents and adolescents under therapy for leukaemia, and also little research comparing them with their healthy peers. The present study aimed to analyse the life satisfaction, hope, psychological wellbeing and reported problems’ intensity in 60 patients aged 8–18 during the first year of therapy, to identify those more at risk and to compare their reports with matched healthy peers. A battery of self-reported questionnaires was administered during hospitalisation or day hospital admissions post 6 months and post 12 months from the diagnosis. Younger patients (aged 8–13 years) were more at risk than older ones in their problems’ intensity and psychological symptoms; females and Acute Myeloid Leukaemia patients reported lower current life satisfaction perceptions; hope was associated with lower depression symptoms and mood problems. Healthy peers have a better perception of current life, but reported a lower hope score, more anxiety symptoms and more cognitive problems than patients. The first 6 months were more critical for patients’ psychological health. Basing on these empirical data, the inclusion of mental health care professionals or supportive psychotherapy into the treatment is recognized as extremely useful.

The effects of aromatherapy massage on improvement of anxiety among patients receiving palliative care: A systematic review of randomized controlled trials

BACKGROUND

Anxiety in patients receiving palliative care is a noteworthy concern because it may affect their quality of life. Aromatherapy has been widely utilized to improve anxiety among patients receiving palliative care.

OBJECTIVE

To investigate the effectiveness of anxiety improvement in patients receiving palliative care by comparing the intervention group (aromatherapy massage) with the control group (common massage alone).

METHODS

A literature search was performed using PubMed, Cochrane Library, Embase, MEDLINE, and CINAHL for all related studies from inception through November 30, 2018 without restriction on language. A quantitative synthesis of randomized controlled trials (RCTs) was conducted to compare the difference in effectiveness scores between the aromatherapy massage and only common massage groups by employing a random-effect model.

RESULTS

We included three RCTs with a total of 160 participants (81 in the intervention group and 79 in the control group) in our systematic review and conducted a quantitative synthesis. The secondary data from the reviewed trials were then pooled using a random-effect model. Anxiety (mean difference = -2.60 [95% confidence interval: -7.82, 2.63], P = .33) was assessed using anxiety scores from the State-Trait Anxiety Inventory.

CONCLUSION

Compared with common massage alone, aromatherapy massage does not provide significant effectiveness of anxiety improvement among patients receiving palliative care.

The prevalence of disability among people with cancer, cardiovascular disease, chronic respiratory disease and/or diabetes: a systematic review

BACKGROUND

Cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease are noncommunicable diseases (NCDs) that cause extensive social and economic burden worldwide, particularly in low-income and middle-income countries. There is growing recognition of the importance of the disabilities that individuals experience as a consequence of these NCDs.

OBJECTIVES

This systematic review examined the prevalence of disabilities associated with cancer, CVD, chronic respiratory disease and diabetes.

METHODS

A comprehensive literature search was conducted in PubMed, CINAHL, Embase, Web of Science, PsycINFO, CIRRIE, WHO database, LILACS and AIM. Studies were included if their samples were representative of people with at least one of these four conditions and if prevalence estimates of disability were provided. As random sampling was not feasible in the majority of cases, studies were included where they offered evidence that their sample was representative of the general population being investigated.

RESULTS

A total of 105 articles were included in the review. Most studies were conducted in high-income countries. The prevalence of difficulties with activities of daily living (i.e. eating, bathing, dressing) was reported to be 10.4-34.5% amongst cancer survivors, 21.1-64.1% in those with CVD, 7.4-49.8% in those with chronic respiratory disease and 12.2-54.5% for those with diabetes. The prevalence of a range of other physical, cognitive and psychological impairments (systemic or structural) was additionally described for each disease.

CONCLUSION

Substantial proportions of people with cancer, CVD, chronic respiratory disease or diabetes experience some form of disability - although there was great variance in prevalence and definitions. The findings of this review support the evidence base of global impact associated with NCD, indicate frequency measures for specific disabilities and inabilities associated with each NCD and provide direction for future systematic reviews.

WHAT IS KNOWN ABOUT THE TOPIC

WHAT THIS ARTICLE ADDS.

