Mental distress and need for psychosocial support in prostate cancer patients: An observational cross-sectional study

Psychometric Properties of a Turkish Version of The Psychosocial Needs Inventory; Sampling from Oncology Patients

OBJECTIVES

This study aimed to assess the reliability and validity of the Psychosocial Needs Inventory (PNI) among Turkish oncology patients.

METHODS

A methodological study was conducted with 1,547 oncology patients. This validation study was divided into two phases. Phase 1 included translation of the PNI according to World Health Organization recommendations, investigation of content validity by experts, and a pilot study involving 136 participants. Phase 2 included a validity and reliability analysis of the PNI. Data analysis comprised exploratory (EFA) and confirmatory factor analyses (CFA), Cronbach's alpha, test-retest reliability, Hotelling's T2 test and item-total score correlation, and the Content Validity Index (CVI).

RESULTS

For the phase 1, the CVI for items and scale were >.75 and .883, respectively. Cronbach's alpha values of the subdimensions ranged between 0.84 and 0.94. The test-retest analyses of the subdimensions showed correlation coefficients based on the pilot test (p < .001). For the phase 2, based on the fit indices in confirmatory factor analysis, the structures of the dimensions "Importance" and "Satisfaction" were acceptable. Cronbach's alpha values of the subdimensions ranged between 0.84 to 0.94 in the "Importance" dimension and 0.86 to 0.94 in the "Satisfaction" dimension. As a result of EFA, the Kaiser-Meyer-Olkin, Bartlett's test (p < 0.001) and PNI Importance explained at 68.46% and PNI Satisfaction at 70.15% of the total variance by the six-factor structure. CFA showed that the indices and validity, including content validity, convergent validity were satisfactory.

CONCLUSION

The PNI, which was found to be a valid and reliable measurement tool, can be used to determine the psychosocial needs of cancer patients.

IMPLICATIONS FOR NURSING PRACTICE

Health professionals need to use the PNI to measure their importance to cancer patients' psychosocial needs and assess their satisfaction with meeting them to improve holistic care and support.

Psychosocial distress and psychosocial resources in couples facing non-melanoma skin cancers and malignant melanoma

BACKGROUND

Skin cancer is the most common cancer worldwide and comprises various non-melanoma skin cancer (NMCS) diagnoses and malignant melanoma (MM). It places a psychological burden on patients and their spouses. The present study aims to investigate psychological distress, temporal changes of psychosocial resources (PR), as well as dyadic dynamics of psychological distress and PR in patients with NMSC or MM and their spouses.

METHODS

Fifty-four heterosexual couples with different skin cancers, diagnosed within the previous 12 months, participated in this quantitative cross-sectional study. Patients and spouses provided information about depression and anxiety (Hospital Anxiety and Depression Scale), PR within the last four weeks and last three years (Essen Resource Inventory), and partnership quality (Partnership Questionnaire, short version). Dyadic dynamics were analyzed with multiple regression analyses.

RESULTS

We found similar distress levels in patients and spouses, as well as in patients with different skin cancers. Spouses from patients with MM reported significant higher distress levels than spouses from patient with NMSC. Patients' depression predicted spouses' depression, and spouses' anxiety predicted patients' anxiety. In patients, we found associations between personal resources (within the last four weeks and three years) and depression, and an association between patients' social resources (within the last three years) and spouses' depression.

CONCLUSIONS

The psychological interdependencies between patients' and spouses' depression and anxiety highlight the importance of considering psychological distress in patients with different skin cancers from a dyadic perspective in clinical contexts. Further, personal resources were indicated as a "distress buffer" for patients' mental health. Our results underline the importance of couple interventions that activate PR in patients with cancer and their spouses.

Identification of distinct symptom profiles in prostate cancer patients with cancer-related cognitive impairment undergoing androgen deprivation therapy: A latent class analysis

Objective

To identify latent classes of cognitive impairment and co-occurring symptoms (fatigue, pain, sleep disturbance, depression) as clusters in patients with prostate cancer undergoing androgen deprivation therapy and to explore the predictors among distinct latent classes.

