The efficacy of short-term psycho-oncological interventions for women with gynaecological cancer: a randomized study

Integrative Medicine for Ovarian Cancer

PURPOSE OF REVIEW

Integrative oncology (IO) services provide a wide range of complementary medicine therapies, many of which can augment the beneficial effects of conventional supportive and palliative care for patients with ovarian cancer. This study aims to assess the current state of integrative oncology research in ovarian cancer care.

RECENT FINDINGS

We review the clinical research both supporting the effectiveness of leading IO modalities in ovarian cancer care as well as addressing potential safety-related concerns. There is growing amount of clinical research supporting the use of IO and implementation of integrative gynecological oncology models of care within the conventional supportive cancer care setting. Additional research is still needed in order to create clinical guidelines for IO interventions for the treatment of female patients with ovarian cancer. These guidelines need to address both effectiveness and safety-related issues, providing oncology healthcare professionals with indications for which these patients can be referred to the IO treatment program.

Investigation on Musculoskeletal Injury and Psychological Empowerment of Reflexologists in Taiwan: Analysis of the Recognition to Alternative Therapy

Many studies have proven that reflexology has been used as a complementary medical treatment. Therefore, the government has started to plan an examination system for reflexology personnel to ensure the quality of service. Reflexologists work long hours, have heavy workloads, and perform poses that do not conform to human factors, which often cause musculoskeletal fatigue. The purpose of this study is to understand the musculoskeletal pain conditions of reflexologists, the psychological empowerment status, and the perceptions of complementary medicine therapy. The data for this study were obtained in two ways: (1) 59 practitioners were surveyed by using a face-to-face questionnaire and (2) a semi-structured interview was carried out for 10 practitioners. This study discovered the following: (1) Reflexology practitioners have musculoskeletal discomfort symptoms in body parts, including the left shoulder (25.4%), left hand or wrist (25.4%), lower back (25.4%), right shoulder (23.7%), left elbow or forearm (22%). (2) Reflexology practitioners are highly psychologically empowered to work. (3) The practitioners of foot therapy hold a positive attitude towards foot therapy and believe that foot therapy is a natural therapy, which is self-serving and can help others. (4) Most reflexologists support the government's desire to promote the reflexology examination system and are willing to help develop the policy. (5) The height of most reflexologist work chairs does not match the height of the guest's seat and is not ergonomic.

A Taxonomy for Psycho-Oncological Intervention Techniques in an Acute Care Hospital in Germany

BACKGROUND

Due to the establishment of a nationwide certification system for cancer centers in Germany, the availability of psycho-oncological services for cancer patients has increased substantially. However, little is known about the specific intervention techniques that are applied during sessions in an acute care hospital, since a standardized taxonomy is lacking. With this study, we aimed at the investigation of psycho-oncological intervention techniques and the development of a comprehensive and structured taxonomy thereof.

METHODS

In a stepwise procedure, a team of psycho-oncologists generated a data pool of interventions and definitions that were tested in clinical practice during a pilot phase. After an adaptation of intervention techniques, interrater reliability (IRR) was attained by rating 10 previously recorded psycho-oncological sessions. A classification of interventions into superordinate categories was performed, supported by cluster analysis.

RESULTS

Between April and June 2017, 980 psycho-oncological sessions took place. The experts agreed on a total number of 22 intervention techniques. An IRR of 89% for 2 independent psycho-oncological raters was reached. The 22 techniques were classified into 5 superordinate categories.

DISCUSSION/CONCLUSION

We developed a comprehensive and structured taxonomy of psycho-oncological intervention techniques in an acute care hospital that provides a standardized basis for systematic research and applied care. We expect our work to be continuously subjected to further development: future research should evaluate and expand our taxonomy to other contexts and care settings.

