Comparison of participants and non-participants in a randomized psychosocial intervention study among patients with malignant melanoma

Effects on long-term survival of psychosocial group intervention in early-stage breast cancer: follow-up of a randomized controlled trial

BACKGROUND

The promise of prolonged survival after psychosocial interventions has long been studied, but not convincingly demonstrated. This study aims to investigate whether a psychosocial group intervention improved long-term survival in women with early-stage breast cancer and investigate differences in baseline characteristics and survival between study participants and non-participants.

METHODS

A total of 201 patients were randomized to two six-hour psychoeducation sessions and eight weekly sessions of group psychotherapy or care as usual. Additionally, 151 eligible patients declined to participate. Eligible patients were diagnosed and treated at Herlev Hospital, Denmark, and followed for vital status up to 18 years after their primary surgical treatment. Cox's proportional hazard regressions were used to estimate hazard ratios (HRs) for survival.

RESULTS

The intervention did not significantly improve survival in the intervention group compared with the control group (HR, 0.68; 95% confidence interval (CI), 0.41-1.14). Participants and non-participants differed significantly in age, cancer stage, adjuvant chemotherapy, and crude survival. When adjusted, no significant survival difference between participants and non-participants remained (HR, 0.77; 95% CI, 0.53-1.11).

CONCLUSIONS

We could not show improved long-term survival after the psychosocial intervention. Participants survived longer than nonparticipants, but clinical and demographic characteristics, rather than study participation, seem accountable for this difference.

Working Conditions and Long-Term Sickness Absence Due to Mental Disorders: A Prospective Record Linkage Cohort Study Among 19- to 39-Year-Old Female Municipal Employees

OBJECTIVE

We examined associations between working conditions and long-term sickness absence due to mental disorders (LTSA-MD) among younger female public sector employees from different employment sectors.

METHODS

Survey data collected in 2017 (n = 3048) among 19- to 39-year-old female employees of the City of Helsinki, Finland, were used to examine job demands, job control, physical workload, computer work, and covariates. Register data on LTSA-MD were used over 1-year follow-up. Negative binomial regression models were applied.

RESULTS

Adverse psychosocial and physical working conditions were associated with higher LTSA-MD during the follow-up. Health and social care workers had the highest number of days of LTSA-MD.

CONCLUSION

Working conditions are important factors when aiming to prevent LTSA-MD among younger employees, in the health and social care sector in particular.

Participation in questionnaire studies among couples affected by breast cancer

OBJECTIVE

Participation bias may be a problem in couple-based psychosocial studies. Therefore, it is important to investigate the characteristics associated with participation. The aim of this study was to analyze whether participation in a longitudinal psychosocial questionnaire study among couples affected by breast cancer was associated with socioeconomic, breast cancer-specific, and other health-related characteristics of the patients and partners.

METHODS

The analyzes are based on 2254 couples who were invited to participate in a nationwide survey on psychosocial adjustment among couples dealing with breast cancer. Participating couples (N = 792) were compared with non-participating couples (N = 1462) with regard to socioeconomic and health-related characteristics obtained from nationwide clinical and administrative registers.

RESULTS

Associations were seen between various socioeconomic variables and couple participation. The patient characteristics older age (OR = 0.15 [95% CI = 0.07-0.55]), low education (OR = 1.95 [95% CI = 1.46-2.68]), disability pension (OR = 0.59 [95% CI = 0.39-0.55]), or non-western ethnicity (OR = 0.36 [95% CI = 0.15-0.82]) reduced couple participation. The partner characteristics older age (OR = 0.23 [95% CI = 0.15-0.43]), low education (OR = 1.67 [95% CI = 1.25-2.22]), receiving disability pension (OR = 0.46 [95% CI = 0.25-0.82]), non-western ethnicity (OR = 0.17 [95% CI = 0.06-0.49]), or high morbidity (OR = 0.76 [95% CI = 0.60-0.96]) also reduced couple participation. Furthermore, couples with low income (OR = 1.49 [95% CI = 1.16-1.95]) had reduced participation. No associations were found between couple participation and breast cancer-related variables.

CONCLUSIONS

Socioeconomic characteristics of patients and partners, and morbidity of partners may influence participation in couple-based psychosocial breast cancer research. Breast cancer-related characteristics do not seem to influence participation.

Psychodynamic interventions in cancer care I: psychometric results of a randomized controlled trial

OBJECTIVE

This study aimed to assess the effectiveness of psychodynamic interventions in cancer care.

METHODS

Between 2006 and 2009, each consecutive outpatient of the Oncology Center of the University Hospital of Lausanne was invited to participate in a trial evaluating the effects of psychological support. Accepting patients were randomly assigned to an immediate intervention or a delayed intervention [4-month waiting list]. Patients who declined support were asked to participate in an observational group [OG]. Socio-demographic and medical data, anxiety, and depression [HADS], psychological distress [SCL-90], alexithymia [TAS] and quality of life [EORTC] were recorded at baseline, and at 1, 4, 8, and 12-months follow-up.