A randomized controlled trial of a group acceptance-based intervention for cancer survivors experiencing anxiety at re-entry ('Valued Living'): study protocol

Background

Anxiety is a common concern of cancer survivors during the transition from active cancer treatment to cancer survivorship (the re-entry phase). This paper presents the study protocol for a novel group-based behavioral intervention to improve mental health, well-being, and medical use outcomes among anxious cancer survivors at re-entry.

Methods/Design

This two-armed, prospective randomized controlled trial will randomize a minimum of 100 re-entry-phase cancer survivors with moderate to high anxiety to the intervention or a usual care control condition. The intervention is delivered in a group format over 7 weeks; content is based on Acceptance and Commitment Therapy (ACT), an acceptance, mindfulness, and values-based intervention. Participants will be recruited from community cancer care centers and the intervention will be led by the onsite clinical social workers. Participants will be assessed at baseline, mid-intervention, post-intervention, and 3- and 6-month follow-up. ACT participants will complete process measures before the beginning of group sessions 2, 4, and 6; all participants will complete the process measures during the regular assessments. The primary outcome is anxiety symptoms; secondary outcomes include anxiety disorder severity, fear of recurrence, depressive symptoms, cancer-related trauma symptoms, sense of life meaning, vitality/fatigue, and medical utilization.

Discussion

This clinical trial will provide valuable evidence regarding the efficacy of the group ACT intervention in community oncology settings.

Trial registration

Clinicaltrials.gov NCT02550925.

Effects of Reflexology and Progressive Muscle Relaxation on Pain, Fatigue, and Quality of Life during Chemotherapy in Gynecologic Cancer Patients

PURPOSE

Our aim was to investigate the effect of reflexology and progressive muscle relaxation (PMR) exercises on pain, fatigue, and quality of life (QoL) of gynecologic cancer patients during chemotherapy.

METHODS

Eighty participants were randomly assigned to one of four groups: reflexology, progressive muscle relaxation (PMR) exercises, both (reflexology + PMR), or a control group. Data were collected with a general data collection form, Brief Pain and Fatigue inventories, and Multidimensional Quality-of-Life Scale-Cancer.

RESULTS

In reflexology and reflexology + PMR groups, a significant decrease in pain severity and fatigue and an increase in QoL were found (p < .05). In the PMR alone group, pain severity and fatigue decreased significantly (p < .05), but there was no significant change identified in QOL (p > .05).

CONCLUSIONS

Reflexology and PMR exercises given to gynecologic cancer patients during chemotherapy were found to decrease pain and fatigue and increase QoL.

The impact of depression and anxiety on quality of life in Chinese cancer patient-family caregiver dyads, a cross-sectional study

Background

Cancer and its treatment can result in psychological distress in both adults with cancer and in their family caregivers. This psychological distress acts as a significant adverse factor in patient-caregiver dyads. The study purposes included: (i) to assess anxiety and depression in adults with cancer and their family caregivers, and examine the dyadic relationship of anxiety and depression in patient-caregiver dyads; (ii) to investigate factors that may modify these relationships; and (iii) to explore the impact of anxiety and depression on patient-caregiver dyad quality of life (QOL).

Methods

This was a secondary analysis of a cross-sectional study. Participants consisted of 641 patient-caregiver dyads. Participants completed a survey assessing adults with cancer-related, family caregiver-related, and family-related variables using a demographic/clinical information sheet. In addition, anxiety/depression and QOL were assessed by using the Chinese version of the Hospital Anxiety and Depression Scale and SF-12 respectively. Data were analyzed by using descriptive statistics, Pearson correlations, subgroup analysis, and the Actor-Partner Interdependence Model.

Results

Nearly one-third of participants had experienced anxiety and depression. Adults with cancer and family caregivers experienced a similar degree of anxiety and depression. Correlations (r) of anxiety and depression between patient-caregiver dyads ranged from 0.25 to 0.32. Various factors influencing the anxiety and depression relationship between patient-caregiver dyads were identified, including adults with cancer-related (e.g., age, gender, marital status, level of being informed about the disease, different types of cancer and treatment), family caregiver-related (e.g., being the spouse of a patient, duration in their role as a family caregiver, and amount of time spent on caregiving each day), and family-related (family relationship pre- and post-cancer, financial burden on the family due to cancer treatment) variables. To some extent, both actor and partner effects were identified for anxiety and depression on the QOL of patient-caregiver dyads.

