Symptom Frequencies and Intensities in Hospitalized Patients With Advanced Cancer Having Depressive Disorder

Psychiatric Comorbidities and Outcomes in Palliative and End-of-Life Care: A Systematic Review

BACKGROUND

Although psychiatric comorbidities are common among individuals at end of life, their impact on outcomes is poorly understood.

METHODS

We conducted a systematic literature review of six databases following preferred reporting items for systematic reviews and meta-analyses guidelines and aimed at assessing the relationship between psychiatric comorbidities and outcomes in palliative and end-of-life care. Six databases were included in our search. This review is registered on PROSPERO (CRD42022335922).

RESULTS

Our search generated 7472 unique records. Eighty-eight full texts were reviewed for eligibility and 43 studies were included in the review. Clinically, psychiatric comorbidity was associated with poor quality of life, increased physical symptom burden, and low function. The impact of psychiatric comorbidity on health utilization varied, though many studies suggested that psychiatric comorbidity increased utilization of palliative care services. Quality of evidence was limited by lack of consistent approach to confounding variables as well as heterogeneity of the included studies.

CONCLUSION

Psychiatric comorbidity is associated with significant differences in care utilization and clinical outcome among patients at end of life. In particular, patients with psychiatric comorbidity and serious illness are at high risk of poor quality of life and high symptom burden. Our finding that psychiatric comorbidity is associated with increased utilization of palliative care likely reflects the complexity and clinical needs of patients with serious illness and mental health needs. These data suggest that greater integration of mental health and palliative care services may enhance quality-of-life among patients at end of life.

Hope and depression: the mediating role of social support and spiritual coping in advanced cancer patients

BACKGROUND

Depression is the most common mental disorder in patients with advanced cancer, which may lead to poor prognosis and low survival rate. This study aims to explore the serial multiple mediating roles of social support and spiritual coping between hope and depression among patients with advanced cancer.

METHODS

A cross-sectional study was conducted in China between May and August 2020. A total of 442 advanced cancer patients were investigated by the following self-reported questionnaires: Herth Hope Index (HHI), Spiritual Coping Questionnaire (SCQ, Chinese version), Social Support Rating Scale (SSRS), Hospital Anxiety and Depression Scale (HADS).

RESULTS

Depression was negatively correlated with hope, social support, and positive spiritual coping (P < 0.01), and positively correlated with negative spiritual coping (P < 0.01). Hope explained 16.0% of the variance in depression. Bootstrap analyses of the hope--social support--positive spiritual coping--depression showed that there were direct [B = -0.220, 95%CI(- 0.354, - 0.072)] and indirect effects of hope on depression mediated solely by social support [B = -0.122, 95%CI(- 0.200, - 0.066)] and positive spiritual coping [B = -0.112, 95%CI(- 0.217,-0.025)], or by both together [B = -0.014, 95%CI(- 0.038,-0.003)]. Similarly, the hope--social support--negative spiritual coping--depression showed that there were direct [B = -0.302, 95%CI(- 0.404, - 0.190)] and indirect effects of hope on depression mediated solely by social support [B = -0.126, 95%CI(- 0.205, - 0.071)] and negative spiritual coping [B = -0.033, 95%CI(- 0.080,-0.002)], or by both together [B = -0.010, 95%CI(- 0.030,-0.001)].

CONCLUSIONS

This study proves the hypothesis that social support and spiritual coping play intermediary roles between hope and depression. Interventions established through hope, social support and spiritual coping can effectively prevent depression from occurring.

Intrathecal Morphine Delivery at Cisterna Magna to Control Refractory Cancer-Related Pain: A Prospective Cohort Study

Background

For patients suffering from primary or metastatic cancer above the middle thoracic vertebrae, refractory pain management still remains a great challenge. Theoretically, inserting a catheter tip into the cisterna magna may be a promising solution. However, at present, there have been no reliable data regarding this novel technique. We therefore investigated the efficacy and safety of an advanced approach for pain relief in a specific population.

Methods

Thirty participants from two hospitals received the intrathecal deliveries of opioid to either one of two sites: cisterna magna (n = 15) or lower thoracic region (n = 15). Pain relief (visual analogue scale, VAS), quality of life (short form (36) health survey, SF-36) as well as depression (self-rating depression scale, SDS) were assessed in the follow-up visits and compared between the two groups.

Results

Patients receiving intrathecal morphine delivery to cisterna magna achieved greater pain improvement indicated as significant decrease of VAS scores at day 1 and 7, and achieved better improvement in physical function (day 7 and 30), role physical (day 7 and 30), body pain (day 7, 30 and 90), general health (day 7, 30 and 90), vitality (day 7, 30 and 90), social function (day 90), role emotional (day 7 and 90), mental health (day 7, 30 and 90) and SDS (day 1 and 7).

Conclusions

Intrathecal morphine delivery to cisterna magna might be an effective and safe technique for patients suffering from cancer at the middle thoracic vertebrae or above to control refractory pain. Trial registration: No. ChiCTR-ONN-17010681.