RESULTS

Of the 1973 approached patients, 1057 were excluded, 530 refused, and 386 were included with 196 of them participating in the OG. Of the patients in the intervention group [IG] [N = 190], 94 were randomized to the immediate intervention and 96 to the delayed intervention group (dIG). IG patients were younger, predominantly female, and had more psychological symptoms compared with those in the OG. Although patients of the IG and OG showed significant improvement in quality of life from baseline to 12-months follow-up, other outcomes [anxiety, depression, psychological distress, and alexithymia] remained unchanged.

CONCLUSIONS

The intervention was not effective with regards to psychometric outcome. The results have to be interpreted in light of the study design [untargeted intervention], the low levels of psychiatric symptoms, dropout of symptomatic patients, and the high prevalence of alexithymia.

Social inequality in cancer rehabilitation: a population-based cohort study

OBJECTIVES

In a healthcare system with equal access we analysed possible associations between cancer survivors' socioeconomic status (SES) and their: 1) need for rehabilitation; 2) participation in rehabilitation activities; and 3) unmet needs for rehabilitation in a 14-month period following date of diagnosis.

METHODS

A population-based cohort study including incident cancer patients diagnosed from 1 October 2007 to 30 September 2008 in Denmark. Fourteen months after diagnosis participants completed a mailed out questionnaire developed to measure different aspects and dimensions of rehabilitation. Individual information on cohabitation status, education, income and labour market status was retrieved from national registers. Logistic regression analyses were used to explore associations between socioeconomic status and rehabilitation outcomes.

RESULTS

A total of 3439 patients responded (70%). Significant interactions between SES and sex were demonstrated and further analyses were therefore stratified for gender. In general, women and to a lesser extent men with short education and low income participated less often in activities and had in some areas more unmet needs. Women living alone more often expressed a rehabilitation need in the physical, emotional and financial area and had to a higher extent unmet needs in a number of areas. Men living alone and men outside the workforce had increased odds of unmet needs in the physical area.

CONCLUSIONS

Despite equal access to care, SES had a significant impact on cancer survivors' rehabilitation. In general, the associations were most pronounced for female cancer patients. We suggest that special attention should be paid to socioeconomically disadvantaged groups by taking into account differences in SES in a clinical setting and when developing targeted rehabilitation programmes.

Psychosomatic services for melanoma patients in tertiary care

BACKGROUND

Individuals diagnosed with malignant melanoma face significant practical and psychological challenges, including existential fears and pain and discomfort associated with treatment. To enhance psychological adjustment, patients receive psychosomatic-psychotherapeutic consultation-liaison services (CLS) within the general medical hospital. However, little is known about the use of these services in routine clinical care.

METHODS

This study includes all patients referred to the CLS of a large German tertiary care hospital between 2005 and 2008 (n=3658). Data were recorded using the CL-BaDo form - a multicenter documentation form for the assessment of clinical characteristics of patients and CLS delivery. Descriptive and inferential statistics were employed to compare patients with melanomas and patients with other dermatological diseases.

RESULTS

Dermatologists requested CLS more often for other dermatology patients than for patients with melanoma. These two groups also differed in the reasons for referral: patients with melanoma were referred more often for acute coping issues; other dermatology patients were referred more often for unexplained physical symptoms. Additionally, the latter group was diagnosed with more and different mental and behavioral disorders. Patients with melanomas received more psychotherapeutic interventions while admitted to hospital but fewer recommendations for further psychosocial treatment after their hospital stay.

CONCLUSION

These findings highlight the need for professional psychosocial support in individuals diagnosed with melanoma - especially when first diagnosed or experiencing a recurrence. Dermatologists play a crucial role in identifying their patients' needs and in navigating them toward available support services.

The effectiveness of psychosocial interventions with cancer patients: an integrative review of the literature (2006-2011)

Background. Previous integrative literature reviews and meta-analyses have yielded conflicting results regarding the effectiveness of psychosocial interventions for cancer patients. Methods. An integrative review of the literature focused on 19 randomized, controlled trials (2006-2011) was completed to examine the effectiveness of psychosocial interventions for cancer patients.

ELIGIBILITY CRITERIA

Inclusion criteria were the study was an English language randomized controlled clinical trial. Results. Seven studies involved nurses. Eleven studies resulted in positive outcomes. Overall, study quality was limited. In eight studies the intervention was not adequately described, 7 studies did not contain a hypothesis, 4 did not include clear eligibility criteria, 10 studies did not randomize appropriately, 9 did not list recruitment dates, 11 did not include a power analysis, 14 did not include blinded patients or data collectors, 11 did not use an intent-to-treat analysis, 10 did not clarify reasons for drop outs, and 11 did not discuss treatment fidelity. Conclusions. Future studies should build on previous findings, use comparable outcome measures, and adhere to standards of quality research. Qualitative studies are needed to determine what cancer patients of varied ages, cancer stages, and racial/ethnic backgrounds believe would be an effective intervention to manage their psychosocial needs.