Complementary Therapies for Patients with Cancer: Reflexology and Relaxation in Integrative Palliative Care. A Randomized Controlled Comparative Study

Objectives: Comparison of the effects of reflexology and relaxation on pain, anxiety, and depression, and quality of life (QoL) of patients with cancer. Design: A stratified random sample was selected, using an experimental design. Location: An outpatient Palliative Care Unit in Attica, Greece. Subjects: 88 patients suffering with cancer. Interventions: The sample was randomly divided into two equal groups, a reflexology and a relaxation group. The number of interventions for both groups was six 30-min weekly sessions. Outcome measures: The Greek Brief Pain Inventory (G-BPI) was used to measure pain, the Greek Hospital Anxiety and Depression Scale for screening anxiety and depression, and finally the Short Form Health Survey was used to measure QoL. Measurements of the above tools were taken three times in both groups as follows: preintervention, at fourth and at sixth week of intervention. Results: Anxiety and depression for both groups exhibited a statistically significant decrease during the observation period (p < 0.001, η² > 0.25) but at the sixth week, there was a more significant decrease in the reflexology group compared with the relaxation group (p = 0.062, η² = 0.044 vs. p = 0.005, η² = 0.096 for anxiety), (p = 0.006, η² = 0.094 vs. p = 0.001, η² = 0.138 for depression). QoL physical and mental component measurements were significantly greater for the reflexology group (p < 0.001, η² = 0.168 and p = 0.017, η² = 0.071, respectively). The baseline-to-sixth week G-BPI measurements were markedly decreased for the reflexology group (p = 0.207, η² = 0.020). Conclusions: Both interventions, relaxation and reflexology, seemed to be effective in decreasing anxiety and depression in patients with cancer. However, reflexology was found to be more effective in improving QoL (physical component) and to have a greater effect on pain management than relaxation.

Can We Change Patients’ Perception of the Psychologist to Promote Support in Oncology? Randomized Impact Study of the Psycho-oncology Intervention

Aims: To assess the interest and the efficacy of a systematic encounter with a psycho-oncologist on the perception of the psychologist among men and women with cancer.

Procedure: The patients who systematically encounter the psycho-oncologist were compared to a control group. Anxio-depression symptoms and the patients’ perception of the psychologist were assessed on two occasions: at the time of diagnosis and 4 months later, during treatment.

Results: On the overall group, we failed to observe significant differences between conditions about the perception of the psychologist, but gender was a critical factor associated with both perception of the psychologist and further psychological consultations. Those men who met a psychologist soon after diagnosis continued to meet the psychologist to a far greater extent than those in the control group. Conversely, women pursued psychological support whether they had encountered the psychologist or not.

Conclusion: Results indicate that an encounter with the psychologist can be helpful to elicit interest in a psychological support, especially for men.

A theory-driven psycho-educational intervention programme for gynaecological cancer patients during treatment trajectory: A randomised controlled trial

OBJECTIVE

This study aims to evaluate the effects of a theory-driven psycho-educational intervention programme on uncertainty in illness, anxiety, and sexual functioning in a cohort of Chinese patients with gynaecological cancer.

METHODS

Women with newly diagnosed gynaecological cancer (n = 202) received either a four-session, 12-week-long, culturally appropriate psycho-educational intervention programme (n = 102) or attention from intervener (n = 100) in a two-group randomised controlled trial. Patient-reported measures included Chinese version of Mishel's Uncertainty in Illness Scale (C-MUIS), Hospital Anxiety and Depression Scale (HADS)-Anxiety subscale, and Sexual Function-Vaginal Changes Questionnaire (SVQ). Data regarding uncertainty in illness and anxiety were collected at baseline and postintervention, while data on sexual functioning were collected postintervention.

RESULTS

Patients receiving psycho-educational intervention reported significantly greater reductions in ambiguity, inconsistency, and overall uncertainty in illness, as measured by C-MUIS (P < .01). They were also more likely to be sexually active (P = .037), report their partners having greater sexual interest (P = .008), and perceive a significantly greater level of intimacy (P = .001) in the SVQ.

CONCLUSIONS

Given the growing population of gynaecological cancer survivors and the universal side effects of the disease and its related treatments, the established design and content of the psycho-educational intervention programme should be incorporated into routine clinical practice.

