1
|
Titze U, Titze B, Hansen T, Barth PJ, Ali FA, Schneider F, Benndorf M, Sievert KD. Ex Vivo Fluorescence Confocal Microscopy of MRI-Guided Targeted Prostate Biopsies for Rapid Detection of Clinically Significant Carcinomas-A Feasibility Study. Cancers (Basel) 2024; 16:873. [PMID: 38473235 DOI: 10.3390/cancers16050873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND MRI-guided prostate biopsies from visible tumor-specific lesions (TBx) can be used to diagnose clinically significant carcinomas (csPCa) requiring treatment more selectively than conventional systematic biopsies (SBx). Ex vivo fluorescence confocal microscopy (FCM) is a novel technique that can be used to examine TBx prior to conventional histologic workup. METHODS TBx from 150 patients were examined with FCM on the day of collection. Preliminary findings were reported within 2 h of collection. The results were statistically compared with the final histology. RESULTS 27/40 (68%) of the csPCa were already recognized in the intraday FCM in accordance with the results of conventional histology. Even non-significant carcinomas (cisPCa) of the intermediate and high-risk groups (serum prostate-specific antigen (PSA) > 10 or 20 ng/mL) according to conventional risk stratifications were reliably detectable. In contrast, small foci of cisPCa were often not detected or were difficult to distinguish from reactive changes. CONCLUSION The rapid reporting of preliminary FCM findings helps to reduce the psychological stress on patients, and can improve the clinical management of csPCa. Additional SBx can be avoided in individual cases, leading to lower rates of complications and scarring in the future surgical area. Additional staging examinations can be arranged without losing time. FCM represents a promising basis for future AI-based diagnostic algorithms.
Collapse
Affiliation(s)
- Ulf Titze
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Barbara Titze
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Torsten Hansen
- Department of Pathology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
- MVZ for Histology, Cytology and Molecular Diagnostics Trier GmbH, 54296 Trier, Germany
| | - Peter J Barth
- Gerhard-Domagk-Institute of Pathology, Münster University Hospital, University of Münster, 48149 Münster, Germany
| | - Furat Abd Ali
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Fried Schneider
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Matthias Benndorf
- Department of Diagnostic and Interventional Radiology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| | - Karl-Dietrich Sievert
- Department of Urology, Medical School and University Medical Center OWL, Klinikum Lippe Detmold, Bielefeld University, 32756 Detmold, Germany
| |
Collapse
|
2
|
Marshall DC, Carney LM, Hsieh K, Dickstein DR, Downes M, Chaudhari A, McVorran S, Montgomery GH, Schnur JB. Effects of trauma history on cancer-related screening, diagnosis, and treatment. Lancet Oncol 2023; 24:e426-e437. [PMID: 37922933 PMCID: PMC10754479 DOI: 10.1016/s1470-2045(23)00438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/30/2023] [Accepted: 08/22/2023] [Indexed: 11/07/2023]
Abstract
Trauma has substantial effects on human health and is recognised as a potential barrier to seeking or receiving cancer care. The evidence that exists regarding the effect of trauma on seeking cancer screening, diagnosis, and treatment and the gaps therein can define this emerging research area and guide the development of interventions intended to improve the cancer care continuum for trauma survivors. This Review summarises current literature on the effects of trauma history on screening, diagnosis, and treatment among adult patients at risk for or diagnosed with cancer. We discuss a complex relationship between trauma history and seeking cancer-related services, the nature of which is influenced by the necessity of care, perceived or measured health status, and potential triggers associated with the similarity of cancer care to the original trauma. Collaborative scientific investigations by multidisciplinary teams are needed to generate further clinical evidence and develop mitigation strategies to provide trauma-informed cancer care for this patient population.
