Assessment of mental health literacy in patients with breast cancer

Patients' and clinicians' knowledge in cancer-related cognitive impairment and its implications: current perspective

Health literacy is essential in cancer care. Low health literacy compromises the capacity to maintain one's health through self-management and collaboration with healthcare providers, especially when facing cognitive side effects related to cancer and its treatments. Cancer-related cognitive impairment (CRCI) is a common phenomenon among cancer patients and might determine a significant impact on their quality of life, yet it is still under identified by both clinicians and patients. This perspective aims to discuss the implications of patients' and healthcare professionals' lack of awareness on the matter and argues about the importance of improving the level of information on CRCI to mitigate difficulties in identifying and managing such manifestations on various levels.

Implementing a community-based shared care breast cancer survivorship model in Singapore: a qualitative study among primary care practitioners

Background

The adaptability of existing recommendations on shared care implementation to Asian settings is unknown. This qualitative study aims to elicit public- and private-sectors primary care practitioners’ (PCPs) perspectives on the sustainable implementation of a shared care model among breast cancer survivors in Singapore.

Methods

Purposive sampling was employed to engage 70 PCPs from SingHealth Polyclinics, National University Polyclinics, National Healthcare Group Polyclinics, and private practice. Eleven focus groups and six in-depth interviews were conducted between June to November 2018. All sessions were audio-recorded and transcribed verbatim. Guided by the RE-AIM framework, we performed deductive thematic analysis in QSR NVivo 12.

Results

PCPs identified low-risk breast cancer survivors who demonstrated clear acceptability of PCPs’ involvement in follow-up as suitable candidates for shared care. Engagement with institution stakeholders as early adopters is crucial with adequate support through PCP training, return pathways to oncologists, and survivorship care plans as communication tools. Implementation considerations differed across practices. Selection of participating PCPs could consider seniority and interest for public and private practice, respectively. Proposed adoption incentives included increased renumeration for private PCPs and work recognition for public PCPs. Public PCPs further proposed integrating shared care elements to their existing family medicine clinics.

Conclusions

PCPs perceived shared care favorably as it echoed principles of primary care to provide holistic and well-coordinated care. Contextual factors should be considered when adapting implementation recommendations to Asian settings like Singapore. With limited competitive pressure, the government is then pivotal in empowering primary care participation in survivorship shared care delivery.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01673-3.

A qualitative exploration of mental health knowledge among pediatric health professionals in the United Arab Emirates

BACKGROUND

Mental health literacy (MHL) is an essential competency for all healthcare professionals. In the United Arab Emirates, previous studies reported a low level of MHL among healthcare professionals working with vulnerable populations such as children and adolescents with chronic illnesses. Further in-depth exploration is necessary to build understanding of beliefs and knowledge about mental illness among pediatric health professionals.

METHODS

Written narratives exploring mental health knowledge were collected from pediatric nurses and analyzed using content analysis. These written narratives were extracted from responses to open-ended questions embedded in a questionnaire completed as part of previous studies. The Standards for Reporting Qualitative Research were followed in reporting this study.

RESULTS

The overarching theme that emerged from the data was that nurses struggled to negotiate the complexities of psychological distress and mental illness. Two overlapping sub-themes were identified: (1) professional knowledge was incomplete, confused, and lacking in clarity and (2) professional knowledge was impacted by cultural beliefs and stigma. A third sub-theme reflected how participants identified with others' suffering and felt powerless to help themselves or others. Participants described stress and mental exhaustion.

CONCLUSIONS

Participants' narratives were characterized by struggles arising from insufficient knowledge, confusion, and deeply-held cultural and religious beliefs. Therefore, they were unable to resolve the conflict between professional knowledge, attitudes, and beliefs about mental illness and stigma arising from cultural and religious beliefs/attitudes. Culturally-specific education is needed for healthcare professionals that addresses contextual, cultural, and religious factors impacting on stigma while actively supporting the healthcare workforce and enabling access to mental health services.