The effectiveness of initial therapy contact: A systematic review

'Initial therapy contacts', defined as (the first) 3 h or less of face-to-face psychological treatment, encompassing both the early phase of a longer therapy and one-off single session therapies, are seen as a critical phase of treatment. However, little is known about the direct effect of initial therapy contacts on change in common symptoms typically presented by patients in psychological therapy services. Our systematic literature search resulted in 35 identified empirical studies on the effect of initial therapy contacts. These studies were analyzed in three stages: 1) A systematic comparison of study characteristics using the preferred reporting items for systematic reviews and meta-analyses; 2) A domain-based evaluation of methodological rigor of the studies, in line with Cochrane's guidelines on assessing risk of bias; 3) A narrative synthesis of reported findings. The considerable variability in therapy format (a stand-alone single session, 2 + 1 format, or initial session of multisession therapy) and study design (post/pre-post measurement, with/without control) limited comparability of studies. The quality assessment indicated that the majority of studies had relatively weak methodologies overall. Qualitative synthesis of the effectiveness results suggests that a significant proportion of patients reported benefits, including symptom change. This positive effect is especially clear when compared to no-treatment controls, and appears to be maintained at follow-up. The findings suggest that a broad range of initial therapy formats, could in itself be beneficial to patients in primary care treatment settings, and that further research is warranted.

Risk factors for developing depression in women with cervical cancer: a nationwide population-based study in Taiwan

Introduction

Depression might affect women with cervical cancer and can deteriorate their quality of life or even their compliance with cancer treatments. The aim of this study was to investigate the incidence of depression and risk factors for developing depression among women with cervical cancer in Taiwan.

Patients and methods

This study enrolled patients with newly diagnosed cervical cancer from the National Health Insurance Research Database in Taiwan. From a population of 21,400,826 residents, each cervical cancer patient was matched with one subject without cervical cancer according to sex, age, and comorbidities with the same diagnostic index. The International Classification of Diseases, Ninth Revision, code 180.9 was used to identify patients with cervical cancer, and 296.0X–296.1X, 296.4X–296.8X, 296.2X–296.3X, 300.4, and 311.X codes were used to identify those with depressive disorders.

Results

In total, 19,316 newly diagnosed cervical cancer patients were enrolled from January 2000 to December 2005, and the median follow-up period was 5.23 years (1.75–8.48 years). The prevalence of depressive disorder was 4.21% (813 of 19,316) in the cervical cancer cohort, and it was 3.85% (744 of 19,316) in the control cohort. The incidence risk ratio of depressive disorders was 1.35 (95% CI =1.22–1.49, P<0.001) among these cervical cancer patients. Cervical cancer, as an independent risk factor, was associated with developing subsequent depressive disorder. In addition, being older (≥65 years old) and the comorbidities of diabetes mellitus, ischemic heart disease, and cerebrovascular disease were also risk factors for predicting depressive disorder in cervical cancer patients.

Discussion

Cervical cancer is a prominent risk factor for the development of depression in women with cervical cancer in Taiwan. The patients with comorbidities, including diabetes mellitus, ischemic heart disease, and cerebrovascular disease, have higher risks of developing depression. However, there were no significant differences among the cervical cancer treatment modalities. In conclusion, these patients require early psychological support and intervention.

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 effects of spiritual care on quality of life and spiritual well-being among patients with terminal illness: A systematic review

BACKGROUND

Terminal illness not only causes physical suffering but also spiritual distress. Spiritual care has been widely implemented by healthcare professionals to assist patients coping with spiritual distress. However, the effects of spiritual care need to be clear.

AIM

To evaluate the effects of spiritual care on quality of life and spiritual well-being among patients with terminal illness.

DESIGN

Systematic review according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.

DATA SOURCES

A comprehensive search was conducted in nine electronic databases from date of inception to May 2017. Hand searches of the bibliographies of relevant articles were also performed. The studies were independently reviewed by two investigators who scored them for methodological quality using the Cochrane Risk of Bias Tool.