Collapse
Affiliation(s)
- Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Lauren M Carney
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Shauna McVorran
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth Cancer Center, Hanover, NH, USA
| | - Guy H Montgomery
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie B Schnur
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
3
|
Anderson LE, Ireland MJ, Myers L, Avenell C, Connaughton T, Goodwin BC. Psychological distress and bowel cancer screening participation. Psychooncology 2023; 32:229-236. [PMID: 36434675 DOI: 10.1002/pon.6072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To better understand barriers to participation in mail-out bowel cancer screening programs, two survey studies tested the relationship between psychological distress and self-reported bowel cancer screening. METHODS First, a nationally representative sample of Australians N = 5421 completed measures of bowel cancer screening and psychological distress (using the Kessler Psychological Distress Scale; K10). Second, N = 479 completed a survey measuring participation in the National Bowel Cancer Screening Program (NBCSP) and psychological distress using the Depression, Anxiety and Stress Scale. In both studies, logistic regressions were conducted to test relationships between psychological distress and self-reported screening participation. RESULTS Study one found that psychological distress had a significant quadratic effect on having ever screened for bowel cancer, where screening rates were similar for those with low, moderate, or high levels of distress, but were lower for those with very high levels of distress. In study two, depression scores had a negative linear relationship with NBCSP participation (higher depression levels were associated with lower screening participation), and anxiety had a quadratic effect whereby NBCSP participation rates were higher with increasing levels of anxiety except in the severe category, where participation was significantly lower. CONCLUSIONS Findings indicate that psychological distress has a complex relationship with screening, and those with extreme levels of distress consistently show lower participation rates. Special efforts to encourage screening may be required for those experiencing extreme psychological distress and mental health disorders.
Collapse
Affiliation(s)
| | - Michael J Ireland
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia.,School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
| | - Larry Myers
- Cancer Council Queensland, Brisbane, Queensland, Australia.,School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
| | - Claire Avenell
- School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
| | - Tanaya Connaughton
- School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia
| | - Belinda C Goodwin
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia
| |
Collapse
|
4
|
Millender E, Dickey SL, Ouma C, Bruneau D, Wisdom-Chambers K, Bagneris JR, Harris RM. Addressing Disparities by Evaluating Depression as a Predictor of Prostate Screenings among Black Men in a Community Health Clinic. J Community Health Nurs 2022; 39:25-39. [PMID: 35191788 DOI: 10.1080/07370016.2022.2028063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To explore prostate and depression screening practices as well as predictors for prostate screening among a diverse group of men seen at a nurse-led community health center. This was a retrospective, exploratory study. Social factors, depression, and prostate screening data on 267 male patients were retrieved from medical records from 2014 to 2018. Patients that were not screened for depression were associated with a lower probability of having received a PSA screening (OR = .40, p = 02). Of those screened for depression, higher scores were associated with lower PSA screening (OR = .89, p = .02). Patients who self-identified as Hispanic (OR = .19, p <. 001), African American (AA) (OR = .06, P = .01) or White (OR = .12, P = .02) had lower odds of PSA screening compared to Black-Caribbean. The above clinical evidence is a practice implication for nurses and health care professionals. Depression screening predicted higher rates of prostate screening, while higher depression scores predicted lower prostate screening. AA and Hispanic subgroups were less likely to be screened for prostate cancer than the non-U.S. born Black-Caribbean men. Findings underscore the importance of developing community-based culturally sensitive approaches to prostate preventative care. Nurses and health providers must understand that diversity within the "Black" population exists, and these differences drive health behaviors. Person-centered care that is culturally sensitive will be essential in developing trust with communities of color to increase prostate cancer screening and health equity.