Methods

A total of 228 patients with prostate cancer were recruited in this cross-sectional study. The assessment instrument included the Perceived Cognitive Impairment Scale, the Fatigue Severity Scale, the Athens Insomnia Scale, the Brief Pain Inventory, the Patient Health Questionnaire-9, the UCLA Loneliness Scale, the International Physical Activity Questionnaire - Short Form, the Charlson comorbidity index, and General Information questionnaire. The identification of different patient subgroups was done by the latent class analysis.

Results

The study identified three distinct latent classes: all low symptoms (class 1, 32%), high depression symptoms (class 2, 37.7%), and high physical symptoms (fatigue, sleep disturbance, and pain) with high cognitive impairment (class 3, 30.3%). Patients who had higher Charlson comorbidity index (P = 0.003) scores were more likely to be classified in class 3. Patients with higher loneliness scores (P < 0.001; P < 0.001) were significantly more likely to fall into class two or three than in class 1. However, having a higher level of physical activity (P = 0.014; P < 0.001) increased the likelihood of being in class 1.

Conclusions

This study exhibited the inter-individual variability of symptom experience in prostate cancer patients with cognitive impairment undergoing androgen deprivation therapy. The result suggests that more emphasis should be placed on screening for fatigue, sleep disturbance, and pain, and future interventions should focus on loneliness and physical activity.

Analysis of distress in patients undergoing radical prostatectomy: A multicenter prospective study

PURPOSE

To analyze the degree of psychological distress experienced pre- and postoperatively in patients who underwent radical prostatectomy after being diagnosed with prostate cancer.

MATERIALS AND METHODS

Patients diagnosed with prostate cancer who underwent radical prostatectomy without history of psychiatric disorders were included in this study. The degree of psychological distress was evaluated using hospital anxiety and depression scale (HADS) and distress thermometer (DT) questionnaires preoperatively and at 1, 3, 6, and 12 months postoperatively.

RESULTS

Distress was high preoperatively and decreased over the entire period. In addition, HADS-anxiety and HADS-depression scores showed an improved severity, shifting from an abnormal state to a borderline state in some patients. However, the DT score, including emotional problems, spiritual concerns, physical problems, family problems, and practical problems, was slightly higher at 1 month postoperatively compared to preoperatively. Furthermore, even at 12 months postoperatively, about one fifth of patients surveyed had a DT score of 4 or higher, requiring psychiatric intervention.

CONCLUSIONS

Before and after radical prostatectomy, a significant number of patients complained of distress such as anxiety, depression, and insomnia, and they needed help from a specialist because of psychological distress even 12 months postoperatively. Therefore, a close evaluation of the patient's psychological distress and supportive treatment are needed during the entire pre- and postoperative period.

Falling off the screening grid-Predictors for postponed utilization of psycho-oncological support in cancer patients and its implications for distress assessment and management

OBJECTIVE

Distress assessment of cancer patients is considered state-of-the-art. In addition to distress scores, individual care needs are an important factor for the initiation of psycho-oncological interventions. In a mono-centric, observational study, we aimed for characterization of patients indicating a subjective need but declining to utilize support services immediately to facilitate implementation of adapted screenings.

METHODS

This study analyzed retrospective data from routine distress screening and associated data from hospital records. Descriptive, variance and regression analyses were used to assess characteristics of postponed support utilization in patients with mixed cancer diagnoses in different treatment settings.

RESULTS

Of the total sample (N = 1863), 13% indicated a subjective need but postponed support utilization. This subgroup presented as being as burdened by symptoms of depression (p < 0.001), anxiety (p < 0.001) and distress (p < 0.001) as subjectively distressed patients with intent to directly utilize support. Time periods since diagnosis were shorter (p = 0.007) and patients were more often inpatients (p = 0.045).