Conclusions

Study findings call attention to anxiety and depression, as well as related factors, in patient-caregiver dyads. The underlined essential components and focus of intervention, which will be developed to decrease psychological distress and improve QOL in patient-caregiver dyads, included individual characteristics of patient-caregiver dyads, family relationship, and anxiety and depression in their counterparts.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-1051-3) contains supplementary material, which is available to authorized users.

An explorative study on systematic assessment of QOL and care needs with the CARES-SF in the early follow-up of patients with digestive cancer

PURPOSE

Systematic assessment of QOL and care needs was applied in two gastroenterology departments to support "Cancer Care for the Whole Patient."

METHODS

Patients with digestive cancer were asked to complete the Cancer Rehabilitation Evaluation System-Short Form (CARES-SF) at the start of treatment and 3 months later. Both times CARES data were processed, and summary reports on the retained insights were sent to the reference nurse for use in further follow-up of the patient. Patients' and reference nurse's experiences with the systematic CARES-assessment were explored with several survey questions and semi-structured interviews, respectively.

RESULTS

The mean age of the 51 participants was 63 years (SD11.17), 52.9% was male. With the CARES-SF, a large variety of problems and care needs was detected. Problems most frequently experienced, and most burdensome for QOL are a mix of physical complaints, side effects from treatment, practical, relational, and psychosocial difficulties. Only for a limited number of experienced problems a desire for extra help was expressed. All patients positively evaluate the timing and frequency of the CARES-assessment. The majority believes that this assessment could contribute to the discussion of problems and needs with healthcare professionals, to get more tailored care. Reference nurses experienced the intervention as an opportunity to systematically explore patients' well-being in a comprehensive way, leading to detection and discussion of specific problems or needs in greater depth, and more efficient involvement of different disciplines in care.

CONCLUSIONS

Systematic QOL and needs assessment with the CARES-SF in oncology can contribute to more patient-centeredness and efficiency of care.

The risk factors for depression in cancer patients undergoing chemotherapy: a systematic review

PURPOSE

This systematic review aims to identify the risk factors for depression in cancer patients undergoing chemotherapy.

METHODS

Eight electronic databases were searched from inception of the databases established until August 2017. References for the included studies were retrieved by manual searching. The quality of the eligible studies was appraised by two persons using the 11-item checklist of the Agency for Healthcare Research and Quality (AHRQ).

RESULTS

Among 5988 potentially relevant articles, 43 studies were eligible, with 17 studies of high quality and 25 studies of moderate quality. A total of 65 factors were extracted, including sociodemographic characteristics (n = 20), physiological condition (n = 20), disease and treatment (n = 12), and psychosocial factors (n = 13). Only social support, anxiety, perceived stress, and self-efficacy were found to be consistently associated with depression in cancer patients. There is not enough evidence to support the link between the other 61 factors and depression in cancer patients undergoing chemotherapy.

CONCLUSIONS

This review suggests that the development of depression programs should take social support, anxiety, perceived stress, and self-efficacy into account. More original studies with rigorous design are necessary to further confirm those 61 inconclusive risk factors for depression in cancer patients receiving chemotherapy.

Development and preliminary testing of a brief clinical tool to enable daily monitoring of chemotherapy toxicity: The Daily Chemotherapy Toxicity self-Assessment Questionnaire