Collapse
Affiliation(s)
- Eugenia Millender
- Center of Populations Sciences for Health Equity, College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Sabrina L Dickey
- College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Christine Ouma
- University of Cincinnati, Blue Ash College, Blue Ash, Ohio, USA
| | - Derminga Bruneau
- College of Nursing, Chamberlain University, Miramar, Florida, USA
| | - Karen Wisdom-Chambers
- Christine E Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Jessica R Bagneris
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, USA
| | - Rachel M Harris
- Center for Population Sciences and Health Equity, Florida State University, Tallahassee, Florida, USA
| |
Collapse
|
5
|
Weygandt J, Robling K, Whitaker LA, McPherson K, Hartwell M, Greiner B. Cancer Screening Among Current and Former U.S. Military Personnel Compared to Civilians: A Cross-Sectional Analysis of the Behavioral Risk Factor Surveillance System. Mil Med 2021; 188:usab439. [PMID: 34865108 DOI: 10.1093/milmed/usab439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/02/2021] [Accepted: 11/04/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Approximately 3% of invasive U.S. cancer diagnoses are made among veterans in a Veterans Affairs (VA) clinic each year, while VA patients only comprise about 1.9% of the U.S. population. Although some research has shown that veterans have higher incidence rates of cancer compared to civilians, evidence is sparse regarding possible disparities in rates of cancer screening between these populations. Thus, the purpose of this study is to compare differences in rates of screening for colorectal, lung, breast, and cervical cancers between current and former U.S. Military service members and civilians. METHODS Using the data extracted from the Behavioral Risk Factor Surveillance System, we assessed the rates of cancer screening among current and former U.S. Military service members compared to civilians from self-reported surveys assessing when individuals had been screened for colorectal or lung cancer among all participants and breast and cervical cancer among women participants. Persons greater than 25 years of age were included in the cervical cancer screening, 50 years of age for colon cancer screening, and 40 years of age for the breast cancer screening-the latter based on recommendations from the American Cancer Society. We used multivariate logistic regression models to determine the adjusted risk ratios (ARRs) of current and former U.S. Military service members receiving screening compared to civilians, adjusting for age, gender, race, education, and health care coverage. RESULTS Current and former U.S. Military service members accounted for 2.6% of individuals included for the cervical cancer screening analysis, 2.2% for the breast cancer screening analyses, nearly 10% of the lung cancer screening, and 15% of the colorectal cancer (CRC) screening analyses. Prevalence of screening was higher for current and former U.S. Military service members among lung cancer and CRC. When controlling for age, race, education, and health care coverage, current and former U.S. Military service members were statistically more likely to be screened for CRC (ARR: 1.05; 95% confidence interval: 1.04-1.07) and lung cancer (ARR: 1.32; 95% confidence interval: 1.15-1.52). The odds of having completed a cervical or breast cancer screening were not significantly different between groups. CONCLUSION Our study showed that current and former U.S. Military service members were more likely to complete CRC and lung cancer screenings, while no significant difference existed between each population with regard to cervical and breast cancer screenings. This is one of the few studies that have directly compared cancer screening usage among civilians and current and former U.S. Military service members. Although current and former U.S. Military service members were more likely to receive several cancer screenings, improvements can still be made to remove barriers and increase screening usage due to the disproportionate rates of cancer mortality in this population. These solutions should be comprehensive-addressing personal, organizational, and societal barriers-to improve prognosis and survival rates among current and former U.S. Military service members.