Attention Dysregulation in Breast Cancer Patients Following a Complementary Alternative Treatment Routine: A Double-Blind Randomized Trial

Introduction:

Breast cancer patients and survivors frequently report fatigue, emotional, and cognitive disturbances, which reduce performance at all levels of occupation and make life quality issues a considerable clinical concern. The aim of this study is to evaluate attention and emotion regulation across radiotherapy period and the possible effects of complementary alternative medicine (CAM).

Methods:

Fifty-seven patients with unilateral breast cancer underwent surgery and systemic chemotherapy before participating in this double-blind randomized study. Two thirds were given CAM (n = 38) while the rest received placebo (carrier only, n = 19). Patients’ attention and anxiety were physiologically tested at baseline, 2 and 4 weeks during the radiation period as well as 1-month after the end of radiation session.

Results:

Both groups showed similar levels of anxiety with no significant differences at baseline nor post-radiotherapy. Long-term significant recovery of attention performance was observed in the CAM patients, accompanied by a similar tendency in anxiety level, measured by the eye-blink probability.

Conclusions:

This study physiologically validates the attention impairment reported among breast cancer survivors; also, it depicted a beneficial late-effect of a routine CAM on attention dysregulation. The suggested non-invasive physiological measures can physiologically monitor patients’ psychological and cognitive well-being as well as evaluate the beneficial effect of CAM in breast cancer patients by assessing their coping ability to support the treatment plan. Thus, the results have potential clinical implications on patients’ and survivors’ quality of life.

Trial Registration:

NIH, NCT02890316. Registered July 2016, http://www.ClinicalTrials.gov

Understanding help-seeking behaviour in relation to psychosocial support services among Japanese cancer patients

BACKGROUND

There are various psychosocial support services for cancer patients in Japan; however, their utilization rate is lower than in Western countries. The aim of this study was to investigate the actual status of the utilization of such services and the related factors of their use, using the transtheoretical model.

METHODS

We conducted an Internet survey of cancer outpatients. They were asked for information on their demographics, physical status and the usage of and intention to use psychosocial support services, and to answer the Hospital Anxiety and Depression Scale.

RESULTS

Data of 712 participants were analyzed; 111 had made use of psychosocial support services (15.6%). Participants who were younger, female, had breast cancer, experience with hormone therapy and did not have a good performance status (Karnofsky Performance Scale) more often used such services when comparing users/experiencers with non-users/inexperienced. Of the inexperienced, 538 were in the Precontemplation stage (89.5%), 62 were in the Contemplation stage (10.3%) and one was in the Preparation stage (0.2%). Approximately 35% of those in the Precontemplation stage would correspond to adjustment disorders or major depression.

CONCLUSIONS

We showed the degree of cancer patients who have used the psychosocial support services and its contents and revealed the factors related to the utilization of such services in Japan. Our study supports previous reports that cancer patients with high levels of distress do not necessarily seek support, and thus future studies should also examine other modifiable factors considering the medical settings.

Mental health literacy, treatment preferences and the lived experience of mental health problems in an Australian cancer sample

OBJECTIVES

The prevalence rates for mental health (MH) problems in cancer patients is high, although reduced uptake of services may be influenced by mental health literacy (MHL). The objective of this study was to investigate the MHL for depression and panic disorder (PD), including treatment preferences in Australian adults who had been diagnosed and treated for cancer, and whether MHL and treatment preferences was influenced by sex, age, and individuals' lived MH experience.

METHOD

A total of 421 cancer survivors (n = 378 females) completed a self-report survey. Participants were asked to specify whether they had a lived experience with anxiety and/or depression, and to indicate treatment preferences for managing cancer-related distress. Two vignettes were administered to assess MHL for depression and PD.

RESULTS

The MHL accuracy for depression was higher than PD. Accuracy rates were higher for females with a lived experience with anxiety and/or depression; although the accuracy rate for PD was significantly lower in males. A high proportion of individuals preferred exercise and in-person counselling to manage depression and PD. Internet-based therapies were not strongly preferred for managing MH problems.

