1
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Lu J, Yang Y, Chen H, Ma H, Tan Y. Effects of different psychosocial interventions on death anxiety in patients: a network meta-analysis of randomized controlled trials. Front Psychol 2024; 15:1362127. [PMID: 38562234 PMCID: PMC10982502 DOI: 10.3389/fpsyg.2024.1362127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This research intended to assess and compare influence of psychosocial interventions in death anxiety in patients, providing evidence-based guidance for both patients and healthcare providers. Design The present study exclusively gathered randomized controlled trials by comprehensively searching across multiple databases, comprising of PubMed, Embase, Cochrane Library, Web of Science, and Scopus. The methodological quality of the enrolled studies involved in the analysis was assessed using the Cochrane bias risk assessment tool, and data analysis was performed utilizing appropriate software. Results This research, encompassing 15 randomized controlled trials with a cumulative sample size of 926 patients, spanned from the earliest possible date to December 2023. The findings of network meta-analysis unveiled that the Rational-Emotive Hospice Care Therapy significantly reduced death anxiety among patients (Sequentially Updated Cumulative Ranking Analysis: 100%). Conclusion The ranking plot of the network suggested that the rational-emotive hospice care therapy exhibited superior efficacy as a psychological treatment for reducing the death anxiety of patients.Systematic review registration: [https://clinicaltrials.gov/], identifier: [CRD42023484767].
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Affiliation(s)
- Jinhong Lu
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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2
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Seiler A, Amann M, Hertler C, Christ SM, Schettle M, Kaeppeli BM, Jung-Amstutz J, Nigg C, Pestalozzi BC, Imesch P, Dummer R, Blum D, Jenewein J. Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers - a randomized controlled study. BMC Palliat Care 2024; 23:73. [PMID: 38486192 PMCID: PMC10938771 DOI: 10.1186/s12904-024-01408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. METHODS In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADStot ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. RESULTS The coalesced group (DT and DT +) revealed a significant increase in patients' perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADStot of patients in the intervention group remained stable over the pre-post period, the control group's HADStot increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. CONCLUSIONS The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one's final days. TRIAL REGISTRATION This study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted.
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Affiliation(s)
- Annina Seiler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Manuel Amann
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian M Christ
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | | | | | - Bernhard C Pestalozzi
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Josef Jenewein
- Privatklinik Hohenegg, Meilen, Switzerland
- University of Zurich, Zurich, Switzerland
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Zheng J, Huang Y, He J, Zhou H, Liu T, Huang J, Shi M, Zhao Y, Fang W, Yang Y, Zhang L. Trends in pain undertreatment among lung cancer patients at the EOL: Analysis of urban city medical insurance data in China. Thorac Cancer 2024; 15:693-701. [PMID: 38316629 PMCID: PMC10961226 DOI: 10.1111/1759-7714.15240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Cancer-related pain is one of the common priority symptoms in advanced lung cancer patients at the end-of-life (EOL). Alleviating pain is undoubtedly a critical component of palliative care in lung cancer. Our study was initiated to examined trends in opioid prescription-level outcomes as potential indicators of undertreated pain in China. METHODS This study used data on 1330 patients diagnosed with lung cancer of urban city medical insurance in China who died between 2014 and 2017. Opioid prescription-level outcomes were determined by annual trends of the proportion of patients filling an opioid prescription, the total dose of opioids filled by decedents, and morphine milligram equivalents per day (MMED) at the EOL (defined as the 60 days before death). We further analyzed monthly changes in the number of opioid prescriptions filled, MMED, and mean daily dose of opioids per prescription (MDDP) of the last 60 days of life by year at death and age, respectively. RESULTS A total of 959 patients with exact dates of death were included, with 432 cases (45.06%; 95% CI: 44.36%-45.77%) receiving at least one opioid prescription at the EOL. The declining trends were shown in the proportion of patients filling any opioid prescription, the total dose of opioids filled by decedents and MMED, with an annual decrease of 0.341% (p = 0.01), 104.23 mg (p = 0.011) and 2.84 mg (p = 0.014), respectively. Within the 31-60 days to the 0-30 days of life, the MMED declined 6.08 mg (95% CI: -7.14 to -5.03; p = 0.000351), while the number of opioid prescriptions rose 0.66 (95% CI: 0.160-1.16; p = 0.025). Like the MMED, the MDDP fell 4.11 mg (95% CI: -5.86 to -2.37; p = 0.005) within the last month before death compared to the previous month. CONCLUSION Terminal lung cancer populations in urban China have experienced reduced access to opioids at the EOL. The clinicians did not prescribe a satisfactory dose of opioids per prescription, while the patients suffered increasing pain in the last 30 days of life. Sufficient opioid analgesic administration should be advocated for lung cancer patients during the EOL period.
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Affiliation(s)
- Jiani Zheng
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Yihua Huang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Junyi He
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Huaqiang Zhou
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Tingting Liu
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Jie Huang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Mengting Shi
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Yuanyuan Zhao
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Wenfeng Fang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Yunpeng Yang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
| | - Li Zhang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouPeople's Republic of China
- State Key Laboratory of Oncology in South ChinaGuangdong Provincial Clinical Research Center for CancerGuangzhouPeople's Republic of China
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Morse L, Cooper BA, Ritchie CS, Wong ML, Kober KM, Harris C, Shin J, Oppegaard K, Hammer MJ, Schimmel AC, Paul SM, Conley YP, Levine JD, Miaskowski C. Stability and consistency of symptom clusters in younger versus older patients receiving chemotherapy. BMC Geriatr 2024; 24:164. [PMID: 38365584 PMCID: PMC10870638 DOI: 10.1186/s12877-024-04755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/28/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND By 2035, the number of newly diagnosed cancer cases will double and over 50% will be in older adults. Given this rapidly growing demographic, a need exists to understand how age influences oncology patients' symptom burden. The study purposes were to evaluate for differences in the occurrence, severity, and distress of 38 symptoms in younger (< 60 years) versus older (≥ 60 years) oncology patients undergoing chemotherapy and to evaluate for differences in the stability and consistency of symptom clusters across the two age groups. METHODS A total of 1329 patients were dichotomized into the younger and older groups. Patients completed demographic and clinical questionnaires prior to the initiation of their second or third cycle of chemotherapy. A modified version of Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, and distress of 38 common symptoms associated with cancer and its treatment. Differences between the two age groups in demographic and clinical characteristics and ratings of occurrence, severity, and distress for the 38 symptoms were evaluated using parametric and nonparametric tests. Exploratory factor analyses were done within each age group to identify symptom clusters using symptom occurrence rates. RESULTS Compared to the younger group (14.8 (± 7.0)), older adults reported a lower mean number of symptoms (12.9 (± 7.2)). Older patients experienced lower occurrence rates for almost 50% of the symptoms. Regarding symptom clusters, an eight-factor solution was selected for both age groups. Across the two age groups, the eight symptom clusters (i.e., physical and cognitive fatigue, respiratory, psychological, hormonal, chemotherapy-related toxicity, weight gain, gastrointestinal, epithelial) were stable. However, symptoms within the physical and cognitive, chemotherapy-related toxicity, and gastrointestinal clusters were not consistent across the age groups. CONCLUSIONS To be able to provide tailored and effective symptom management interventions to older oncology patients, routine assessments of the core symptoms unique to the symptom clusters identified for this group warrants consideration. The underlying mechanism(s) for these inconsistencies in symptom burden is an important focus for future studies.