CONCLUSIONS

Despite high heterogeneity among the subgroups, this study identified distress-related factors and time since diagnosis as possible predictors for postponed utilization of psycho-oncological interventions. Results suggest the necessity for time-individualized support which may improve utilization by distressed patients.

Patient's Desire and Real Availability Concerning Supportive Measures Accompanying Radical Prostatectomy: Differences between Certified Prostate Cancer Centers and Non-Certified Centers Based on Patient-Reported Outcomes within the Cross-Sectional Study Improve

Certification as a prostate cancer center requires the offer of several supportive measures to patients undergoing radical prostatectomy (RP). However, it remains unclear how patients estimate the relevance of these measures and whether the availability of these measures differs between certified prostate cancer centers (CERTs) and non-certified centers (NCERTs). In 20 German urologic centers, a survey comprising questions on the relevance of 15 supportive measures was sent to 1000 patients at a median of 15 months after RP. Additionally, patients were asked to rate the availability of these measures using a four-item Likert scale. The aim of this study was to compare these ratings between CERTs and NCERTs. The response rate was 75.0%. In total, 480 patients underwent surgery in CERTs, and 270 in NCERTs. Patients rated 6/15 supportive measures as very relevant: preoperative medical counselling concerning treatment options, a preoperative briefing answering last questions, preoperative pelvic floor exercises (PFEs), postoperative PFEs, postoperative social support, and postoperative rehabilitation addressing physical fitness recovery. These ratings showed no significant difference between CERTs and NCERTs (p = 0.133-0.676). In addition, 4/9 of the remaining criteria were rated as more detailed by patients in CERTs. IMPROVE represents the first study worldwide to evaluate a patient-reported assessment of the supportive measures accompanying RP. Pertinent offers vary marginally between CERTs and NCERTs.

Effect of depression, anxiety, and distress screeners on the need, intention, and utilization of psychosocial support services among cancer patients

PURPOSE

In clinical cancer care, distress screening is recommended to identify highly burdened patients in objective need for psychosocial support to improve psychological distress and quality of life and to enhance patient empowerment. It is however unclear whether distress screeners are suitable for psychosocial care planning and thus whether they can predict the willingness that is need, intention, and utilization, to seek psychosocial support.

METHODS

In a secondary analysis of a cluster intervention study, we assessed cancer patients with three distress screeners (DT, PHQ-9, GAD-7) at baseline. The willingness to seek psychosocial support services was assessed binary for psychosocial services at 3 and 6 months. Logistic regression models were applied to examine the predictive effect of the screeners on need, intention, and utilization. We corrected all models for multiple testing.

RESULTS

The 660 patients included in the study were on average 60 years, 54% were male. At the 3- and 6-month follow-up, 353 and 259 patients participated, respectively. The screeners were best in predicting the need for support (OR reaching up to 1.15, 1.20, and 1.22 for the PHQ-9, GAD-7, and DT respectively). The intention was predicted by the PHQ-9 and GAD-7, whereas utilization of psychosocial support services was not predicted by the screeners.

CONCLUSION

The three distress screeners might be useful in psychosocial care planning, as they are able to predict the need and to some degree the intention to seek psychosocial support. Future research needs to examine potential barriers and supporting factors that may explain utilization of psychosocial support.

TRIAL REGISTRATION

The study was retrospectively registered (2/2021) at ClinicalTrials.gov (number: NCT04749056).

Health-related quality of life of advanced prostate cancer patients and spouses: results from actor-partner interdependence models

Background

Patients with prostate cancer (PC) and their spouses are confronted with several treatment-related and psychosocial challenges that can reduce their health-related quality of life (HRQoL). Patients with advanced PC (aPC) and their spouses are at highest risk for psychological distress and show lower HRQoL compared with couples in other phases. The aim of this study was to investigate the psychological interdependencies between HRQoL and anxiety, fear of progression (FoP), and depression in patients with aPC and their spouses.