Inequalities in therapeutic treatment during cardiac inpatient rehabilitation in Germany

OBJECTIVE

Cardiac patients of low socio-economic status (SES) display low health status and increased need for rehabilitation. This study's objective was to examine whether and to what extent inequalities in the provision of rehabilitative health care occur in Germany.

METHODS

We conducted an observational study with two points of measurement on 543 patients in cardiac inpatient rehabilitation. We used logistic regression and analysis of covariance to explore whether patients experience unequal therapeutic rehabilitative treatment.

RESULTS

Patients of low SES were less frequently physically active, more likely to smoke and displayed a higher number of physical and psychological symptoms when entering rehabilitation. They were less likely to receive a number of therapies with differences being significant for core therapies of cardiovascular rehabilitation. Patients of higher SES received fewer hours of dietary counselling on average.

CONCLUSIONS

While the latter difference might be in line with the needs of different socio-economic groups, most differences are unlikely to be tailored to patients' needs. Potential causes of inequalities in service provision like structural factors and aspects of the doctor-patient encounter should be further investigated.

Comparison of participants and non-participants in a randomized study of prevention of depression in patients with acute coronary syndrome

BACKGROUND

The prevalence of depression and anxiety in patients after acute coronary syndrome (ACS) is higher than in the general population. In a study on prevention of post-ACS depression, more than half of eligible patients declined participation.

AIMS

The aim of this study was to evaluate whether symptoms of depression and anxiety in participants and non-participants predicted participation in the study.

METHODS

This substudy was conducted between May 2005 and April 2007. Patients with ACS, eligible for the study (n=302) were asked four questions on depression and anxiety from the Primary Care Evaluation of Mental Disorders (PRIME-MD) screening questionnaire.

RESULTS

The PRIME-MD screening data were available on 232 patients (76.8% of eligible patients). Thirty-eight (35.5%) of 107 participants and 30 (24.0%) of 125 non-participants had a positive screening for depression (NS), and 47 (43.9%) participants and 55 (44%) non-participants were screened positive for anxiety (NS). Non-participants were older (P=0.002), while no significant differences in gender or cardiac diagnosis were found.

CONCLUSIONS

Symptoms of depression and anxiety were highly prevalent in patients after ACS but did not predict participation in the study of prevention of depression.

Cancer-related psychosocial research: what are the perspectives of cancer care centre users on participation?

PURPOSE

To explore the perspectives of cancer care centre users on participation in psychosocial research to inform research design and ethics.

METHODS

The study is based on a qualitative research design. Fourteen semistructured interviews were carried in people diagnosed with cancer and carers. The interview included four main questions about practical barriers to participation, types of research design, motivating factors and the conduct of research in a cancer care support setting. The data were analysed using qualitative content analysis.

RESULTS

Interviewees demonstrated a willingness to participate in psychosocial research within certain circumstances. There were no practical barriers identified, although they considered payment for research-related travel important. The most acceptable research design was the face-to-face interview and the least preferred was the randomised control trial. The factors that motivated participation were altruism, valuing research, and making a contribution to the centre. Interviewees supported the conduct of research in cancer care support centres conditional upon delaying recruitment during the initial months of users' visits and its need to be discreet to avoid deterring visitors from accessing the centre.

CONCLUSIONS

The study concludes that the personal interaction between participants and researchers is the most important feature of decision-making by patients/carers to join studies. Taking into account the perspectives of people affected by cancer during the early stages of research design may enhance recruitment and retention and can contribute to the development of research protocols and ethics.

Selection by socioeconomic factors into the Danish National Birth Cohort

BACKGROUND

Low participation at recruitment to the Danish National Birth Cohort (DNBC) has raised concern about non-participation bias. Objective To study the socioeconomic pattern of participation to the DNBC.

METHODS

Independently of the DNBC, we identified the DNBC source population in two geographical areas of Denmark by means of local birth registers with full coverage. Socioeconomic information came from national registers, and the source population consisted of 48,560 births including 15,290 participating women. For every socioeconomic characteristic, we estimated the prevalence ratio [prevalence (participants)/prevalence (source population)] which corresponds to the relative representation of the group (presented in percentages with 95% confidence intervals).