CONCLUSIONS

The MHL for depression and PD is moderate for adult cancer survivors, with higher levels indicated for individuals with a personal lived experience with anxiety and/or depression. Public health campaigns for enhancing MHL should broaden to include individuals experiencing comorbid physical health conditions. Health providers also need to take into account client preferences for evidence-based therapies.

Cancer patient utilisation of psychological care in Germany: The role of attitudes towards seeking help

OBJECTIVE

Even if significantly distressed, many patients with cancer do not seek psychological help. There is growing evidence that attitudes are central barriers for help-seeking, and instruments to assess cancer patients' attitudes towards help-seeking are urgently needed. This study aimed to evaluate the German Attitudes towards Seeking Help after Cancer Scale (ASHCa-G) and investigated the relationship between patients' attitudes and psychological care utilisation.

METHODS

The ASHCa-G was presented to 270 patients with cancer (age 63.0 ± 12.7 years, 44.8% women). Item analyses, principal component analysis and associations with age, social support, help-seeking intention and psychological care utilisation were calculated. A hierarchical logistic regression was performed to ascertain the leading role of attitudes in explaining psychological care utilisation.

RESULTS

Principal component analysis supported a two-component solution, which showed good internal consistency for the positive attitudes (α = 0.80) and negative attitudes (α = 0.75) subscales. The associations with age, distress and help-seeking intention confirmed the validity of the ASHCa-G. Positive attitudes explained most variance of cancer patients' current psychological care utilisation.

CONCLUSION

The ASHCa-G seems to be a reliable and valid questionnaire for assessing attitudes towards seeking psychological help among patients with cancer. Clinical practice might profit from identifying attitudinal barriers that hinder patients with cancer from seeking psychological help.

Differences in perception of breast cancer treatment between patients, physicians, and nurses and unmet information needs in Japan

Purpose

Discrepancies exist between healthcare provider and patient perceptions surrounding breast cancer treatment. Significant treatment changes in the last 10 years have made re-evaluation of these perceptions necessary.

Methods

Physicians and nurses involved in breast cancer treatment, and patients who had received breast cancer chemotherapy (past 5 years), were questioned using an Internet survey. Participants ranked physical concerns (treatment side effects), psychological concerns, priorities for treatment selection, and side effects to be avoided during treatment. Patients were asked about desired treatment information/information sources. Rankings were calculated using the mean value of scores. Spearman’s rank correlation was used to determine the concordance of rankings among groups.

Results

Survey respondents included 207 patients, 185 physicians, and 150 nurses. Patients and nurses similarly ranked distressing physical concerns; physician rankings differed. Quality of life (QoL) and treatment response ranked high with physicians and patients when considering future treatment; nurses prioritized QoL. All three groups generally agreed on ranking of psychological concerns experienced during chemotherapy, explanation of treatment options, and how treatment decisions were made, although more patients thought treatment decisions should be made independently. Healthcare providers reported providing explanations of treatment side effects and information on physical/psychological support options while patients felt both were lacking. Concordance was calculated as 0.47 (patient–physician), 0.83 (patient–nurse), and 0.76 (physician–nurse). Patients desired additional information, preferring healthcare providers as the source.

Conclusions

Specific areas for improvement in breast cancer patient care were identified; programs should be implemented to address unmet needs and improve treatment in these areas.

Electronic supplementary material

The online version of this article (10.1007/s00520-019-05029-z) contains supplementary material, which is available to authorized users.

Depression Literacy in Urban and Suburban Residents of Tehran, the Capital of Iran; Recognition, Help Seeking and Stigmatizing Attitude and the Predicting Factors

Background:

Recognizing the mental health literacy condition among the people is an important step towards promotion of mental health of a society. This study has been conducted to evaluate the depression literacy among Tehran city and its suburban residents.