Methods

Ninety-six heterosexual couples with aPC participated in this cross-sectional study. Patients and spouses provided information about anxiety and depression (Patient Health Questionnaire-4), fear of progression (short form of the Fear of Progression Questionnaire), and HRQoL (EORTC QoL-C30, version 3). Psychological interdependencies were analyzed with various actor-partner interdependence models using structural equation modeling.

Results

Anxiety, FoP, and depression were significant predictors of HRQoL for patients with aPC and their spouses (actor effects). Spouses’ anxiety and FoP were negatively associated with patients’ HRQoL (partner effects), showing that patients’ HRQoL is associated with their own and their spouses’ anxiety and FoP. No partner effect was revealed between depression and HRQoL in the patients or spouses.

Conclusions

The resulted partner effects between spouses and patients underline the importance of considering HRQoL in patients with aPC from a dyadic perspective. It is important that physicians explore patients’ and spouses’ needs and psychological burden to offer support and access to psycho-oncological services. Future studies are needed to investigate the effects of suitable interventions on spouses’ anxiety and FoP.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07100-8.

What interventions affect the psychosocial burden experienced by prostate cancer patients undergoing active surveillance? A scoping review

PURPOSE

Living with untreated prostate cancer (PCa) may cause anxiety and uncertainty in men undergoing active surveillance (AS). Developing a psychosocial support program for such patients might promote psychosocial well-being and patient engagement. This review aims to identify interventions with the potential to influence the psychosocial burden of prostate cancer patients undergoing AS.

METHODS

A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews Checklist. A systematic search was conducted in six databases and included publications dating from 2009. All available and eligible evidence was included in this review.

RESULTS

After screening 2824 articles, 12 studies were included in the review: nine quantitative, one qualitative, and two mixed method papers. The relative strength of these studies was limited and the quality of most was moderate.

CONCLUSIONS

The described interventions can be categorized into three major themes: information and education, coping and (psycho)social support, and lifestyle. Psychosocial support for men undergoing AS should entail involvement of family and spouse during the decision-making process, tailored information about PCa treatments, risks, benefits, protocols, lifestyle adjustments, and complementary and alternative medicine. Assessment and promotion of effective coping and self-management strategies are recommended. Healthcare providers should actively promote physical activity and nutritional improvements. Physical activity programs may also be helpful in facilitating peer support, which is especially important for men with limited social support. Future research should investigate combining interventions to increase efficacy and optimize supportive care during AS.

Screening for Psychological Distress in Vietnamese Cancer Patients: An Evaluation of the Distress Thermometer

Background

Psychological distress is prevalent in patients with cancer, negatively affecting their treatment and quality of life. Clinical guidelines recommended screening all cancer patients routinely for psychological problems using simple measures such as the Distress Thermometer (DT) and Problem List (PL). This study is the first research in Vietnam to identify the optimal DT cutoff point to screen distress and the relationship with PL items among cancer patients.

Methods

300 cancer patients were recruited from 10 departments at Vietnam National Cancer Hospital (K hospital) and completed the DT and PL. Participants also completed the Patient Health Questionnaire‐9 (PHQ‐9) and the Generalized Anxiety Disorder‐7 (GAD‐7) with standard cutoff scores for identifying significant depression and anxiety.

Results

Receiver operating characteristic (ROC) curve analyses showed that a DT cutoff score of 4 had an area under the ROC curve of 0.81 and 0.82 using the PHQ‐9 and GAD‐7 cutoff scores of 10 as the criterion, respectively. This indicated good overall accuracy. This cutoff also showed a sensitivity of 0.87 and 0.92 for PHQ‐9 and GAD‐7 total score defined cases, respectively. Both specificity values were 0.58. In terms of the PL, 164 distressed patients (54.7%) reported significantly more emotional problems, family issues, and practical and physical problem, implying various causes contribute to psychological distress among cancer patients.

Conclusions

The study showed that the DT with a cutoff of 4 accompanied with PL is a simple and effective instrument compared to previous, longer measures commonly used to detect psychosocial distress in Vietnamese cancer patients. This cutoff point also identified patients with problems contributing towards distress.