Close monitoring of chemotherapy toxicity can be instrumental in ensuring prompt symptom management and quality care. Our aim was to develop a brief clinical tool to enable daily assessment of chemotherapy toxicity and investigate/establish its content validity, feasibility/applicability, internal consistency and stability. Development of the Daily Chemotherapy Toxicity self-Assessment Questionnaire (DCTAQ) was based on an initial item pool created from two scoping reviews. Expert panel review (n = 15) and cognitive debriefing with patients with cancer (n = 7) were used to establish content validity. Feasibility/acceptability, applicability (self-report vs. interview-like administration), internal consistency (KR-20) and test-retest reliability (at 1-hr intervals) of the DCTAQ were field-tested with 82 patients with breast or colorectal cancer receiving active chemotherapy at eight hospitals. Initial development/content validity stages enabled item revisions and re-wording that led to a final, 11-item DCTAQ version with 10 core symptom items plus one open-ended "any other symptom" item. Feasibility and acceptability were demonstrated through the absence of participant withdrawals, absence of missing data and no complaints about tool length. The DCTAQ was found to have modest internal consistency (KR-20 = 0.56), but very good test-retest reliability. The DCTAQ is a brief clinical tool that allows for rapid and accurate daily assessments of chemotherapy toxicity in clinical practice.

"Health in the Mirror": An Unconventional Approach to Unmet Psychological Needs in Oncology

Background: The introduction of aesthetic care programs for cancer patients inside hospitals could help patients cope with the side effects of both disease and treatment. The specific objective of this study is to evaluate whether a complementary and supportive program, called "Health in the Mirror," has a positive effect on participants by analyzing certain psychological variables. Methods: Eighty-eight female cancer patients were included in this analysis. The support program is composed of three group aesthetic interventions that address both physical and psychological aspects that accompany cancer and its treatment. Patients were asked to complete a battery of tests in order to measure the impact of the program on certain psychological variables including anxiety, depression, body image, self-esteem, and quality of life. Outcome variables were measured at three different time-points: prior to participation, on the last day of the program, and after a 3-month follow-up. Results: Participating in the psychosocial support program "Health in the Mirror" determines an improvement in the psychological variables measured. Results revealed a significant reduction in depressive symptoms, anxiety and body image issues, as well as an improvement in self-esteem levels; this suggests that participating in this program could facilitate better adjustment to disease and treatment. Discussion: This study legitimizes the importance of implementing supportive and complementary therapies together with conventional therapies; the therapeutic approach to cancer cannot be restricted solely to medical care, but it must consider the patient as a whole person with needs that are not only physical or medical, but also psychological, social, and existential.

Specialized palliative care in advanced cancer: What is the efficacy? A systematic review

Objective:

Due to the multiple physical, psychological, existential, and social symptoms involved, patients with advanced cancer often have a reduced quality of life (QoL), which requires specialized palliative care (SPC) interventions. The primary objective of the present systematic review was to review the existing literature about SPC and its effect on QoL, on physical and psychological symptoms, and on survival in adult patients with advanced cancer.

Method:

We utilized a search strategy based on the PICO (problem/population, intervention, comparison, and outcome) framework and employed terminology related to cancer, QoL, symptoms, mood, and palliative care. The search was performed in Embase, PubMed, and the Cochrane Central Register of Controlled Trials. Selected studies were analyzed and categorized according to methods, results, quality of evidence, and strength of recommendation.

Results:

Six randomized controlled trials (RCTs) were selected for analysis (out of a total of 1,115 studies). Two other studies were found by hand search, one of which was only published in conference abstract form. The RCTs differed in terms of aims, interventions, control groups, and outcomes; however, the primary aim of all of them was to investigate the effect of SPC on patient QoL. Five studies found improved QoL in the intervention group. Physical symptom intensity decreased in two studies, and three studies found improved mood in the intervention group. However, physical and psychological symptoms were secondary outcomes in these studies. Survival was improved in two studies. All the studies offered generalizability, but the level of evidence validity varied among them.

Significance of results:

Due to several methodological limitations, the evidence offered in these studies ranged from low to high. The evidence in this field of study in general is still nascent, but there is growing support for the utilization of SPC to improve the quality of life of adult patients with advanced cancer. The evidence that SPC reduces physical and psychological symptoms is moderate, while the evidence that it prolongs survival is low.

Identification of Distress in Oncology Patients: A Comparison of the Hospital Anxiety and Depression Scale and a Thorough Clinical Assessment

BACKGROUND

Screening is recommended to identify cancer patients with distress, anxiety, and depression. The ability of current methods to identify distress in oncology patients is of high importance.