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Affiliation(s)
- Lisa Morse
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital Morgan Institute, Boston, MA, USA
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Medical Group, Oakland, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joosun Shin
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, CA, USA.
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way- N631Y, 94143-0610, San Francisco, CA, USA.
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Kool M, Hafkamp E, Gol J, Aukema EJ, Malfitano C, Reyners A, Hales S, van de Poll L, Rodin G, de Vries F. Managing cancer and living meaningfully (CALM): Implementation in Dutch cancer care. Psychooncology 2024; 33:e6281. [PMID: 38282218 DOI: 10.1002/pon.6281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Managing Cancer and Living Meaningfully (CALM) is a brief, evidence-based psychotherapy tailored for patients with advanced cancer that has not yet been implemented routinely in Dutch cancer care. The aim of this study was to assess the feasibility, acceptability, sustainability and effectiveness of CALM in different clinical settings in the Netherlands. METHODS In 2019 and 2020 a multi-center, intervention-only study was performed in three Dutch cancer care settings. Professionals were trained to provide CALM under supervision. Patients diagnosed with advanced cancer were included and filled out questionnaires to measure depression (Patient Health Questionnaire-9), death anxiety (Death and Dying Distress Scale), and anxiety (hospital anxiety and depression scale-anxiety) at baseline, 3 and 6 months. The Clinical Evaluation Questionnaire was used to assess acceptability of CALM at 3 and 6 months. RESULTS Sixty-four patients (55% of the eligible patients) were included in the study and 85% of the included patients received 3 or more CALM sessions. Of the 24 trained therapists, 15 (63%) started providing CALM. Two years post-study, CALM was provided in each center by a total of 19 therapists. On average, patients perceived CALM to be at least somewhat helpful. A significant decrease in severity of depression (p = 0.006), death anxiety (p = 0.008), and anxiety (p = 0.024) was observed over time. CONCLUSIONS This study shows that CALM therapy is feasible, acceptable, and sustainable in three Dutch cancer care settings, although not all predefined feasibility criteria for therapists were met. CALM can be effective in decreasing feelings of depression, anxiety, and death anxiety in patients with advanced cancer.
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Affiliation(s)
- Marianne Kool
- Center for Quality of Life, Antoni van Leeuwenhoek -Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Emma Hafkamp
- Center for Quality of Life, Antoni van Leeuwenhoek -Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Janna Gol
- Centre of Expertise in Palliative Care, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Eline J Aukema
- Ingeborg Douwes Centrum (IDC), Centre of Expertise in Psycho-Oncology, OLVG, Amsterdam, the Netherlands
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - An Reyners
- Centre of Expertise in Palliative Care, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lonneke van de Poll
- Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Froukje de Vries
- Department of Psychiatry, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
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Cui J, Fang P, Bai J, Tan L, Wan C, Yu L. Meta-Analysis of Effects of Early Palliative Care on Health-Related Outcomes Among Advanced Cancer Patients. Nurs Res 2023; 72:E180-E190. [PMID: 37733650 DOI: 10.1097/nnr.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early palliative care (PC) has received more attention for improving health-related outcomes for advanced cancer patients in recent years, but the results of previous studies are inconsistent. OBJECTIVES This study aimed to use meta-analysis and trial sequence analysis to evaluate the effect of early PC on health-related outcomes of advanced cancer patients. METHODS All English publications were searched in PubMed, Web of Science, Embase, and the Cochrane Library from inception to March 2023, with a restriction that the study type was a randomized controlled trial. RESULTS The results showed that early PC positively affected quality of life, satisfaction with care, and symptom burden reduction. However, early PC had no significant effect on anxiety or survival. Trial sequence analysis results showed that the effect of early PC on the quality of life was stable. DISCUSSION This systematic review suggested that early PC could positively affect health-related outcomes for advanced cancer patients. Early PC can be used widely in clinical settings to improve health-related outcomes of advanced cancer. However, because of the trial sequence analysis results, further well-designed, clinical, randomized controlled trials with larger sample sizes are necessary to draw definitive conclusions.
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Gontijo Garcia GS, Meira KC, de Souza AH, Guimarães NS. Anxiety and depression disorders in oncological patients under palliative care at a hospital service: a cross-sectional study. BMC Palliat Care 2023; 22:116. [PMID: 37580770 PMCID: PMC10426043 DOI: 10.1186/s12904-023-01233-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the risk and protective factors associated with anxiety and depression symptoms in cancer patients at an advanced stage of cancer. METHODS A cross-sectional study was conducted on patients with advanced cancer who were receiving palliative care. Cancer patients aged 18 years or older, with preserved cognitive function who completed the questionnaires were eligible. The questionnaires of Hospital Anxiety and Depression Scale (HADS) and health related of quality of life questionnaire; the European Organization for Research and Treatment of Cancer (EORTC-C30) were applied. Outcome variables were the depression and anxiety symptoms of cancer patients under palliative care, according to the answers to the 14 items that make up the HADS Scale. The analysis used the R software, version 4.2.0. RESULTS Seventy cancer patients with advanced cancer were included. The colon was the most common neoplastic diagnostic (20%), followed by breast (12.9%) and lung (10%). The prevalence of depression was 44.3%, 25.7% anxiety and 52.9% had both symptoms. Patients with a high level of functionality had a lower chance of anxiety (OR = 0.80;p = 0.025), depression (OR = 0.82; p = 0.007), and anxiety and depression (OR = 0.82p = 0.008). We observed a lower chance of depression and depression/anxiety who showed a high level of Overall Performance. Three symptoms increased the chance of depression/anxiety: nausea/vomiting (p = 0.019), fatigue (0.031), loss of appetite (0.048). CONCLUSION This study found high prevalence of anxiety and depression.Better quality of life and functionality were negatively associated with these outcomes. Examining the patient's functions will assist the clinician in alleviating symptoms of anxiety and depression, giving cancer patients in palliative care more dignity. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | - Karina Cardoso Meira
- Escola de Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- OPENS: Observatory of Epidemiology, Nutrition and Health Research, Faculdade Ciências Médicas de Minas Gerais/FELUMA, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra Hubner de Souza
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- OPENS: Observatory of Epidemiology, Nutrition and Health Research, Faculdade Ciências Médicas de Minas Gerais/FELUMA, Belo Horizonte, Minas Gerais, Brazil
| | - Nathalia Sernizon Guimarães
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
- OPENS: Observatory of Epidemiology, Nutrition and Health Research, Faculdade Ciências Médicas de Minas Gerais/FELUMA, Belo Horizonte, Minas Gerais, Brazil.