RESULTS

The overall participation rate was 31%. Women outside the work force or with no further education than compulsory school were underrepresented in the DNBC by 62% (59%; 64%) and 43% (41%; 45%), respectively. Also, women were underrepresented by 18% (13%; 23%) if they were unemployed, by 22% (20%; 24%) if they were in the lowest income group, 38% (35%; 40%) if they received a high proportion of social benefits, and 28% (24%; 31%) if they were singles. Particularly women with low resources according to two socioeconomic factors were strongly underrepresented, typically by 50-67%.

CONCLUSION

Groups with low socioeconomic resources in terms of education, occupation, income and civil status are underrepresented in the DNBC compared to the background population. These discrepancies must be taken into account when results from the DNBC and other cohorts of pregnant women are interpreted-especially when descriptive results are presented.

Psychosocial outcomes and service use among young adults with cancer

At the crossroads between pediatric and older adult groups, young adults with cancer may be underserved or inadequately or inappropriately served by existing support services. Empirical evidence has not established well the extent to which utilization of psychosocial support services delivered throughout a continuum of care results in desired outcomes. If self-efficacy is demonstrated to play a significant role in promoting quality of life and psychological well-being in young adult cancer patients, then a cancer-specific self-efficacy model can serve as an evidence-based framework for developing, implementing, and testing new interventions. A focus on self-efficacy has the potential to promote young adults' abilities to remain active and independent, seek and understand medical information, manage stress, cope with treatment-related side effects, maintain a "positive attitude," regulate emotions, and seek social support. Future research should aim to identify which patients represent at-risk targets for intervention, as well as the most appropriate time points along the continuum of care at which patients/survivors are most likely to benefit from delivery/utilization of psychosocial support services.

Quantifying the recruitment challenges with couple-based interventions for cancer: applications to early-stage breast cancer

OBJECTIVE

Despite mounting evidence supporting the use of psychosocial interventions to promote adaptation to cancer, enrolling participants into these interventions is challenging. This is particularly salient for couple-based interventions, and newer, more targeted recruitment strategies to increase enrollment are needed. However, there have been few published empirical studies focused specifically on recruitment-related variables associated with enrollment into these types of interventions. To better understand how to encourage participation in couple-based psychosocial interventions for cancer, we examined facilitating and impeding factors to enrollment into a couple-based intervention for women with early-stage breast cancer.

METHOD

In this sample of 99 women diagnosed with early-stage breast cancer, patient demographic variables and method of approaching eligible patients were examined as predictors of enrollment into a randomized controlled trial comparing couple-based relationship enhancement with treatment as usual.

RESULTS

Results indicated that women were more likely to enroll if they were contacted at home or at a follow-up medical appointment rather than when first diagnosed at a busy multidisciplinary clinic; they were also more likely to enroll the closer they lived to the research facility.

CONCLUSIONS

In addition to decreasing participant burden, timing and setting of recruitment efforts may have important implications for enhancing participation rates in couple-based intervention studies for cancer.

Social and psychological determinants of participation in internet-based cancer support groups

PURPOSE

In this study, we identified the social and psychological characteristics of Danish cancer patients that determine use of the internet for support.

MATERIALS AND METHODS

We invited 230 cancer patients taking part in a public rehabilitation program to participate in an internet module comprising training in the retrieval of cancer-related information from the internet and self-support groups. Persons who were motivated to join the internet groups (N = 100; 47%) were compared with persons who chose not to participate (N = 111) on the basis of self-reported baseline questionnaire data. Nineteen persons either did not return the questionnaire or had missing values in confounding variables.

RESULTS

Cancer patients who were motivated to participate in internet support groups belong to higher socioeconomic groups (based on household income and employment) compared to non-participants. We observed no difference between the two groups in quality of life or psychological well-being, while coping to some extent seemed related to participation in internet support groups.

CONCLUSION

This study adds to the discussion on social inequality in internet use by cancer patients, showing that patients who are not inclined to use internet-based interventions are characterized by social position and employ more passive coping strategies.

Impact of psychotherapy on cancer survival: time to move on?

PURPOSE OF REVIEW

The effect of psychotherapy on the survival of cancer patients has been debated for the past 20 years, mainly due to contradictory findings in the studies published so far. Several reviews have been published, almost all of which criticize the methods used in the studies. In 2007, three replication studies were published, which indicate that the hypothesis that psychotherapy prolongs life should be abandoned. The purpose of the present review of randomized studies of psychosocial intervention is to determine the strength of the evidence for enhanced survival after participation in psychosocial interventions.

RECENT FINDINGS

Three recently published replication studies, which addressed a number of the methodological flaws of earlier studies, did not report better survival among the patients receiving the intervention than among those in the control group.

SUMMARY

The hypothesis that psychotherapy enhances survival should be abandoned in the light of the latest replication studies, which show null results for improved survival after psychotherapy. The evidence to date points to a need for investigating the interactions between the medical, psychological, social and health behaviour components of intervention programmes, as recently published studies indicate reduced mortality among patients who engage in physical activity and change to a healthier diet.