How psychological therapy may prolong survival in cancer patients: new evidence and a simple theory

Late effects of cancer and cancer treatment--the perspective of the patient

PURPOSE

Understanding the experience of late effects from the perspective of cancer survivors is essential to inform patient-centred care. This study investigated the nature and onset of late effects experienced by survivors and the manner in which late effects have affected their lives.

METHODS

Sixteen purposively selected cancer survivors participated in a qualitative interview study. The data were analysed inductively using a narrative schema in order to derive the main themes that characterised patients' accounts of late effects.

RESULTS

Individual survivors tended to experience more than one late effect spanning a range of physical and psychological effects. Late effects impacted on relationships, working life, finances and the ability to undertake daily activities. Survivors reported experiencing psychological late effects from around the end of treatment whereas the onset of physical effects occurred later during the post-treatment period. Late effects were managed using formal health services, informal social support and use of 'wellbeing strategies'. Survivors engaged in a process of searching for reasons for experiencing late effects and struggled to make sense of their situation. In particular, a process of 'peer-patient comparison' was used by survivors to help them make sense of, or cope with, their late effects. There appeared to be an association between personal disposition and adaptation and adjustment to the impact of late effects.

CONCLUSIONS

Cancer survivors identified potential components for supported self-management or intervention programmes, as well as important considerations in terms of peer comparisons, personal disposition and making sense of experienced late effects.

Acceptance of disability: determinants of overcoming social frustration

The article is devoted to the subjective reaction of patients at different stages of disabling disease, in the context of the formation of a specific cognitive-emotional and motivational model of “internal picture of disability”, depending on the severity of social frustration as the most important deconditioning factor. We wanted to identify psychological determinant of the specificity of adaptive activity of the patient to the situation disabling disease, depending on the level of increase social frustration. Nature of adaptation to the disabling disease depending on the level of increase social frustration expressed by: 1) decrease in self-esteem of patient self-efficacy with an increase in subjective experience of disability; 2) the growing tension of personal protective mechanisms; 3) reductions coping competence, which, depending on the rise of frustration, becomes effective instead of the rational-intelligent, more maladaptive emotional.

Impact of relaxation training according to the Yoga In Daily Life® system on anxiety after breast cancer surgery

The purpose of this pilot study was to gather information on the immediate and short-term effects of relaxation training according to the Yoga In Daily Life® (YIDL®) system on anxiety of breast cancer patients. The YIDL® system is a holistic system being practised and taught worldwide and has been proven to be highly effective in the prevention and treatment of various diseases. The system aims to establish physical, mental, spiritual, and social health. Thirty-two patients at the Institute for Oncology Ljubljana were randomized to the experimental (n=16) and to the control groups (n=16). Both groups received the same standard physiotherapy for 1 week, while the experimental group additionally received 1-hour group relaxation training session according to the YIDL® system per day. At discharge, the experimental group was issued with audiocassette recordings containing similar instructions for relaxation training to be practiced for 3 weeks individually at home. Anxiety measures were obtained by blinded assessors using standardized questionnaires. The results indicate that relaxation training according to the YIDL® system could be a useful clinical physiotherapy intervention for breast cancer patients experiencing anxiety.

An eHealth system supporting palliative care for patients with non-small cell lung cancer: a randomized trial

BACKGROUND

In this study, the authors examined the effectiveness of an online support system (Comprehensive Health Enhancement Support System [CHESS]) versus the Internet in relieving physical symptom distress in patients with non-small cell lung cancer (NSCLC).

METHODS

In total, 285 informal caregiver-patient dyads were assigned randomly to receive, for up to 25 months, standard care plus training on and access to either use of the Internet and a list of Internet sites about lung cancer (the Internet arm) or CHESS (the CHESS arm). Caregivers agreed to use CHESS or the Internet and to complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint-patient symptom distress-was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale.

RESULTS

Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm. Significant differences were observed at 4 months (P = .031; Cohen d = .42) and at 6 months (P = .004; d = .61). Similar but marginally significant effects were observed at 2 months (P = .051; d = .39) and at 8 months (P = .061; d = .43). Exploratory analyses indicated that survival curves did not differ significantly between the arms (log-rank P = .172), although a survival difference in an exploratory subgroup analysis suggested an avenue for further study.

CONCLUSIONS

The current results indicated that an online support system may reduce patient symptom distress. The effect on survival bears further investigation.