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Lynch FA, Rodin G, Jefford M, Duffy M, Lai-Kwon J, Heynemann S, Mileshkin L, Briggs L, Burke J, Leigh L, Spelman T, Ftanou M. Evaluation of Managing Cancer and Living Meaningfully (CALM) in people with advanced non-small cell lung cancer treated with immunotherapies or targeted therapies: protocol for a single-arm, mixed-methods pilot study. BMJ Open 2023; 13:e072322. [PMID: 37524546 PMCID: PMC10391815 DOI: 10.1136/bmjopen-2023-072322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION People with advanced non-small cell lung cancer (NSCLC) treated with immunotherapies (IT) or targeted therapies (TT) may have improved outcomes in a subset of people who respond, raising unique psychological concerns requiring specific attention. These include the need for people with prolonged survival to reframe their life plans and tolerate uncertainty related to treatment duration and prognosis. A brief intervention for people with advanced cancer, Managing Cancer and Living Meaningfully (CALM), could help people treated with IT or TT address these concerns. However, CALM has not been specifically evaluated in this population. This study aims to evaluate the acceptability and feasibility of CALM in people with advanced NSCLC treated with IT or TT and obtain preliminary evidence regarding its effectiveness in this population. METHODS AND ANALYSIS Twenty people with advanced NSCLC treated with IT or TT will be recruited from Peter MacCallum Cancer Centre, Melbourne, Australia. Participants will complete three to six sessions of CALM delivered over 3-6 months. A prospective, single-arm, mixed-methods pilot study will be conducted. Participants will complete outcome measures at baseline, post-intervention, 3 months and 6 months, including Patient Health Questionnaire, Death and Dying Distress Scale, Functional Assessment of Cancer Therapy General and Clinician Evaluation Questionnaire. The acceptability of CALM will be assessed using patient experiences surveys and qualitative interviews. Feasibility will be assessed by analysis of recruitment rates, treatment adherence and intervention delivery time. ETHICS AND DISSEMINATION Ethics approval has been granted by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/82047/PMCC). Participants with cancer will complete a signed consent form prior to participation, and carers and therapists will complete verbal consent. Results will be made available to funders, broader clinicians and researchers through conference presentations and publications. If CALM is found to be acceptable in this cohort, this will inform a potential phase 3 trial.
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Affiliation(s)
- Fiona Anne Lynch
- Psychosocial Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Psychology Department, Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Gary Rodin
- Global Institute of Psychosocial, Palliative and End-of- Life Care (GIPPEC), Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Mary Duffy
- Lung Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sarah Heynemann
- Department of Medical Oncology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Lung Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Briggs
- Patient Representative, Melbourne, Victoria, Australia
| | - John Burke
- Patient Representative, Melbourne, Victoria, Australia
| | - Lilian Leigh
- Patient Representative, Sydney, New South Wales, Australia
| | - Tim Spelman
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Psychosocial Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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Nguyen L, Hallet J, Eskander A, Chan WC, Noel CW, Mahar A, Sutradhar R. The impact of a cancer diagnosis on nonfatal self-injury: a matched cohort study in Ontario. CMAJ Open 2023; 11:E291-E297. [PMID: 37015741 PMCID: PMC10079310 DOI: 10.9778/cmajo.20220157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Psychological distress following a cancer diagnosis potentially increases the risk of intentional, nonfatal self-injury. The purpose of this work is to evaluate and compare rates of nonfatal self-injury among individuals in Ontario diagnosed with cancer against matched controls with no history of cancer. METHODS Adults in Ontario diagnosed with cancer from 2007 to 2019 were matched to 2 controls with no history of cancer, based on age and sex. We calculated the absolute and relative difference in rates of nonfatal self-injury in the 5 years before and after the index date (date of cancer diagnosis and dummy date for controls). We used crude difference-in-differences methods and adjusted Poisson regression-based analyses to examine whether the change in rates of nonfatal self-injury before and after index differed between cancer patients and controls. RESULTS The cohort included 803 740 people with cancer and 1 607 480 matched controls. In the first year after diagnosis, individuals with cancer had a 1.17-fold increase in rates of nonfatal self-injury (95% confidence interval [CI] 1.03-1.33) compared with matched controls, after accounting for pre-existing differences in rates of nonfatal self-injury and other clinical characteristics between the groups. Rates of nonfatal self-injury remained elevated in the cancer group by 1.07-fold for up to 5 years after diagnosis (95% CI 0.95-1.21). INTERPRETATION In this study, incidence of nonfatal self-injury was higher among individuals diagnosed with cancer, with the greatest impact observed in the first year after diagnosis. This work highlights the need for robust and accessible psychosocial oncology programs to support mental health along the cancer journey.
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Affiliation(s)
- Lena Nguyen
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.
| | - Julie Hallet
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Antoine Eskander
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Wing C Chan
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Christopher W Noel
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Alyson Mahar
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Rinku Sutradhar
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
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10
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Nazari F, Khoshnood Z, Shahrbabaki PM. The Relationship Between Authenticity and Death Anxiety in Cancer Patients. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:966-979. [PMID: 33615894 DOI: 10.1177/0030222821997603] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
One of the many problems cancer patients experience is death anxiety. This descriptive-analytical cross-sectional study aimed to investigate the relationship between authenticity and death anxiety in cancer patients. The participants were 172 cancer patients who referred to medical centers in southeast Iran. The data were collected using authenticity inventory, and death and dying anxiety scale. There was a negative correlation between authenticity and death anxiety, i.e. patients who indicated higher authenticity scores showed lower levels of death anxiety. It seems that developing a comprehensive care program for increasing awareness of authenticity in patients, may be effective in reducing patient death anxiety.
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Affiliation(s)
- Faezeh Nazari
- Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zohreh Khoshnood
- Nursing Research Center, Department of Public Health Nursing, Razi Faculty Nursing and Midwifery, Kerman University of Medical Science, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty Nursing and Midwifery, Kerman University of Medical Science, Kerman, Iran
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11
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Jibb LA, Nanos SM, Alexander S, Malfitano C, Rydall A, Gupta S, Schimmer AD, Zimmermann C, Hales S, Nissim R, Marmar C, Schultebraucks K, Mah K, Rodin G. Traumatic stress symptoms in family caregivers of patients with acute leukaemia: protocol for a multisite mixed methods, longitudinal, observational study. BMJ Open 2022; 12:e065422. [PMID: 36332954 PMCID: PMC9639100 DOI: 10.1136/bmjopen-2022-065422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The diagnosis, progression or recurrence of cancer is often highly traumatic for family caregivers (FCs), but systematic assessments of distress and approaches for its prevention and treatment are lacking. Acute leukaemia (AL) is a life-threatening cancer of the blood, which most often presents acutely, requires intensive treatment and is associated with severe physical symptoms. Consequently, traumatic stress may be common in the FCs of patients with AL. We aim to determine the prevalence, severity, longitudinal course and predictors of traumatic stress symptoms in FCs of patients with AL in the first year after diagnosis, and to understand their lived experience of traumatic stress and perceived support needs. METHODS AND ANALYSIS This two-site longitudinal, observational, mixed methods study will recruit 223 adult FCs of paediatric or adult patients newly diagnosed with AL from two tertiary care centres. Quantitative data will be collected from self-report questionnaires at enrolment, and 1, 3, 6, 9 and 12 months after admission to hospital for initial treatment. Quantitative data will be analysed using descriptive and machine learning approaches and a multilevel modelling (MLM) approach will be used to confirm machine learning findings. Semi-structured qualitative interviews will be conducted at 3, 6 and 12 months and analysed using a grounded theory approach. ETHICS AND DISSEMINATION This study is funded by the Canadian Institutes of Health Research (CIHR number PJT 173255) and has received ethical approval from the Ontario Cancer Research Ethics Board (CTO Project ID: 2104). The data generated have the potential to inform the development of targeted psychosocial interventions for traumatic stress, which is a public health priority for high-risk populations such as FCs of patients with haematological malignancies. An integrated and end-of-study knowledge translation strategy that involves FCs and other stakeholders will be used to interpret and disseminate study results.