OBJECTIVE

We compared the Hospital Anxiety and Depression Scale (HADS) with a thorough clinical assessment. Furthermore, we explored the agreement of HADS with clinical assessment outcomes as a function of age, sex, and treatment intention.

METHODS

One hundred forty-six oncology patients, representing both sexes, different ages (<65/≥ 65 years), and treatment intention (curative/palliative), completed the HADS before the clinical assessment. Two study team members (blind to the HADS results) completed clinical assessments of anxiety, depression, and distress analogous to categories used in the HADS.

RESULTS

The HADS identified 49 participants and the clinical assessment 71 participants as having anxiety, depression, or distress. The overall agreement between the HADS and the clinical assessment was moderate. The greatest differences were found to be a function of participant sex and age. Agreement between the methods was better for females than for males in relation to distress and anxiety and better for the older (≥ 65 years) than younger participants in relation to depression. By treatment intention, agreement was equal for all domains.

CONCLUSION

Especially male and young participants appear to have potential problems that the HADS fails to identify.

IMPLICATIONS FOR PRACTICE

When the HADS is used for screening, nurses must be aware of psychosocial problems perceived by patients that are not covered by the HADS. Many patients identified as having distress have resources to manage problems without additional support.

Quality of Life among Cancer Patients

Introduction:

Cancer is a leading cause of death. People living with cancer experience a variety of symptoms. Quality of life (QOL) is a major concern of patients with terminal cancer. Symptoms affect their QOL. Management of symptoms improves distress and QOL.

Objective:

The objective of the study was to assess the QOL among cancer patients.

Materials and Methods:

A survey was conducted among 768 cancer patients selected by a convenient sampling technique. Data was collected from cancer patients by interview technique using structured and validated interviewed schedule.

Results:

Out of 768 cancer patients, 30.2% patients were in the age group of 51–60 years, majority with head–and-neck cancer (40.1%), and 57.7% had stage III disease. QOL of majority of patients was influenced by their symptoms. 82.3% of them had low QOL scores.

Conclusion:

Cancer patients experienced many symptoms that affected their QOL. There is a need to develop interventions for effective management of symptoms that will empower the patients to have a greater sense of control over their illness and treatment and to improve the QOL.

The Chinese version of hospital anxiety and depression scale: Psychometric properties in Chinese cancer patients and their family caregivers

PURPOSE

The Hospital Anxiety and Depression Scale (HADS) acts as one of the most frequently used self-reported measures in cancer practice. The evidence for construct validity of HADS, however, remains inconclusive. The objective of this study is to evaluate the psychometric properties of the Chinese version HADS (C-HADS) in terms of construct validity, internal consistency reliability, and concurrent validity in dyads of Chinese cancer patients and their family caregivers.

METHODS

This was a cross-sectional study, conducted in multiple centers: one hospital in each of the seven different administrative regions in China from October 2014 to May 2015. A total of 641 dyads, consisting of cancer patients and family caregivers, completed a survey assessing their demographic and background information, anxiety and depression using C-HADS, and quality of life (QOL) using Chinese version SF-12. Data analysis methods included descriptive statistics, confirmatory factor analysis (CFA), and Pearson correlations.

RESULTS

Both the two-factor and one-factor models offered the best and adequate fit to the data in cancer patients and family caregivers respectively. The comparison of the two-factor and single-factor models supports the basic assumption of two-factor construct of C-HADS. The overall and two subscales of C-HADS in both cancer patients and family caregivers had good internal consistency and acceptable concurrent validity.

CONCLUSIONS

The Chinese version of the HADS may be a reliable and valid screening tool, as indicated by its original two-factor structure. The finding supports the basic assumption of two-factor construct of HADS.

Assessing cancer patients' quality of life and supportive care needs: Translation-revalidation of the CARES in Flemish and exhaustive evaluation of concurrent validity

BACKGROUND

The prevalence of cancer increases every year, leading to a growing population of patients and survivors in need for care. To achieve good quality care, a patient-centered approach is essential. Correct and timely detection of needs throughout the different stages of the care trajectory is crucial and can be supported by the use of screening and assessment in a stepped-care approach. The Cancer Rehabilitation Evaluation System (CARES) is a valuable and comprehensive quality of life and needs assessment instrument. For use in Flemish research and clinical practice, the CARES tool was translated for the Dutch-speaking part of Belgium (Flanders) from its original English format. This protocol paper describes the translation and revalidation of this Flemish CARES version.