Collapse
Affiliation(s)
- Jonas Weygandt
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK 74464, USA
| | - Kristyn Robling
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK 74464, USA
| | - Liza-Ann Whitaker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK 74464, USA
| | - Kristen McPherson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
- Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK 74464, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, USA
| | - Benjamin Greiner
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| |
Collapse
|
6
|
Aboumrad M, Shiner B, Mucci L, Neupane N, Schroeck FR, Klaassen Z, Freedland SJ, Young-Xu Y. Posttraumatic stress disorder and suicide among veterans with prostate cancer. Psychooncology 2020; 30:581-590. [PMID: 33247977 DOI: 10.1002/pon.5605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/06/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effect of a preexisting posttraumatic stress disorder (PTSD) diagnosis on suicide and non-suicide mortalities among men with newly diagnosed prostate cancer, and examine potential mediating factors for the relationship between PTSD and suicide. METHODS We used patient-level data from Veterans Health Administration electronic medical records to identify men (age ≥40 years) diagnosed with prostate cancer between 2004 and 2014. We used Fine and Gray regression model to estimate the risk for competing mortality outcomes (suicide, non-suicide, and alive). We used structural equation models to evaluate the mediating factors. RESULTS Our cohort comprised 214,649 men with prostate cancer, of whom 12,208 (5.7%) had a preexisting PTSD diagnosis. Patients with PTSD compared to those without utilized more healthcare services and had lower risk cancer at diagnosis. Additionally, they experienced more suicide deaths (N = 26, 0.21% vs. N = 269, 0.13%) and fewer non-suicide deaths (N = 1399, 11.5% vs. N = 45,625, 22.5%). On multivariable analysis, PTSD was an independent suicide risk factor (HR = 2.35; 95% CI: 1.16, 4.78). Depression, substance use disorder, and any definitive prostate cancer treatment were partial mediators. However, PTSD was associated with lower non-suicide mortality risk (HR = 0.86; 95% CI: 0.77, 0.96). CONCLUSION Patients with PTSD experienced greater suicide risk even after adjusting for important mediators. They may have experienced lower non-suicide mortality risk due to favorable physical health resulting from greater healthcare service use and early diagnosis of lower risk cancer. Our findings highlight the importance of considering psychiatric illnesses when treating patients with prostate cancer and the need for interventions to ameliorate suicide risk.
Collapse
Affiliation(s)
- Maya Aboumrad
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Brian Shiner
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Lorelei Mucci
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nabin Neupane
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Florian R Schroeck
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Zachary Klaassen
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Stephen J Freedland
- Cedars-Sinai Medical Center, Los Angeles, California, USA.,Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Yinong Young-Xu
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| |
Collapse
|
7
|
Goldberg H, Noorani R, Benton JZ, Lodh A, Berlin A, Chandrasekar T, Wallis CJD, Ahmad AE, Klaassen Z, Fleshner NE. Is there an association between a history of military service and cancer diagnosis? Results from a US national-level study of self-reported outcomes. Cancer Causes Control 2020; 32:47-55. [PMID: 33064242 DOI: 10.1007/s10552-020-01355-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine cancer prevalence in men with and without military service history, using national-level self-reported outcomes. METHODS A cross-sectional survey-based US study, including men aged 18 and above from the Health Information National Trends Survey database between 2011 and 2014. The primary endpoint was self-reported cancer prevalence. Multivariable logistic regression analyses assessed the association of various covariates with the prevalence of cancer. RESULTS A total of 4,527 men were analyzed, with 1,352 (29.9%) reporting a history of military service. Compared to men with no military service history, men with a military service history were older (median of 65 [IQR 56, 74] vs. 53 [IQR 41, 62] years, p < 0.0001), more commonly Caucasian (71.4% vs. 61.4%, p < 0.0001), born in the US (95.6% vs. 79.5%, p < 0.0001), attained higher education level and annual household income (p < 0.0001), and consisted of more smokers(58.3% vs. 44.5%, p < 0.0001). The age-adjusted comparison demonstrated a higher cancer prevalence in men with military service history (20.5% vs. 7.6%, p < 0.0001). Specifically, genitourinary, dermatological, gastrointestinal, and hematological cancers were generally more prevalent. Adjusting for all available confounders, multivariable models showed that military service history was associated with 1.56 (95% CI 1.20-2.03), and 1.57 (95% CI 1.07-2.31) increased odds of having any cancer, and specifically genitourinary cancer, respectively. CONCLUSIONS Further research is needed to ascertain whether the association between military service and increased cancer diagnosis results from better screening programs or increased exposure to risk factors during military service.