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Affiliation(s)
- Lindsay A Jibb
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie M Nanos
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Aaron D Schimmer
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Charles Marmar
- Department of Psychiatry, New York University, New York, New York, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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12
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Chen Z, He G, Zhao Y, Han C, Xu L, Jian H, Chu Q, He Y. Symptom burden and emotional distress in advanced lung cancer: the moderating effects of physicians' communication skills and patients' disease understanding. Support Care Cancer 2022; 30:9497-9505. [PMID: 35971009 DOI: 10.1007/s00520-022-07323-9] [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: 04/03/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The elevated physical symptom burden in advanced lung cancer can disrupt patients' emotional well-being, and current literature suggests that physicians' good communication skills might be a buffer. However, little is known about for which group of patients this buffering effect is most effective. Based on a cross-sectional study in patients with advanced lung cancer, the present study examined whether the moderating effect of physicians' communication skills on the association between physical symptoms and emotional distress would further depend on patients' perceived disease understanding. METHODS Patients with advanced lung cancer (n = 199) completed a questionnaire including measures of physical symptoms related to lung cancer, anxiety, and depressive symptoms, perceptions of physicians' communication skills, and self-reported understanding of their disease. RESULTS Hierarchical regression analyses indicated a significant three-way interaction among physical symptoms, perceptions of physicians' communication skills, and perceived disease understanding on both anxiety and depression. Specifically, physicians' good communication skills exerted a buffering effect only for patients with lower levels of disease understanding. CONCLUSION Our findings indicate that improving physicians' communication skills may be especially beneficial for reducing the maladaptive emotional reactions to symptom burden for patients with limited disease understanding. When time and resources for communication are restricted, enhanced awareness and focused training may be directed at communicating with patients who possess limited knowledge about their disease.
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Affiliation(s)
- Zhonglin Chen
- Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Rd, Shanghai, 200030, China
| | - Gan He
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Rd, Shanghai, 200025, China
| | - Yi Zhao
- Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Rd, Shanghai, 200030, China
| | - Chenyan Han
- Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Rd, Shanghai, 200030, China
| | - Lei Xu
- Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Rd, Shanghai, 200030, China
| | - Hong Jian
- Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Rd, Shanghai, 200030, China
| | - Qiao Chu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Rd, Shanghai, 200025, China.
| | - Yaping He
- School of Public Health, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Rd, Shanghai, 200025, China. .,Center for Health Technology Assessment, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai Jiao Tong University, No. 227 South Chongqing Rd, Shanghai, 200025, China.
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13
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Magill N, Walker J, Symeonides S, Gourley C, Hobbs H, Rosenstein D, Frost C, Sharpe M. Depression and anxiety during the year before death from cancer. J Psychosom Res 2022; 158:110922. [PMID: 35500323 DOI: 10.1016/j.jpsychores.2022.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Previous studies of depression and anxiety during the year before death have reported different findings. We therefore aimed to study depression and anxiety in patients who had died from cancer and had previously attended cancer clinics. METHODS We analysed routine data on 4869 deceased patients who had completed the Hospital Anxiety and Depression Scale (HADS) as part of their routine cancer care. The HADS data were linked with demographic, cancer and mortality data from national registries. We used data from all HADS completed in the last year of life to investigate the relationships between mean depression (HADS-D) and anxiety (HADS-A) scores and the percentages of high scores (≥11 on each subscale) and time to death (Analysis 1). This analysis used multivariable linear regression with cubic splines and robust standard errors to allow for multiple HADS from the same patients. We also investigated within-patient changes in scores (Analysis 2) in a subset of patients who had completed more than one HADS. RESULTS In Analysis 1, modelled mean HADS-D scores increased by around 2.5 and the percentage of high HADS-D scores increased from 13% at six months before death to 30% at one month before death. Changes in HADS-A were smaller and occurred later. In Analysis 2, similar patterns were observed in individual patients' HADS scores. CONCLUSION Depression should be looked for and treated in patients with cancer and a prognosis of six months or less, in order to maximise the quality of patients' remaining life.
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Affiliation(s)
- Nicholas Magill
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Stefan Symeonides
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Charlie Gourley
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Harriet Hobbs
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Donald Rosenstein
- Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
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14
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Psychological interventions targeting patients with metastatic cancer and prolonged survival expectancies: advances and challenges. Curr Opin Oncol 2022; 34:256-264. [PMID: 35703243 DOI: 10.1097/cco.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the formats and techniques of psychological interventions designed for patients with metastatic cancer and prolonged survival expectancies. RECENT FINDINGS Fifteen interventional studies were selected for this article. One group of psychological interventions focused primarily on patients' adaptation by increasing their knowledge, developing patients' stress management skills, promoting their open communication with healthcare providers, and helping them deal with existential concerns. Another group of interventions focused on patients with moderate and high levels of distress. These interventions provided specific techniques to manage anxiety, depression, fear of cancer progression, and existential distress. Interestingly, interventions targeting distressed patients are not necessarily longer or more intensive than interventions targeting adaptation. The interventions were examined in few randomized controlled trials, and incorporated a broad range of techniques, making comparison of their efficacy difficult. No intervention specifically targeted patients newly diagnosed with metastatic cancer. SUMMARY On the basis of this review, we proposed suggestions according to patients' levels of distress, which differ in intensity, format, techniques, and tools offered. These suggestions may be relevant for the future development and assessment of interventions targeting patients with newly diagnosed metastatic cancer and prolonged survival expectancies.
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15
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Is spiritual well-being related to survival time of inpatients with advanced cancer? An East Asian cohort study. Palliat Support Care 2022; 21:483-491. [PMID: 35757916 DOI: 10.1017/s1478951522000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES It has been suggested that psychosocial factors are related to survival time of inpatients with cancer. However, there are not many studies examining the relationship between spiritual well-being (SWB) and survival time among countries. This study investigated the relationship between SWB and survival time among three East Asian countries. METHODS This international multicenter cohort study is a secondary analysis involving newly admitted inpatients with advanced cancer in palliative care units in Japan, South Korea, and Taiwan. SWB was measured using the Integrated Palliative Outcome Scale (IPOS) at admission. We performed multivariate analysis using the Cox proportional hazards model to identify independent prognostic factors. RESULTS A total of 2,638 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. The median survival time was 18.0 days (95% confidence interval [CI] 16.5-19.5) in Japan, 23.0 days (95% CI 19.9-26.1) in Korea, and 15.0 days (95% CI 13.0-17.0) in Taiwan. SWB was a significant factor correlated with survival in Taiwan (hazard ratio [HR] 1.27; 95% CI 1.01-1.59; p = 0.04), while it was insignificant in Japan (HR 1.10; 95% CI 1.00-1.22; p = 0.06), and Korea (HR 1.02; 95% CI 0.77-1.35; p = 0.89). SIGNIFICANCE OF RESULTS SWB on admission was associated with survival in patients with advanced cancer in Taiwan but not Japan or Korea. The findings suggest the possibility of a positive relationship between spiritual care and survival time in patients with far advanced cancer.