Impact of relaxation training according to Yoga In Daily Life® system on perceived stress after breast cancer surgery

The purpose of this pilot study was to gather information on the immediate and short-term effects of relaxation training according to Yoga In Daily Life(®) (YIDL) system on the psychological distress of breast cancer patients. 32 patients at the Institute for Oncology of Ljubljana were randomized to the experimental (N=16) and to the control group (N=16). Both groups received the same standard physiotherapy for 1 week, while the experimental group additionally received a group relaxation training sessions according to YIDL(®) system. At discharge the experimental group was issued with audiocassette recordings containing the similar instructions for relaxation training to be practiced individually at home (for further 3 weeks). An experimental repeated measures design was used to investigate the differences over 1 month period in stress levels, changes in mental health and psychological parameters. Measures were obtained at three time points during the study period: baseline, at 1 week, and at 4 weeks, by blinded investigators using standardized questionnaires General Health Questionnaire-12 (GHQ-12), Rotterdam Symptom Checklist (RSCL) psychological subscale, Perceived Stress Scale (PSS). Patients who received relaxation training reported feeling significantly less distressed during hospitalization and after discharge-period than did the controls that did not receive relaxation training. The results indicate that relaxation training according to Yoga in Daily Life(®) system could be useful clinical physiotherapy intervention for breast cancer patients experiencing psychological distress. Although this kind of relaxation training can be applied to clinical oncology in Slovenia, more studies need to be done.

Activism among exceptional patients with cancer

BACKGROUND

The "exceptional patients" with cancer are survivors who had advanced cancer considered incurable by medical report and who subsequently became disease-free or experienced unexplained survival time given the nature of their disease or treatment. This experience is a puzzling phenomenon that has not been formally investigated in a cancer population. The purpose of this study was to understand exceptional patients' accounts of their experience.

MATERIALS AND METHODS

This study used a narrative approach with a cross-case thematic analysis. Recruitment took place at health care centers in the USA and Israel. Oncologists in both centers were asked to identify patients who had an exceptional disease course. Patients were then contacted and interviewed; an audio recording was made of each narrative account and then transcribed. Interviews and thematic analyses were conducted independently at each site. These thematic findings from each site were discussed with both research teams and a common underlying theme was identified, which is the focus of this report.

RESULTS

Twenty-six participants were interviewed: 14 from the USA and 12 from Israel. All the participants have had advanced disease with a range of diagnoses that included breast, colorectal, pancreatic, ovarian cancer, glioblastoma multiforme, and others. The main recurrent theme from both the US and Israeli sites was personal activism. This was manifested in taking charge and getting involved in the process of diagnosis and treatment, as well as becoming more altruistic in their relationships with others. In many cases, this was reflected in a change in a philosophy about life.

CONCLUSIONS

In this study, we found that activism was a major theme that was independently observed in both Israel and the U.S.A. This has implications for health care providers to facilitate patient engagement in the care and treatment of their disease. Further research on this phenomenon is needed.

What is an exceptional cancer trajectory?: Multiple stakeholder perspectives on cancer trajectories in relation to complementary and alternative medicine use

BACKGROUND

Although links between exceptional cancer trajectories (ECTs) and complementary and alternative medicines (CAMs) have been suggested, most research on ECT uses predefined criteria for ECTs without necessarily including CAM use. Little knowledge can be found about subjective perspectives of ECTs in relation to CAM.

OBJECTIVES

This Swedish study explores how patients, significant others, and CAM and biomedical health care (BHC) providers reason about ECT, including the role of CAM.

METHODS

Using a case study approach, open interviews were conducted with multiple stakeholders about cancer trajectories reported as exceptional.

RESULTS

In-depth analysis of 5 cases indicated that although all stakeholders agreed that the reported cases were positive, in no case was the same trajectory considered exceptional by all stakeholders. Different stakeholders shared neither conceptualizations of what constituted an ECT nor attributions for positive trajectories. Patients, significant others, and CAM providers emphasized unexpectedly long survival and well-being in ECTs, whereas BHC providers only referred to survival. CAM and BHC providers normalized reported trajectories, although the forms for this differed between provider groups. CONCLUDING DISCUSSION: Stakeholders' accounts are discussed relative to different health care domains, legitimization processes, and legal constraints, which have led to the lack of a public sphere for CAM use in cancer.

The effects of psychological status of the patients with digestive system cancers on prognosis of the disease

To assess the association between psychological status and prognosis of patients with digestive system cancer, epidemiological investigations were conducted in 2 periods to obtain information about the patients' psychological status, survival time, and quality of life. Adjusted relative risks (95% confidence interval) of 1-year survival rate for anxiety and depression were 8.43 (1.18-60.20) and 9.62 (1.76-52.63), respectively. Relations between quality of life and depression and social support were statistically significant (P <.05). This study offers evidences that psychological status in a short-term postoperative period may affect 1-year survival rate, and poor psychological status and social support after being discharged from hospitals are associated with poor quality of life.

Effects of nutritional and psychological status of the patients with advanced stomach cancer on physical performance status

GOALS OF THE WORK

The aim of this study was to assess the associations between coping mode, nutritional status, and psychological status and performance status of the patients with advanced stomach cancer.

MATERIALS AND METHODS

An epidemiological survey was conducted among 233 patients with advanced stomach cancer in Fujian, China. In-person interviews were performed for the participants with respect to information of psychological status prior to chemotherapy, nutritional status during chemotherapy, and physical performance status after chemotherapy.