RESULTS

No statistical pooling of outcomes was performed and a narrative summary was chosen to describe the included studies. A total of 19 studies with 1548 participants were identified in the systematic review, corresponding to seven kinds of interventions. The risk of bias for these studies were all rated as moderate. A majority of studies indicated that spiritual care had a potential beneficial effect on quality of life and spiritual well-being among patients with terminal illness.

CONCLUSION

It is suggested that healthcare professionals integrate spiritual care with usual care in palliative care. When providing spiritual care, healthcare professionals should take into consideration patients' spiritual needs, preference, and cultural background. More multicenter and disciplinary studies with rigorous designs are needed in the future.

Management of sexuality, intimacy, and menopause symptoms in patients with ovarian cancer

Issues of sexuality, intimacy, and early menopause significantly impact the quality of life of patients following the diagnosis and treatment of ovarian cancer. These are undertreated problems. Successful treatment requires the provider's awareness of the problem, ability to identify it, and willingness to treat it. Unfortunately many providers do not address these issues in the pretreatment or perioperative period. Furthermore, patients do not often alert their providers to their symptoms. While systemic hormone therapy may improve many of the issues, they are not appropriate for all patients given their action on estrogen receptors. However, other nonhormonal treatments exist including selective serotonin reuptake inhibitors, antiepileptics, natural remedies, and pelvic floor physical therapy. In addition psychological care and the involvement of the partner can be helpful in managing the sexual health concerns of these patients. At the time of diagnosis or at initial consultation, women should be informed of the potential physiologic, hormonal, and psychosocial effects of ovarian cancer on sexuality and that there is a multimodal approach to dealing with symptoms.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment

Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.

Overcoming communication challenges in integrative supportive cancer care: The integrative physician, the psycho-oncologist, and the patient

BACKGROUND

Complementary/integrative medicine (CIM) services are increasingly being integrated into conventional supportive cancer care, presenting a number of challenges to communication between healthcare professionals (HCPs). The purpose of the present study was to explore the impact of the communication between integrative physicians (IPs) trained in CIM and social workers (SWs) working as psycho-oncologists in the same oncology setting. We examine whether IP-SW communication correlates with the number of patient-SW sessions, as provided within the oncology department.

METHODS

SW-IP communication, defined as a summary of the IP consultation sent to the patient's SW, was compared to SW-patient communication, defined as the number of psycho-oncology treatment sessions.

RESULTS

Of 344 patients referred by their oncology HCP for IP consultation, 91 were referred by an SW and 253 by an oncologist or nurse. IP-to-SW summaries were provided for 150 patients referred by a non-SW HCP (43.6%), and for 91 of SW-referred patients (26.5%). In all, 32 patients referred to the IP had no psycho-oncology interaction with an SW; 58 only one meeting; and 254 with ≥2 interactions, with 119 having >6 sessions. SW-patient interactions were greater with higher rates of IP-SW communication, for both patients referred by an SW (79.1%) and those referred by a non-SW HCP (77.3%) when compared to patients for whom no summary was provided (64.1%; p= 0.02).

CONCLUSION

A greater level of IP-SW communication, measured by the provision of an IP summary to the patient's SW, was found to correlate with a higher rate of SW-patient interactions. The use of a structured two-way referral-summary between IPs and SWs has the potential to advance the SW-patient psycho-oncology interaction, within an integrative supportive cancer care setting.

Targeted drugs and Psycho-oncological intervention for breast cancer patients

Personalized medicine is a new field based on molecular biology and genomics in which targeted tumor therapies are administered to patients. Psycho-oncology is a complementary approach that considers social and psychological aspects of patients as part of the treatments for cancer patients.

The aim of this mini-review is to weigh clinical benefits for breast cancer patients of both treatments and possibily enhance benefits by modulating the use of both interventions. We have compared and evaluated on the one hand the use of anti Vascular Endothelial Growth Factor and, on the other hand, psycho-oncological interventions in metastatic and non-metastatic breast cancer patients.