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16
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Loughan AR, Willis KD, Braun SE, Rodin G, Lanoye A, Davies AE, Svikis D, Mazzeo S, Malkin M, Thacker L. Managing cancer and living meaningfully (CALM) in adults with malignant glioma: a proof-of-concept phase IIa trial. J Neurooncol 2022; 157:447-456. [PMID: 35437687 PMCID: PMC9909556 DOI: 10.1007/s11060-022-03988-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Managing Cancer and Living Meaningfully (CALM) is an evidence-based, brief, semi-structured psychotherapy designed to help patients with advanced cancer cope with the practical and profound challenges of their illness. However, no study to date has investigated its feasibility, acceptability, and preliminary effectiveness in adults with malignant glioma, despite the well-documented incidence of psychological distress in this vulnerable and underserved population. METHODS Fourteen patients with glioma and elevated symptoms of depression and/or death anxiety enrolled in the trial: 83% glioblastoma, 75% female, Mage = 56 years (SD = 15.1; range = 27-81). Feasibility was assessed based on established metrics. Acceptability was measured by post-session surveys and post-intervention interviews. Preliminary intervention effects were explored using paired t-tests, comparing psychological distress at baseline and post-intervention. RESULTS Of the 14 enrolled patients, 12 were evaluable. Nine completed the study (75% retention rate). Three patients withdrew due to substantial disease progression which affected their ability to participate. Participants reported high perceived benefit, and all recommended the program to others. Baseline to post-intervention assessments indicated reductions in death anxiety, generalized anxiety, and depression, and increases in spirituality. Quality of life and fear of cancer recurrence remained stable throughout the study period. CONCLUSIONS CALM appears feasible for use with adults with malignant glioma. Enrollment and retention rates were high and comparable to psychotherapy trials for patients with advanced cancer. High perceived benefit and reductions in symptoms of death anxiety, generalized anxiety, and depression were reported by participants. These findings are extremely encouraging and support further study of CALM in neuro-oncology. TRIAL REGISTRATION NUMBER NCT04646213 registered on 11/27/2020.
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Affiliation(s)
- Ashlee R Loughan
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA.
- Massey Cancer Center, Richmond, VA, USA.
- Division of Neuro-Oncology, Department of Neurology, Virginia Commonwealth University, School of Medicine, VCU Massey Cancer Center, 1201 East Marshall St, Richmond, VA, 23298-0037, USA.
| | - Kelcie D Willis
- Massey Cancer Center, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah Ellen Braun
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA
- Massey Cancer Center, Richmond, VA, USA
| | - Gary Rodin
- Princess Margaret Cancer Center, Toronto, Canada
| | - Autumn Lanoye
- Massey Cancer Center, Richmond, VA, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexandria E Davies
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Malkin
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA
- Massey Cancer Center, Richmond, VA, USA
| | - Leroy Thacker
- Massey Cancer Center, Richmond, VA, USA
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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17
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Seiler A, Schettle M, Amann M, Gaertner S, Wicki S, Christ SM, Theile G, Feuz M, Hertler C, Blum D. Virtual Reality Therapy in Palliative Care: A Case Series. J Palliat Care 2022:8258597221086767. [PMID: 35293818 DOI: 10.1177/08258597221086767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Virtual reality (VR) opens a variety of therapeutic options to improve symptom burden in patients with advanced disease. Until to date, only few studies have evaluated the use of VR therapy in the context of palliative care. This case series aims to evaluate the feasibility and acceptability of VR therapy in a population of palliative care patients. METHODS In this single-site case series, we report on six palliative care patients undergoing VR therapy. The VR therapy consisted of a one-time session ranging between 20 to 60 minutes depending on the patient's needs and the content chosen for the VR sessions. A semi-structured survey was conducted and the Edmonton Symptom Assessment System (ESAS) and the Distress Thermometer were performed pre- and post-intervention. RESULTS Overall, VR therapy was well accepted by all patients. Five out of six patients reported having appreciated VR therapy. There were individual differences of perceived effects using VR therapy. The semi-structured survey revealed that some patients felt a temporary detachment from their body and that patients were able to experience the VR session as a break from omnipresent worries and the hospital environment ("I completely forgot where I am"). There was a considerable reduction in the total ESAS score post-treatment (T0 ESASTot = 27.2; T1 ESASTot = 18.8) and a slightly reduction in distress (T0 DTTot = 4.4; T1 DTTot = 3.8). However, two patients were more tired after the intervention.Significance of Results: Our preliminary results demonstrate that VR therapy is acceptable, feasible and safe for use within a palliative care population and appears to be a viable treatment option. Clinical trials are both warranted and necessary to confirm any therapeutic effects of VR therapy, as is the need to tailor VR systems better for use in palliative care settings.
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Affiliation(s)
- A Seiler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - M Amann
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Gaertner
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Wicki
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Internal Medicine Centre, Hirslanden Klinik Aarau, Switzerland
| | - S M Christ
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - G Theile
- Clinic Susenberg, Zurich, Switzerland
| | - M Feuz
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - C Hertler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - D Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
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18
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Temel JS, Petrillo LA, Greer JA. Patient-Centered Palliative Care for Patients With Advanced Lung Cancer. J Clin Oncol 2022; 40:626-634. [PMID: 34985932 DOI: 10.1200/jco.21.01710] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The evidence base demonstrating the benefits of an early focus on palliative care for patients with serious cancers, including advanced lung cancer, is substantial. Early involvement of specialty-trained palliative care clinicians in the care of patients with advanced lung cancer improves patient-reported outcomes, such as quality of life, and health care delivery, including hospice utilization. Since the time that many of these palliative care trials were conducted, the paradigm of cancer care for many cancers, including lung cancer, has changed dramatically. The majority of patients with advanced lung cancer are now treated with immune checkpoint inhibitors or targeted therapies, both of which have had a significant impact on patient's experience and outcomes. With this changing landscape of lung cancer therapeutics, patients are facing new and different challenges, including dealing with novel side effect profiles and coping with greater uncertainty regarding their prognosis. Patients who are living longer with their advanced cancer also struggle with how to address survivorship issues, such as sexual health and exercise, and decision making about end-of-life care. Although palliative care clinicians remain well-suited to address these care needs, they may need to learn new skills to support patients treated with novel therapies. Additionally, as the experience of patients with advanced lung cancer is becoming more varied and individualized, palliative care research interventions and clinical programs should also be delivered in a patient-centered manner to best meet patient's needs and improve their outcomes. Tailored and technology-based palliative care interventions are promising strategies for delivering patient-centered palliative care.