METHODS

After forward-backward translation of the CARES into Flemish we aim to recruit 150 adult cancer patients with a primary cancer diagnosis (stage I, II or III) for validation. In this study with a combination of qualitative and a quantitative approach, qualitative data will be collected through focus groups and supplemented by two phases of quantitative data collection: i) an initial patient survey containing questions on socio-demographic and medical data, the CARES and seven concurrent instruments; and ii) a second survey administered after 1 week containing the CARES and supplementary questions to explore their impressions on the content and the feasibility of the CARES.

DISCUSSION

With this extensive data collection process, psychometric validity of the Flemish CARES can be tested thoroughly using classical test theory. Internal consistency of summary scales, test-retest reliability, content validity, construct validity, concurrent validity and feasibility of the instrument will be examined. If the Flemish CARES version is found reliable, valid and feasible, it will be used in future research and clinical practice. Comprehensive assessment with the CARES in a stepped-care approach can facilitate timely identification of cancer patients' psychosocial concerns and care needs so it can contribute to efficient provision of patient-centered quality care.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02282696 (July 16, 2014).

Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship

Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.

Changes in attitudes, practices and barriers among oncology health care professionals regarding sexual health care: Outcomes from a 2-year educational intervention at a University Hospital

PURPOSE

To examine the attitudes, practices and perceived barriers in relation to a sexual health care educational intervention among oncology health care professionals at the Landspítali-National University Hospital of Iceland.

METHODS

The design was quasi experimental, pre - post test time series. A comprehensive educational intervention project, including two workshops, was implemented over a two year time period. A questionnaire was mailed electronically to all nurses and physicians within oncology at baseline (T1, N = 206), after 10 months (T2, N = 216) and 16 months (T3, N = 210).

RESULTS

The response rate was 66% at T1, 45% at T2 and 38% at T3. At all time points, the majority of participants (90%) regarded communication about sexuality part of their responsibilities. Mean scores on having enough knowledge and training, and in six of eight practice issues increased significantly over time. Overall, 10-16% reported discussing sexuality-related issues with more than 50% of patients and the frequency was significantly higher among workshop attendants (31%) than non-attendants (11%). Overall, the most common barriers for discussing sexuality were "lack of training" (38%) and "difficult issue to discuss" (27%), but the former barrier decreased significantly by 22% over time.

CONCLUSIONS

The intervention was successful in improving perception of having enough knowledge and training in providing sexual health care. Still, the issue remains sensitive and difficult to address for the majority of oncology health care professionals. Specific training in sexual health care, including workshops, should be available to health care professionals within oncology.

A Randomized Controlled Trial for the Effectiveness of Progressive Muscle Relaxation and Guided Imagery as Anxiety Reducing Interventions in Breast and Prostate Cancer Patients Undergoing Chemotherapy

Objective. To test the effectiveness of guided imagery (GI) and progressive muscle relaxation (PMR) as stress reducing interventions in patients with prostate and breast cancer who undergo chemotherapy. Methods. Patients were randomly assigned to either the control group or the intervention group (PMR and GI). Patients were observed for a total duration of 3 weeks and assessed with the SAS and BECK-II questionnaires for anxiety and depression, respectively, in addiotion to two biological markers (saliva cortisol and saliva amylase) (trial registration number: NCT01275872). Results. 256 patients were registered and 236 were randomly assigned. In total 104 were randomised to the control group and 104 to the intervention group. Intervention's mean anxiety score and depression score changes were significantly different compared to the control's (b = −29.4, p < 0.001; b = −29.4, p < 0.001, resp.). Intervention group's cortisol levels before the intervention (0.30 ± 0.25) gradually decreased up to week 3 (0.16 ± 0.18), whilst the control group's cortisol levels before the intervention (0.21 ± 0.22) gradually increased up to week 3 (0.44 ± 0.35). The same interaction appears for the Amylase levels (p < 0.001). Conclusions. The findings showed that patients with prostate and breast cancer undergoing chemotherapy treatment can benefit from PMR and GI sessions to reduce their anxiety and depression.

Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis

BACKGROUND

Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls.

METHODS

We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls.

FINDINGS

Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11·6% (95% CI 7·7-16·2) in the pooled sample of 51 381 cancer survivors and 10·2% (8·0-12·6) in 217 630 healthy controls (pooled relative risk [RR] 1·11, 95% CI 0·96-1·27; p=0·17). The prevalence of anxiety was 17·9% (95% CI 12·8-23·6) in 48 964 cancer survivors and 13·9% (9·8-18·5) in 226 467 healthy controls (RR 1·27, 95% CI 1·08-1·50; p=0·0039). Neither the prevalence of depression (26·7% vs 26·3%; RR 1·01, 95% CI 0·86-1·20; p=0·88) nor the prevalence of anxiety (28·0% vs 40·1%; RR 0·71, 95% CI 0·44-1·14; p=0·16) differed significantly between cancer patients and their spouses.

INTERPRETATION

Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses.

FUNDING

None.

Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature

PURPOSE

This study aimed to review quantitative literature pertaining to studies of music-based interventions in palliative cancer care and to review the neurobiological literature that may bare relevance to the findings from these studies.

METHODS

A narrative review was performed, with particular emphasis on RCTs, meta-analyses, and systematic reviews. The Cochrane Library, Ovid, PubMed, CINAHL Plus, PsycINFO, and ProQuest were searched for the subject headings music, music therapy, cancer, oncology, palliative care, pain, anxiety, depression, mood, quality of life, prevalence, neuroscience, functional imaging, endogenous opioids, GABA, 5HT, dopamine, and permutations of these same search terms. Data for the review were comprised of articles published between 1970 and 2012. References of all the cited articles were also reviewed.

RESULTS

Available evidence suggests that music-based interventions may have a positive impact on pain, anxiety, mood disturbance, and quality of life in cancer patients. Advances in neurobiology may provide insight into the potential mechanisms by which music impacts these outcomes.

CONCLUSIONS

More research is needed to determine what subpopulation of cancer patients is most likely to respond to music-based interventions, what interventions are most effective for individual outcomes, and what measurement parameters best gauge their effectiveness.

Menopausal symptoms, sexual function, depression, and quality of life in Korean patients with breast cancer receiving chemotherapy

PURPOSE

The purpose of this study was to study the relationships among menopausal symptoms, sexual function, depression, and quality of life in women with breast cancer undergoing chemotherapy.

METHODS

Two hundred women participated in this cross-sectional study. Data were collected with the Menopause Rating Scale (MRS), Female Sexual Function Index (FSFI), Beck Depression Inventory II (BDI-II), and the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B). Data were analyzed using descriptive statistics, t-tests, ANOVA, Scheffe's test, and Pearson product moment correlations using SPSS v. 20.

RESULTS

Participants had alterations in menopausal symptoms and sexual function, and were depressed with a decreased quality of life. These factors are known to influence satisfaction with family support (p < 0.05) and sexual relationships (p < 0.05).

CONCLUSIONS

Nurses should provide education to women with breast cancer on their sexual issues and encourage them to attend family support programs. They should also encourage family members to be proactive in addressing menopausal and depressive symptoms in these women with a goal to enhance their sexual functioning and quality of life.

Coping, quality of life, depression, and hopelessness in cancer patients in a curative and palliative, end-of-life care setting

BACKGROUND

Coping strategies may be important factors influencing quality of life (QOL), depression, and hopelessness. However, most studies on this issue were performed in patients still undergoing anticancer treatment. Unknown is which coping strategies are of importance for palliative-cancer patients who no longer receive treatment.

OBJECTIVE

The objectives of this study were to assess coping strategies in curatively treated and palliative-cancer patients no longer receiving anticancer treatment and to examine the relation of these coping strategies with QOL, depression, and hopelessness.

METHODS

A descriptive research design was used. Ninety-two curative and 59 palliative patients filled out the COPE-Easy abbreviated version, the European Organisation for Research-and-Treatment of Cancer QOL-Questionnaire version 2.0, Beck Depression Inventory for Primary Care, and Beck Hopelessness Scale.