Methods:

This is a cross-sectional study of 18- to 68-year-old residents in Tehran city and suburb in 2017. Sampling in Tehran city was conducted using Random Digit Dialing (RDD) and 1340 people were recruited. In suburb Shamsabad and Salehabad from south of Tehran were considered as clusters and data gathering conducted by face to face interview. Depression literacy was assessed by a structured questionnaire. After introducing a vignette with a psychiatric disorder, participants were questioned in the domains of recognition of the disorder, intention to seek help and attitudes toward social stigma.

Results:

Correct recognition was 52.2% and 30% and intention to seek help was 54% and 33.3% in Tehran city and suburb, respectively. Female gender (P < 0.001), age increasing (P = 0.002) and higher education (P < 0.001) significantly scaled up the chance of correct recognition of depression, when female gender (P = 0.001), increasing age (P < 0.001), and being married (P = 0.01) could significantly improve the probability of seeking help. Results also showed that being married (P = 0.005) and higher education (P < 0.001) predicted lower stigma.

Conclusions:

Overall depression literacy in Tehran city and suburb was low, so intervention among target population in order to increase the depression literacy seems to be necessary.

Association of plasma leptin, pro-inflammatory adipokines and cancer-related fatigue in early-stage breast cancer patients: A prospective cohort study

Cancer‐related fatigue (CRF) is subjective and has wide inter‐individual variability. Given that leptin is commonly associated with fatigue syndrome, its use as a potential biomarker for CRF is being investigated. The primary objective of this study was to evaluate the association between leptin and CRF in early‐stage breast cancer patients receiving chemotherapy. In a prospective cohort study, patients completed assessments at baseline (T1), during chemotherapy (T2) and after chemotherapy (T3). Levels of plasma leptin and adipokines were measured using a Luminex bead‐immunoassay and CRF was measured using the Multi‐Dimensional Fatigue Symptom Inventory‐Short Form (MFSI‐SF). Data were analysed longitudinally using a generalised estimating equation incorporating clinically relevant parameters and pro‐inflammatory adipokines. The analysis included 136 patients (mean age ± SD = 51.5 ± 8.8 years; 69.1% receiving anthracycline‐based chemotherapy). More patients experienced CRF at T3 (23.8%) than at T2 (13.8%) compared to baseline. An increase was observed in the median plasma leptin level at T2, followed by a decrease at T3 (T1: 4.07 ng/mL, T2: 4.95 ng/mL and T3: 3.96 ng/mL). In the multivariate model, the change in leptin levels over time was significantly associated with the total MFSI‐SF score (β = −0.15, P = 0.003) after adjusting for the tumour necrosis factor‐α (TNF‐α) level, anxiety, depression, insomnia, age, menopausal status and type of chemotherapy. This is the first study to report leptin as a biomarker that predicts the onset of CRF over time. Future studies are required to validate the findings.

The validation of the visual screening tool for anxiety disorders and depression in hypertension and/or diabetes

Background

Depression and anxiety disorders remain poorly detected at primary health care, particularly in patients with hypertension and/or diabetes. A visual screening tool for anxiety disorders and depression (VISTAD) has been developed, but not validated.

Aim

To validate the VISTAD in primary health care participants diagnosed with hypertension and/or diabetes.

Setting

Participants were recruited from five primary health care centres in the Eastern Cape, South Africa (urban, peri-urban and rural).

Methods

The study used a cross-sectional study design to validate the VISTAD. The VISTAD was validated against the International Neuropsychiatric Interview (M.I.N.I) using field testing. A demographic questionnaire was used to collect data on socio-economic variables.

Results

Sixty-nine (87%) females and 10 (13%) males with a mean age of 49 (SD 8.6844) participated in the study. Fifty black people (63%), 16 mixed race people (20%) and 13 white people (16%) participated in the study. The majority of the participants (77%) did not complete high school. The area under curve score (AUC) for the VISTAD in screening for depression was 0.91, and for anxiety disorders, 0.87 post-traumatic stress disorder, 0.87 panic disorder, 0.85 social phobia, 0.88 agoraphobia, and 0.83 generalised anxiety disorder revealing acceptable psychometric properties.