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Affiliation(s)
- Jennifer S Temel
- Harvard Medical School, Boston, MA.,Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Laura A Petrillo
- Harvard Medical School, Boston, MA.,Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Joseph A Greer
- Harvard Medical School, Boston, MA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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19
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Nursing, psychotherapy and advanced cancer: A scoping review. Eur J Oncol Nurs 2021; 56:102090. [PMID: 35026499 DOI: 10.1016/j.ejon.2021.102090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Many individuals with advanced cancer have unmet psychological needs and often lack access to supportive care. Psychotherapy for adults with advanced cancer is a promising way to address some of the challenges in meeting these care needs. Nurses are the largest cohort of healthcare workers who can practice as psychotherapists and are positioned ideally to integrate these interventions as part of routine care. The purpose of this scoping review is to map the literature on psychotherapeutic interventions among adults with advanced cancer and to explore the nursing role in this body of evidence. METHODS We conducted a scoping review for relevant quantitative, qualitative, and mixed methods studies. The content of included studies was analyzed and grouped based on two broad categories that describe how nursing's role was mentioned, described, and utilized: 1. Nurses are not the interventionist/psychotherapist and, 2. Nurses are mentioned as the interventionist/psychotherapist. RESULTS Eighty-six studies were included. Overall, majority of studies did not mention a role for nursing in any capacity. Some studies mentioned a non-interventionist role for nursing in the research study. Fourteen studies mentioned nurses as interventionists/psychotherapists. These studies focused on feasibility, acceptability and patient related outcomes of brief psychotherapies. Dignity therapy was the most common psychotherapy in studies where nurses were utilized as interventionists, followed by life review and supportive expressive therapies. Very few studies discussed nursing's role in this area and nursing's capacity to deliver this form of care. CONCLUSION There is paucity in nursing research focused on psychotherapy for adults with advanced cancer. It is feasible and acceptable for nurses to deliver brief psychotherapies to adults with advanced cancer, and the integration of these techniques in everyday practice has great potential that must be explored. The development of this knowledge base is needed to support future education, research, and practice policy agendas.
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Mercadante S, Coluzzi F. Factors Influencing Pain Expression in Patients with Cancer: An Expert Opinion. Pain Ther 2021; 10:765-775. [PMID: 34014529 PMCID: PMC8586270 DOI: 10.1007/s40122-021-00272-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/07/2021] [Indexed: 11/05/2022] Open
Abstract
Pain is a multidimensional experience that requires an appropriate assessment, and simple numbering may not be enough for the different components that are involved in the clinical expression. In consideration of the subjectivity of the symptom, each assessment should start from the way in which the patients perceive the pain and from how they deal with it. Some factors related to individual patient characteristics may make pain management difficult because of interference with the clinical pain expression. These factors may amplify the reporting of pain. Cognitive disorders and psychological distress seem to strongly influence pain expression and may render the analgesic treatment more difficult. Aberrant behaviors, such as alcoholism, smoking, and opioid misuse, may play a role, although geographic differences were found in terms of prevalence of the phenomenon, especially in some countries. Finally, the assessment of patients' expectation and the meaning of the personal feeling of changes in pain intensity provide new concepts in pain assessment, which may allow better personalization of the analgesic therapy. A modern pain assessment should include a multitude of factors influencing the phenotype of pain.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care Unit and Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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21
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Niveau N, New B, Beaudoin M. How Should Self-Esteem Be Considered in Cancer Patients? Front Psychol 2021; 12:763900. [PMID: 34777169 PMCID: PMC8581674 DOI: 10.3389/fpsyg.2021.763900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
Numerous studies showed that cancer significantly increases the risk of developing depressive and anxious symptoms. It has been shown that self-esteem is an important psychological resource and is associated with many health behaviors. Furthermore, the vulnerability model of low self-esteem, which has received strong empirical support, highlights that low self-esteem is a real risk factor in the development of depressive disorders. This article aims at providing an overview of the involvement of self-esteem in the psychological adjustment to cancer. After briefly reviewing the literature, we suggest that its implication in the development of depressive disorders and its association with coping strategies and social support in cancer patients justify the consideration of self-esteem in oncology psychological care, especially in young adult patients and those with significant physical impairment following treatment.
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Affiliation(s)
- Noémie Niveau
- LPNC, CNRS, Univ. Savoie Mont-Blanc, Chambéry, France.,LIP/PC2S, Univ. Savoie Mont-Blanc, Chambéry, France
| | - Boris New
- LPNC, CNRS, Univ. Savoie Mont-Blanc, Chambéry, France
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22
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Arai D, Sato T, Nakachi I, Fujisawa D, Takeuchi M, Sato Y, Kawada I, Yasuda H, Ikemura S, Terai H, Nukaga S, Inoue T, Nakamura M, Oyamada Y, Terashima T, Sayama K, Saito F, Sakamaki F, Naoki K, Fukunaga K, Soejima K. Longitudinal Assessment of Prognostic Understanding in Patients with Advanced Lung Cancer and Its Association with Their Psychological Distress. Oncologist 2021; 26:e2265-e2273. [PMID: 34510654 DOI: 10.1002/onco.13973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/19/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Accurate prognostic understanding in patients with advanced cancer is essential for shared decision making; however, patients may experience psychological burden through knowing the incurable nature of advanced cancer. It has been unclear how their prognostic understanding fluctuates and whether accurate prognostic understanding is associated with psychological distress from the time of diagnosis over time. MATERIALS AND METHODS We longitudinally investigated prognostic understanding in 225 patients with newly diagnosed advanced lung cancer at 16 hospitals in Japan until 24 months after diagnosis. We examined associated factors with being consistently accurate in prognostic understanding, especially focusing on its association with psychological well-being. RESULTS The proportion of patients with an inaccurate prognostic understanding remained approximately 20% over time with the presence of patients with inconsistent understanding. Patients with consistently accurate prognostic understanding showed a significantly lower Emotional Well-Being subscale score at both 3 and 6 months after diagnosis (p = .010 and p = .014, respectively). In multivariate analyses, being consistently accurate in prognostic understanding was significantly associated with female gender and higher lung cancer-specific symptom burden at 3 months (p = .008 and p = .005, respectively) and lower emotional well-being at 6 months (p = .006). CONCLUSION Although substantial proportions of patients with advanced lung cancer had inaccurate prognostic understanding from the time of diagnosis over time, patients with consistently accurate prognostic understanding experienced greater psychological burden. Our findings highlight the importance of continuous psychological care and support for patients who understand their severe prognosis accurately. IMPLICATIONS FOR PRACTICE This study demonstrated that approximately 20% of patients with advanced lung cancer had an inaccurate understanding about their prognosis, not only at the time of diagnosis but also at the later time points. Being consistently accurate in prognostic understanding was significantly associated with elevated levels of psychological distress. Although accurate prognostic understanding is essential for decision making for treatment and advance care planning, health care providers should be aware of psychological burdens in patients that accept their severe prognosis accurately. Appropriate care and support for such patients are warranted from diagnosis over time.