Collapse
Affiliation(s)
- Hanan Goldberg
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Rodrigo Noorani
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - John Z Benton
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Atul Lodh
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Techna Institute, University Health Network, Toronto, ON, Canada
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher J D Wallis
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.,Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ardalan E Ahmad
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Neil E Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| |
Collapse
|
8
|
Azizoddin DR, Lakin JR, Hauser J, Rynar LZ, Weldon C, Molokie R, Enzinger AC, Payvar S, Martin JL. Meeting the guidelines: Implementing a distress screening intervention for veterans with cancer. Psychooncology 2020; 29:2067-2074. [PMID: 33009712 DOI: 10.1002/pon.5565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/02/2020] [Accepted: 09/29/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Guidelines recommend systematic evaluation of distress screening and referral for cancer patients. Implementation remains a notable gap for cancer centers serving disadvantaged communities. We present the implementation of a distress screening program within a Veterans Affairs hospital oncology clinic, serving a majority African American (AA) male population of low socioeconomic status (SES). METHODS The Coleman Foundation funded this program supporting a palliative care physician and psychologist to implement screening in a phased approach as follows: (1) Organizing key stakeholders, (2) educating clinical staff, (3) delivering distress screening, (4) generating documentation, and (5) implementing clinical action and referral pathways. We utilized validated measures in the "Patient Screening Questions for Supportive Care" screening tool. RESULTS This program was unsuccessful in screening all veterans with cancer; however, we were able to implement 3 years of longitudinal screening. In distress screens from the initial program period (n = 253), patients were primarily males (95.6%) of older age (m = 70, standard deviation = 9.45), AA (76.4%), with various cancers of advanced disease (69%). Males reported moderate psychosocial distress and elevated financial needs. For males with elevated psychosocial distress (n = 63, PHQ-4 ≥3), 36% were previously connected with psychosocial services. Following screening, engagement increased as the majority (77%) established psychosocial care. CONCLUSIONS This screening program had mixed success. Centralized program staff and available supportive care referrals were critical for program implementation. Screening may have increased engagement in social work/mental health services for males of low SES. Screening programs should be tailored to the needs of underserved communities with accessible housing/food subsidies.
Collapse
Affiliation(s)
- Desiree R Azizoddin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Hauser
- Section of Palliative Care, Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois, USA.,Section of Palliative Care, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Z Rynar
- Department of Psychiatry, Jesse Brown VA Medical Center, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christine Weldon
- Department of Medicine, Hematology and Oncology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.,The Center for Business Models in Healthcare, Glencoe, Illinois, USA
| | - Robert Molokie
- Hematology/Medical Oncology, Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois, USA.,Department of Hematology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea C Enzinger
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Payvar
- Department of Psychiatry, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Joanna L Martin
- Section of Palliative Care, Department of Medicine, Jesse Brown VA Medical Center, Chicago, Illinois, USA.,Section of Palliative Care, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
9
|
Lee SY, Park CL. Trauma exposure, posttraumatic stress, and preventive health behaviours: a systematic review. Health Psychol Rev 2017; 12:75-109. [PMID: 28854859 DOI: 10.1080/17437199.2017.1373030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Psychological trauma has implications for many aspects of physical health, including preventive health behaviours (PHBs). However, whether trauma exposure additionally contributes to PHBs above and beyond the effects of posttraumatic stress disorder (PTSD) symptoms remains unclear. In this systematic review, 32 studies were analysed to characterise: (1) the relationships between trauma exposure and PHBs, (2) the relationships between PTSD symptoms and PHBs, (3) the unique associations between trauma exposure and PHBs, independent of PTSD symptoms, and (4) the unique associations between PTSD symptoms and PHBs, independent of trauma exposure. Findings were variable across the three examined PHBs (physical activity, diet, medical screening) when only trauma exposure or PTSD symptoms were taken into account. Clearer relationships emerged between trauma exposure and PHBs when PTSD symptoms were taken into account, demonstrating that trauma exposure is related to PHB engagement above and beyond the effects of PTSD symptoms. Additionally, PTSD symptoms shared unique associations with physical activity and screening frequency, which were not explained by trauma exposure. Our review reveals that teasing apart the effects of trauma exposure and PTSD symptoms on PHBs brings greater clarity to the strength and direction of these associations.