RESULTS

In both curative and palliative patients, active coping strategies and acceptance were beneficial in terms of QOL, depression, and hopelessness, unlike avoidant coping strategies and venting of emotions. Palliative patients scored higher on the coping strategy, seeking moral support. For the outcome variable, emotional functioning, significant interactions were observed between the variable, curative/palliative care setting, and the coping strategy, seeking moral support. For the outcome variable, role functioning, significant interactions were observed between the variable, curative/palliative care setting, and the coping strategy, waiting.

CONCLUSIONS

Coping strategies were significantly correlated to QOL, depression, and hopelessness. However, this correlation differed in the curative and palliative, end-of-life care setting.

IMPLICATIONS FOR PRACTICE

The observed relations between coping strategies, QOL, depression, and hopelessness give room to cognitive-behavioral nursing interventions. Specific attention is needed for differences in coping strategies between curative and palliative patients.

The psychometric properties of the Icelandic version of the distress thermometer and problem list

OBJECTIVE

While a significant number of cancer patients experience distress only a minority are offered appropriate psychosocial interventions. Untreated distress can interfere with compliance to treatment and quality of life. The purpose of this study was to evaluate the psychometric properties and feasibility of the Icelandic translation of the distress thermometer (DT) and problem list, a tool developed to screen for distress in cancer patients.  

METHODS

Participants were 149 cancer patients receiving treatment at outpatient oncology clinics at Landspítali-The National University Hospital of Iceland, mean±SD age 59.06 years ±12.92. Participants answered the DT, HADS and GHQ-30, demographic questions and questions regarding the DT.  

RESULTS

Scores on the DT ranged from 0 to 10 with a mean ±SD score of 3.09 ± 2.40, 7.30 ± 4.86 on HADS and 5.28 ± 5.60 on GHQ-30. Significant correlations were between the DT and all categories on the Problem List as well as between the DT and HADS (r = 0.45), and between DT and GHQ-30 (r = 0.57). ROC-analysis supported that a cut-off point of 3 gives the best sensitivity and specificity for the DT predicting depression or anxiety according to the HADS and GHQ. Sixty-nine (48.3%) patients scored < or =2 on DT and 74 (51.7%) scored ≥3.  

CONCLUSION

The Icelandic version of the DT is a valid instrument to screen for distress in clinical practice. The study adds to a growing literature suggesting that this brief instrument may aid in identifying cancer patients suffering from distress and consequently providing appropriate treatment.

Family members of cancer patients: Needs, quality of life and symptoms of anxiety and depression

BACKGROUND

Family members of cancer patient's have multiple needs, many of which are not adequately met. Unmet needs may affect psychological distress and quality of life (QOL). The purpose of this study was to assess needs and unmet needs, QOL, symptoms of anxiety and depression, and the relationship between those variables in a large sample of family members of cancer patients in different phases of illness.

MATERIAL AND METHODS

Of 332 family members invited to participate, 330 accepted and 223 (67%) completed a cross-sectional, descriptive study. Data was collected with the Family Inventory of Needs (FIN), Quality of Life Scale (QOLS) and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Of 20 needs assessed the mean (SD) number of important needs and unmet needs was 16.4 ± 4.3 and 6.2 ± 5.6, respectively. Twelve important needs were unmet in 40-56% of the sample. The mean number of unmet needs was significantly higher among women than men, other relatives than spouses, younger family members, those currently working and those of patients with metastatic cancer. QOL was similar to what has been reported for healthy populations and cancer caregivers in advanced stages. The prevalence of symptoms of anxiety and depression was high (20-40%). Anxiety scores were higher among women than men and both anxiety and depression scores were highest during years 1-5 compared to the first year and more than five years post diagnosis. There was a positive relationship between number of important needs and QOL, and between needs met and QOL. Additionally, there was a significant relationship between anxiety and unmet needs. Finally, there was a significant relationship between QOL and symptoms of anxiety and depression.

CONCLUSION

The results support the importance of screening needs and psychological distress among family members of cancer patients in all phases of illness.