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Affiliation(s)
- Daisuke Arai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Takashi Sato
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Medicine, Keiyu Hospital, Yokohama, Japan
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ichiro Nakachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Daisuke Fujisawa
- Division of Patient Safety, Keio University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Mari Takeuchi
- Palliative Care Center, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Shigenari Nukaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takashi Inoue
- Department of Internal Medicine, Sano-Kosei General Hospital, Sano, Japan
| | - Morio Nakamura
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Yoshitaka Oyamada
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Koichi Sayama
- Division of Pulmonary Medicine, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Fumio Sakamaki
- Division of Pulmonary Medicine, Department of Medicine, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
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23
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Malhotra C, Malhotra R, Bundoc F, Teo I, Ozdemir S, Chan N, Finkelstein E. Trajectories of Suffering in the Last Year of Life Among Patients With a Solid Metastatic Cancer. J Natl Compr Canc Netw 2021; 19:1264-1271. [PMID: 34492633 DOI: 10.6004/jnccn.2021.7014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/23/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Reducing suffering at the end of life is important. Doing so requires a comprehensive understanding of the course of suffering for patients with cancer during their last year of life. This study describes trajectories of psychological, spiritual, physical, and functional suffering in the last year of life among patients with a solid metastatic cancer. PATIENTS AND METHODS We conducted a prospective cohort study of 600 patients with a solid metastatic cancer between July 2016 and December 2019 in Singapore. We assessed patients' psychological, spiritual, physical, and functional suffering every 3 months until death. Data from the last year of life of 345 decedents were analyzed. We used group-based multitrajectory modeling to delineate trajectories of suffering during the last year of a patient's life. RESULTS We identified 5 trajectories representing suffering: (1) persistently low (47% of the sample); (2) slowly increasing (14%); (3) predominantly spiritual (21%); (4) rapidly increasing (12%); and (5) persistently high (6%). Compared with patients with primary or less education, those with secondary (high school) (odds ratio [OR], 3.49; 95% CI, 1.05-11.59) education were more likely to have rapidly increasing versus persistently low suffering. In multivariable models adjusting for potential confounders, compared with patients with persistently low suffering, those with rapidly increasing suffering had more hospital admissions (β=0.24; 95% CI, 0.00-0.47) and hospital days (β=0.40; 95% CI, 0.04-0.75) during the last year of life. Those with persistently high suffering had more hospital days (β=0.70; 95% CI, 0.23-1.17). CONCLUSIONS The course of suffering during the last year of life among patients with cancer is variable and related to patients' hospitalizations. Understanding this variation can facilitate clinical decisions to minimize suffering and reduce healthcare costs at the end of life.
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Affiliation(s)
- Chetna Malhotra
- 1Lien Centre for Palliative Care.,2Program in Health Services and Systems Research, and
| | - Rahul Malhotra
- 2Program in Health Services and Systems Research, and.,3Centre for Ageing Research and Education, Duke-NUS Medical School
| | | | - Irene Teo
- 1Lien Centre for Palliative Care.,4National Cancer Centre Singapore; and
| | - Semra Ozdemir
- 1Lien Centre for Palliative Care.,2Program in Health Services and Systems Research, and
| | - Noreen Chan
- 5Division of Palliative Care, National University Cancer Institute, Singapore
| | - Eric Finkelstein
- 1Lien Centre for Palliative Care.,2Program in Health Services and Systems Research, and
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24
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Peralta JR, Adriano Rengifo CE, Mariño Rugel AM. Desesperanza y su relación con el apoyo social percibido en pacientes peruanos con neoplasias hematológicas. PSICOONCOLOGIA 2021. [DOI: 10.5209/psic.75631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: El propósito del presente estudio fue determinar la relación significativa entre el apoyo social y la desesperanza en pacientes peruanos con neoplasias hematológicas que se encuentren en alguna de las fases del tratamiento. Método: El estudio fue de tipo descriptivo-correlacional. La muestra estuvo conformada por 110 pacientes hematooncológicos de ambos sexos, con edades entre 16 a 25 años. Los instrumentos utilizados fueron la Escala Multidimensional de Apoyo Social Percibido (MSPSS) y la Escala de Desesperanza de Beck (BHS). Resultados: Se reportan niveles altos de apoyo social percibido (81%) y niveles normales de desesperanza (82%) en los pacientes hematooncológicos. El apoyo social percibido se correlaciona inversa y significativamente con la desesperanza, aunque en magnitudes bajas a moderadas. Cabe destacar que la dimensión Expectativa de desgracia en el futuro, no se correlaciona significativamente con el apoyo social percibido y sus dimensiones. Igualmente, la dimensión Creencias que los acontecimientos negativos son durables, no se correlaciona con la dimensión Apoyo de familia. Por otro lado, se encontró diferencias significativas del apoyo social percibido con el sexo y la religión, asimismo, la desesperanza con la edad, tiempo de diagnóstico y fase de tratamiento. Conclusión: El apoyo social percibido se relaciona con la desesperanza en pacientes hematooncológicos peruanos. Por tanto, se corrobora que el apoyo social que recibe el paciente ante la desesperanza de una enfermedad hematooncológica, sirve como soporte y tolerancia de dicha enfermedad y sus efectos durante el tratamiento.
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25
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Hiratsuka Y, Suh SY, Kim SH, Cheng SY, Yoon SJ, Koh SJ, Park SA, Seo JY, Kwon JH, Park J, Park Y, Hwang SW, Lee ES, Ahn HY, Hui D, Chen PJ, Yamaguchi T, Morita T, Tsuneto S, Mori M, Inoue A. Factors related to spiritual well-being in the last days of life in three East Asian countries: An international multicenter prospective cohort study. Palliat Med 2021; 35:1564-1577. [PMID: 34148395 DOI: 10.1177/02692163211022179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some factors associated with spiritual well-being in dying patients have previously been reported. However, there has been no cross-cultural study comparing factors related to spiritual well-being. The current investigation may shed light on this under-investigated area through a comparison of diverse factors. AIM We aimed to (1) examine factors associated with spiritual well-being in the last days and (2) compare those factors across three East Asian countries. DESIGN This is an international multicenter prospective cohort study. SETTING/PARTICIPANTS Newly admitted inpatients with far advanced cancer in palliative care units in Japan, Korea and Taiwan were enrolled. Each patient was classified into one of two groups based on spiritual well-being score in the last days of life. Univariate and multivariate analyses were performed to identify the factors related to better spiritual well-being score in each country. RESULTS A total of 1761 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. Seven variables were significant in Japan, three in Korea, and five in Taiwan. "Good death scale [acceptance]," "fatigue" and "expressed wish for hastened death" were unique in Japan. "Visit from a pastoral care worker within 48 h of death" was unique in Korea. "Patient's preferences for place of death," "dyspnea" and "continuous deep sedation" were unique in Taiwan. CONCLUSIONS This study found novel factors related to spiritual well-being in the last days of life, several of which differed according to country. Recognition of factors associated with spiritual well-being can improve the quality of palliative care.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Sang-Yeon Suh
- Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea.,Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Su-Jin Koh
- Department Hematology and Oncology, Ulsan University Hospital Ulsan University College of Medicine, Ulsan, South Korea
| | - Shin Ae Park
- Hospice & Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Ji-Yeon Seo
- Hospice & Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Youngmin Park
- Department of Family Medicine, Hospice and Palliative Care Center, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sun Wook Hwang
- Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Eunpyeong-gu, Seoul, South Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang-si, Gyeonggi-do, Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
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26
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Quality of End-of-Life Care for People with Advanced Non-Small Cell Lung Cancer in Ontario: A Population-Based Study. ACTA ACUST UNITED AC 2021; 28:3297-3315. [PMID: 34590598 PMCID: PMC8406090 DOI: 10.3390/curroncol28050286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Ensuring high quality end of life (EOL) care is necessary for people with advanced non-small-cell lung cancer (NSCLC), given its high incidence, mortality and symptom burden. Aggressive EOL care can adversely affect the quality of life of NSCLC patients without providing meaningful oncologic benefit. Objectives: (1) To describe EOL health services quality indicators and timing of palliative care consultation provided to patients dying of NSCLC. (2) To examine associations between aggressive and supportive care and patient, disease and treatment characteristics. Methods: This retrospective population-based cohort study describes those who died of NSCLC in Ontario, Canada from 2009–2017. Socio-demographic, patient, disease and treatment characteristics as well as EOL health service quality and use of palliative care consultation were investigated. Multivariable logistic regression models examined factors associated with receiving aggressive or supportive care. Results: Aggressive care quality indicators were present in 50.3% and supportive care indicators in 60.3% of the cohort (N = 37,203). Aggressive care indicators decreased between 2009 and 2017 (57.4% to 45.3%) and increased for supportive care (54.2% to 67.5%). Benchmarks were not met by 2017 in 3 of 4 cases. Male sex and greater comorbidity were associated with more aggressive EOL care and less supportive care. Older age was negatively associated and rurality positively associated with aggressive care. No palliative care consultation occurred in 56.0%. Conclusions: While improvements in the use of supportive rather than aggressive care were noted, established Canadian benchmarks were not met. Moreover, there is variation in EOL quality between groups and use of earlier palliative care must improve.