Collapse
Affiliation(s)
- Sharon Y Lee
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Crystal L Park
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| |
Collapse
|
10
|
Abstract
Approximately 18% of the US adult population has a mental illness, yet only 13% with mental illness receive any treatment. Although pharmacotherapy and psychotherapy are the mainstays of treatment, treatment discontinuation and failure are common. Skepticism toward such treatments has fueled interest in and use of complementary therapies, such as acupuncture, meditation, and natural products. Many medical providers are unaware of the use of these therapies by their patients, and knowledge of the evidence base for these therapies is often lacking. This article presents current evidence-based recommendations for complementary therapies in the treatment of depression, anxiety, and posttraumatic stress disorder.
Collapse
Affiliation(s)
- Gary N Asher
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, CB# 7595, Chapel Hill, NC 27599-7595, USA.
| | - Jonathan Gerkin
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27759, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27759, USA
| |
Collapse
|
11
|
Gartlehner G, Wagner G, Matyas N, Titscher V, Greimel J, Lux L, Gaynes BN, Viswanathan M, Patel S, Lohr KN. Pharmacological and non-pharmacological treatments for major depressive disorder: review of systematic reviews. BMJ Open 2017; 7:e014912. [PMID: 28615268 PMCID: PMC5623437 DOI: 10.1136/bmjopen-2016-014912] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/16/2017] [Accepted: 04/27/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study aims to summarise the evidence on more than 140 pharmacological and non-pharmacological treatment options for major depressive disorder (MDD) and to evaluate the confidence that patients and clinicians can have in the underlying science about their effects. DESIGN This is a review of systematic reviews. DATA SOURCES This study used MEDLINE, Embase, Cochrane Library, PsycINFO and Epistemonikos from 2011 up to February 2017 for systematic reviews of randomised controlled trials in adult patients with acute-phase MDD. METHODS We dually reviewed abstracts and full-text articles, rated the risk of bias of eligible systematic reviews and graded the strength of evidence. RESULTS Nineteen systematic reviews provided data on 28 comparisons of interest. For general efficacy, only second-generation antidepressants were supported with high strength evidence, presenting small beneficial treatment effects (standardised mean difference: -0.35; 95% CI -0.31 to -0.38), and a statistically significantly higher rate of discontinuation because of adverse events than patients on placebo (relative risk (RR) 1.88; 95% CI 1.0 to 3.28).Only cognitive behavioural therapy is supported by reliable evidence (moderate strength of evidence) to produce responses to treatment similar to those of second-generation antidepressants (45.5% vs 44.2%; RR 1.10; 95% CI 0.93 to 1.30). All remaining comparisons of non-pharmacological treatments with second-generation antidepressants either led to inconclusive results or had substantial methodological shortcomings (low or insufficient strength of evidence). CONCLUSIONS In contrast to pharmacological treatments, the majority of non-pharmacological interventions for treating patients with MDD are not evidence based. For patients with strong preferences against pharmacological treatments, clinicians should focus on therapies that have been compared directly with antidepressants. TRIAL REGISTRATION NUMBER International Prospective Register of Systematic Reviews (PROSPERO) registration number: 42016035580.