Both treatments did not increase survival of metastatic breast cancer patients, while in a selected study psycho-oncological interventions extended lifespan of non-metastatic breast cancer patients and ameliorate psychological and social factors of metastatic breast cancer patients. Because the two approaches address completely different aspects of cancer patients, if the comparison is limited to the extension of survival, the value of these two treatments cannot be assessed and compared.

It is likely that by comparing patients reported outcomes, possibly by using standardized Quality of Life questionnaires, both patients and health care providers can weigh the benefits of the two treatments. It is therefore important to evaluate the use of cancer patients’ quality of life measures as a mean to improve their experiences about life and treatment, and possibly to extend their survival.

A person-centered intervention targeting the psychosocial needs of gynecological cancer survivors: a randomized clinical trial

PURPOSE

We investigated the effect of a person-centered intervention consisting of two to four nurse-led conversations using guided self-determination tailored to gynecologic cancer (GSD-GYN-C) on gynecological cancer survivors' quality of life (QOL), impact of cancer, distress, anxiety, depression, self-esteem, and self-reported ability to monitor and respond to symptoms of recurrence.

METHODS

We randomly assigned 165 gynecological cancer survivors to usual care (UC) plus GSD-GYN-C or UC alone. Self-reported QOL-cancer survivor (QOL-CS) total score and subscale scores on physical, psychological, social, and spiritual well-being were assessed before randomization and at 3 and 9 months after randomization using t tests. Bonferroni and Pipper corrections were applied for multiple testing adjustments.

RESULTS

At 9 months, the GSD-GYN-C plus UC group scored significantly higher on the QOL-CS total scale (P = 0.02) and on the QOL-CS physical well-being subscale (P = 0.01), compared to women receiving UC alone. After adjusting for baseline scores, only the difference in the physical well-being subscale was statistically significant. No other measured outcomes differed between the intervention and control groups after baseline adjustment.

CONCLUSION

We observed higher physical well-being 9 months after randomization in the GSD-GYN-C group, as compared to women receiving usual care.

IMPLICATIONS FOR CANCER SURVIVORS

The results suggest that the person-centered intervention GSD-GYN-C may improve physical well-being in gynecological cancer survivors. However, further testing is needed.

Abordaje de la ansiedad en pacientes diagnosticados de cáncer

Objetivo: El diagnóstico de cáncer puede ser considerado como un potente estresor que puede provocar reacciones emocionales e incluso trastornos emocionales como por ejemplo, trastornos de ansiedad, del estado de ánimo o trastornos adaptativos. Dada la elevada frecuencia de patología ansiosa en pacientes con diagnóstico de cáncer, nuestro objetivo es revisar la eficacia de los tratamientos psicológicos utilizados para el abordaje de la sintomatología ansiosa en pacientes con cáncer.Método: Se ha realizado una búsqueda bibliográfica en la base de datos PubMed mediante los términos: . Se analizaron artículos científicos publicados desde febrero de 2007 hasta febrero de 2016, con pacientes oncológicos como población diana.Resultados: Se han analizado un total de 40 artículos, con homogeneidad en cuanto a diagnóstico, tipo de cáncer y sexo (mayoritariamente mujeres). 34 de los artículos demuestran ser efectivos en la reducción de la ansiedad. Las más utilizadas fueron el mindfulness, los enfoques cognitivo-conductuales y la relajación. Las terapias complementarias han demostrado resultados variables. Técnicas como el yoga fueron ineficaces.Conclusiones: Existen múltiples opciones no farmacológicas para lograr una reducción de la ansiedad en pacientes oncológicos. La mayoría de técnicas evaluadas demuestran eficacia para reducir la ansiedad e incluso conseguir otros beneficios como la reducción de sintomatología depresiva asociado al nuevo diagnóstico de cáncer o asociado a las intervenciones relacionadas con el cáncer.