MAIN RESULTS

Multivariate logistic regression analyses showed that the level of hemoglobin (HB), level of daily calorie intake, score of Depression Status Inventory (DSI), and score of confrontation subscale of Medical Coping Modes Questionnaire had a significant influence on performance status (P < 0.05). The relative risks (95% confidence interval) were 2.06 (1.12-3.79) for low level of hemoglobin versus normal level of hemoglobin, 1.16 (1.02-1.32) for low level of daily calorie intake versus normal level of daily calorie intake, 5.89 (2.00-17.31) for DSI score > or =40 versus DSI score <40, and 3.17 (1.73-5.78) for low score of confrontation versus high score of confrontation, respectively.

CONCLUSIONS

Depression, low score of "Confrontation", low levels of HB, and low level of daily calorie intake may be the risk factors of poor performance status of the patients with advanced stomach cancer.

Mind-body medicine and cancer

Mind-body medicine, grounded in a respectful, therapeutic partnership, should be a central element in the care of every person diagnosed with cancer. This article reviews some of the physiologic foundations of mind-body medicine, the introduction of mind-body approaches to cancer care in the 1970s, the specific mind-body approaches that have been used, and the evidence that supports their use. The importance of group support for enhancing the effectiveness of these approaches is discussed. Guidelines are offered for integrating mind-body approaches and perspectives in the care of people who have cancer.

Effects of nutritional and psychological status in gastrointestinal cancer patients on tolerance of treatment

AIM: To assess the effects of poor nutritional and psychological status on tolerance of cancer treatment and the recovery of physical performance status in patients with gastrointestinal cancer.

METHODS: An epidemiological survey with respect to nutritional and psychological status in patients with gastrointestinal cancer was conducted among 182 operated patients in four provincial-level hospitals from December 2005 to June 2006. The food frequency survey method, state-trait anxiety inventory (STAI) and depression status inventory (DSI) were used to obtain information about the diet and psychological status in the patients. Nutritional status in the participants was reflected by serum albumin (Alb), hemoglobin (HB) and body mass index (BMI).

RESULTS: Alb, protein intake and anxiety were associated with the severity of side effects of treatment. The adjusted relative risk (RR) for Alb, protein intake and anxiety was 3.30 (95% CI: 1.08, 10.10, P = 0.03), 3.25 (95% CI: 1.06, 9.90, P = 0.04) and 1.48 (95% CI: 1.29, 1.70, P < 0.0001), respectively. Moreover, calorie intake, HB and depression were associated with the recovery of physical performance status in the patients. Adjusted relative risk was 2.12 (95% CI: 1.09, 4.03, P = 0.028), 2.05 (95% CI: 1.08, 3.88, P =0.026) and 1.07 (95% CI: 1.02, 1.12, P = 0.007), respectively.

CONCLUSION: Both poor nutrition status and psychological status are independent risk factors for severe side effects of cancer treatment, and have impact on the recovery of physical performance status in patients after treatment.

What is the state of the evidence on the mind–cancer survival question, and where do we go from here? A point of view

GOALS OF WORK

There is long history of anecdote and surmise linking psychosocial factors to cancer incidence and survival. However, over the past three decades, an increasing number of rigorous studies have investigated the possibility of a mind-cancer survival connection. The objective of this paper is (1) to review the past 30 years of psycho-oncology research on the mind-cancer survival question, (2) to review the methodological debate and interpretations of the research findings, and (3) to consider future research directions.

MAIN RESULTS

Over the past three decades, a small number of studies have been published. Some observational and quasi-experimental studies suggest the possibility that coping and psychological factors may influence disease outcomes, but clinical trials suggest that psychosocial interventions do not prolong survival. Methodological comment and interpretation about the significance of these trials vary. Some researchers view the mind-cancer survival question as resolved and negative, whereas others identify conceptual and methodological challenges and view the possible impact of psychosocial factors on survival as simply unproven. We take the position that the question is unanswered.

CONCLUSION

Recommended future research directions include: (1) more trials based on testable theories, targeted interventions, and greater specificity in the measurement model and (2) new research questions and more rigorous observational, prospective, and longitudinal studies, case studies, mixed methods, and innovative design approaches being developed by complementary and alternative medicine researchers. Further research is warranted on the mind-cancer survival question.

Appraising the self-assessed support needs of Turkish women with breast cancer

The purposes of this study were to establish the range of needs of women with breast cancer and to examine how women's needs might form clusters that could provide the basis for developing a standardized scale of needs for use by local breast care nurses in the evaluation of care. The sample consisted of 143 women with breast cancer who were admitted to the outpatient and inpatient oncology clinics in a university hospital in Erzurum, Turkey. The data were collected by questionnaire, and included demographic characteristics and the self-assessed support needs of women with breast cancer. Statistical analyses have shown that the standardized scale of needs has statistically acceptable levels of reliability and validity. The women's support needs mostly clustered in Family and Friends (79%) and After Care (78.3%). The most frequently required support category was Family and Friend; however, the women were in need of support of all categories. In terms of age ranges, there are statistically significant differences in relation to Femininity and Body Image, and Family and Friends of the seven categories. Women experienced a high level of needs associated with a diagnosis of breast cancer. The results in this study should increase awareness among cancer care professionals about a range of psychosocial needs and may help them target particular patient groups for particular support interventions.