Conclusion

The use of the VISTAD as a screening tool at primary health care in people living with hypertension and/or diabetes is recommended. The VISTAD could, therefore, play a key role in the prevention and early treatment of individuals diagnosed with hypertension and/or diabetes across cultures and levels of education. The VISTAD needs to be validated in a large population representative of primary care patients diagnosed with hypertension and/or diabetes.

A feasibility study to determine the benefits of upper extremity virtual rehabilitation therapy for coping with chronic pain post-cancer surgery

BACKGROUND

Persistent pain in shoulder and arm following post-surgical breast cancer treatment can lead to cognitive and physical deficits. Depression is also common in breast cancer survivors. Virtual reality therapy with integrative cognitive and physical rehabilitation has not been clinically trialed for this population. The novel BrightArm Duo technology improved cognition and upper extremity (UE) function for other diagnoses and has great potential to benefit individuals coping with post-surgical breast cancer pain.

OBJECTIVES

The aim of this study was to explore the feasibility of BrightArm Duo therapy for coping with post-surgical chronic pain and associated disability in breast cancer survivors with depression.

METHODS

BrightArm Duo is a robotic rehabilitation table modulating gravity loading on supported forearms. It tracks arm position and grasping strength while patients play three-dimensional (3D) custom integrative rehabilitation games. Community-dwelling women (N = 6) with post-surgical breast cancer pain in the upper arm trained on the system twice a week for 8 weeks. Training difficulty increased progressively in game complexity, table tilt and session length (20-50 minutes). Standardized assessments were performed before and after therapy for pain, cognition, emotion, UE function and activities of daily living.

RESULTS

Subjects averaged upwards of 1300 arm repetitions and 850 hand grasps per session. Pain intensity showed a 20% downward trend (p = 0.1) that was corroborated by therapist observations and participant feedback. A total of 10 out of 11 cognitive metrics improved post-training (p = 0.01) with a significant 8.3-point reduction in depression severity (p = 0.04). A total of 17 of 18 range of motion metrics increased (p < 0.01), with five affected-side shoulder improvements above the Minimal Clinically Important Difference (8°). In all, 13 out of 15 strength and function metrics improved (p = 0.02) with lateral deltoid strength increasing 7.4 N on the affected side (p = 0.05).

CONCLUSION

This pilot study demonstrated feasibility of using the BrightArm Duo Rehabilitation System to treat cancer survivors coping with upper body chronic pain. Outcomes indicate improvement in cognition, shoulder range, strength, function and depression.

Perceptions and Barriers of Survivorship Care in Asia: Perceptions From Asian Breast Cancer Survivors

Purpose

With the long-term goal to optimize post-treatment cancer care in Asia, we conducted a qualitative study to gather in-depth descriptions from multiethnic Asian breast cancer survivors on their perceptions and experiences of cancer survivorship and their perceived barriers to post-treatment follow-up.

Methods

Twenty-four breast cancer survivors in Singapore participated in six structured focus group discussions. The focus group discussions were voice recorded, transcribed verbatim, and analyzed by thematic analysis.

Results

Breast cancer survivors were unfamiliar with and disliked the term “survivorship,” because it implies that survivors had undergone hardship during their treatment. Cognitive impairment and peripheral neuropathy were physical symptoms that bothered survivors the most, and many indicated that they experienced emotional distress during survivorship, for which they turned to religion and peers as coping strategies. Survivors indicated lack of consultation time and fear of unplanned hospitalization as main barriers to optimal survivorship care. Furthermore, survivors indicated that they preferred receipt of survivorship care at the specialty cancer center.

Conclusion

Budding survivorship programs in Asia must take survivor perspectives into consideration to ensure that survivorship care is fully optimized within the community.