Collapse
Affiliation(s)
- Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria
- RTI-University of North Carolina Evidence-based Practice Center, RTI International, North Carolina, USA
| | - Gernot Wagner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria
| | - Nina Matyas
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria
| | - Viktoria Titscher
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria
| | | | - Linda Lux
- RTI-University of North Carolina Evidence-based Practice Center, RTI International, North Carolina, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Meera Viswanathan
- RTI-University of North Carolina Evidence-based Practice Center, RTI International, North Carolina, USA
| | - Sheila Patel
- RTI-University of North Carolina Evidence-based Practice Center, RTI International, North Carolina, USA
| | - Kathleen N Lohr
- RTI-University of North Carolina Evidence-based Practice Center, RTI International, North Carolina, USA
| |
Collapse
|
12
|
Lin J, McGlynn KA, Carter CA, Nations JA, Anderson WF, Shriver CD, Zhu K. The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System. Cancer Epidemiol Biomarkers Prev 2016; 25:1564-1571. [PMID: 27566418 PMCID: PMC5777503 DOI: 10.1158/1055-9965.epi-16-0316] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/05/2016] [Accepted: 08/03/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Higher cancer-related mortality has been observed among people with mental health disorders than in the general population. Both delay in diagnosis and inadequate treatment due to health care access have been found to explain the higher mortality. The U.S. Military Health System (MHS), in which all beneficiaries have equal access to health care, provides an ideal system to study this disparity where there are no or minimal barriers to health care access. This study assessed preexisting mental health disorders and stage at diagnosis, receipt of cancer treatment, and overall survival among patients with non-small cell lung cancer (NSCLC) in the U.S. MHS. METHODS The study used data from the linked database from the Department of Defense's Central Cancer Registry and the MHS Data Repository (MDR). The study subjects included 5,054 patients with histologically confirmed primary NSCLC diagnosed between 1998 and 2007. RESULTS Patients with a preexisting mental disorder did not present with more advanced disease at diagnosis than those without. There were no significant differences in receiving cancer treatments between the two groups. However, patients with a mental health disorder had a higher mortality than those without [adjusted HR, 1.11; 95% confidence interval (CI), 1.03-1.20]. CONCLUSIONS Poor survival in NSCLC in patients with a preexisting mental health disorder is not necessarily associated with delay in diagnosis and/or inadequate cancer treatment. IMPACT This study contributes to the current understanding that health care access may not be sufficient to explain the poor survival among patients with NSCLC with preexisting mental health disorders. Cancer Epidemiol Biomarkers Prev; 25(12); 1564-71. ©2016 AACR.
Collapse
Affiliation(s)
- Jie Lin
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Corey A Carter
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Joel A Nations
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Craig D Shriver
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, Maryland
| |
Collapse
|
13
|
Pucheril D, Sammon JD, Sood A, Abdollah F, Choueiri TK, Meyer C, Hanske J, Kim SP, Nguyen PL, Kibel AS, Weissman JS, Menon M, Trinh QD. Contemporary nationwide patterns of self-reported prostate-specific antigen screening in US veterans. Urol Oncol 2015; 33:503.e7-15. [DOI: 10.1016/j.urolonc.2015.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/15/2015] [Accepted: 07/26/2015] [Indexed: 11/24/2022]
|
14
|
Starosta AJ, Luta G, Tomko CA, Schwartz MD, Taylor KL. Baseline Attitudes About Prostate Cancer Screening Moderate the Impact of Decision Aids on Screening Rates. Ann Behav Med 2015; 49:762-8. [PMID: 25724634 PMCID: PMC4959888 DOI: 10.1007/s12160-015-9692-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The impact of decision aids on prostate cancer screening outcomes has been inconsistent. PURPOSE We assessed whether pre-existing attitudes moderated the impact of decision aids on screening. METHODS Men aged 45-70 (56.2% Caucasian, 39.9% African-American) were randomly assigned to a print decision aid (N = 630), a web decision aid (N = 631), or usual care (N = 632). Telephone interviews assessed pro/con screening attitudes and screening behaviors at baseline, 1-month and 13-months post-randomization. RESULTS Logistic regression analyses revealed significant arm by attitude interactions: Higher baseline cons scores predicted lower screening in the print (OR = 0.60 (95% CI: 0.40, 0.92)) and web (OR = 0.61 (95% CI: 0.40, 0.91)) arms but not in usual care (OR = 1.34 (95% CI: 0.90, 2.00)). CONCLUSIONS The decision aids amplified the impact of men's baseline attitudes about limitations of screening: Compared to the usual care arm, men in both decision aid arms were less likely to be screened when they perceived more limitations of screening.
Collapse
Affiliation(s)
- Amy J Starosta
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | | | | | | | | |
Collapse
|