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Shafiq M, Malhotra R, Teo I, Ozdemir S, Kanesvaran R, Malhotra C. Trajectories of physical symptom burden and psychological distress during the last year of life in patients with a solid metastatic cancer. Psychooncology 2021; 31:139-147. [PMID: 34432911 DOI: 10.1002/pon.5792] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To delineate the trajectories of physical symptoms and psychological distress among patients with a solid metastatic cancer during the last year of life. METHODS We used data of 345 decedents from a prospective cohort of 600 patients with a Stage IV solid cancer. Using group-based trajectory modelling, we assessed (a) demographic (age, gender, education, cancer site) predictors of trajectory membership, (b) shift in trajectories associated with planned and unplanned hospitalizations, emergency room visits and chemotherapy, and (c) the association between trajectory membership and place of death. RESULTS We identified three trajectories of physical symptoms-"persistent mild" (56%), "progressive moderate" (36%), and "progressive severe" (8%), and two for psychological distress-"persistent mild" (72%) and "progressive distress" (28%). Females (β = 1.40 [SE = 0.55], p-value = 0.01) and highly educated patients (β = 1.46 [SE = 0.62], p-value = 0.02) were more likely to experience progressive severe symptoms compared to persistent mild symptoms. Older patients were less likely (β = -1.01 [SE = 0.33], p-value = 0.003), while those with gynecological cancers (β = 1.51 [SE = 0.65], p-value = 0.02) were more likely to experience progressive distress compared to persistent mild distress. Planned and unplanned hospitalizations, emergency room visits, and chemotherapy were associated with a worsening in trajectories. Patients with higher distress were more likely to die in a hospice compared to a hospital. CONCLUSIONS Interventions to improve physical symptoms and distress can focus on patients at risk of being in worse trajectories and at critical time points in the last year of life-hospitalizations, emergency room visits, and chemotherapy.
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Affiliation(s)
| | | | - Irene Teo
- Duke-NUS Medical School, Singapore, Singapore.,National Cancer Centre Singapore, Singapore, Singapore
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- Duke-NUS Medical School, Singapore, Singapore
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28
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Walshe C, Roberts D, Calman L, Appleton L, Croft R, Perez Algorta G, Skevington S, Lloyd-Williams M, Grande G. Peer Mentors for People with Advanced Cancer: Lessons Learnt from Recruiting and Training Peer Mentors for a Feasibility Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:710-718. [PMID: 31994006 PMCID: PMC8328854 DOI: 10.1007/s13187-020-01692-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Peer mentors may offer distinctive forms of support to people with advanced cancer. Whilst peer mentor programmes are known, little is understood about recruiting and training peer mentors to support those with advanced cancer. The purpose of this study is to determine the feasibility of recruiting and training peer mentors for a novel peer mentor intervention to promote well-being in people with advanced cancer. Feasibility study testing proactive introduction to a trained peer mentor for 12 weeks in the context of a randomized controlled two-arm trial and nested qualitative process evaluation was used. Peer mentors have/had cancer, recruited via an open call. Two-day training included a new bespoke module on coping with cancer. Descriptive recruitment and training data were captured, supplemented by qualitative interviews, analysed thematically. Forty-eight people expressed interest, mostly female (69%), with breast cancer (32%), and recruited via social media (49%). Twelve people completed training, with attrition often due to availability or mentors' own health; many had advanced cancer themselves. They wanted to 'give something back', but also formed supportive bonds with fellow mentors. It is feasible to recruit and train people with lived experience of cancer to be peer mentors, but those with particular characteristics may predominate. Broad social media based recruitment may have merit in widening the pool of potential peer mentors.
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Affiliation(s)
- Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Bailrigg, Lancaster, UK.
| | - Diane Roberts
- Division of Nursing, Midwifery and Social Work, Manchester University, Manchester, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, School of Health Sciences, Southampton University, Southampton, UK
| | - Lynda Appleton
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | | | | | - Suzanne Skevington
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester University, Manchester, UK
| | | | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, Manchester University, Manchester, UK
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29
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Li M, Shapiro GK, Klein R, Barbeau A, Rydall A, Bell JAH, Nissim R, Hales S, Zimmermann C, Wong RKS, Rodin G. Medical Assistance in Dying in patients with advanced cancer and their caregivers: a mixed methods longitudinal study protocol. BMC Palliat Care 2021; 20:117. [PMID: 34289838 PMCID: PMC8296526 DOI: 10.1186/s12904-021-00793-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The legal criteria for medical assistance in dying (MAiD) for adults with a grievous and irremediable medical condition were established in Canada in 2016. There has been concern that potentially reversible states of depression or demoralization may contribute to the desire for death (DD) and requests for MAiD. However, little is known about the emergence of the DD in patients, its impact on caregivers, and to what extent supportive care interventions affect the DD and requests for MAiD. The present observational study is designed to determine the prevalence, predictors, and experience of the DD, requests for MAiD and MAiD completion in patients with advanced or metastatic cancer and the impact of these outcomes on their primary caregivers. METHODS A cohort of patients with advanced or metastatic solid tumour cancers and their primary caregivers will be recruited from a large tertiary cancer centre in Toronto, Ontario, Canada, to a longitudinal, mixed methods study. Participants will be assessed at baseline for diagnostic information, sociodemographic characteristics, medical history, quality of life, physical and psychological distress, attitudes about the DD and MAiD, communication with physicians, advance care planning, and use of psychosocial and palliative care interventions. Measures will subsequently be completed every six months and at the time of MAiD requests. Quantitative assessments will be supplemented by qualitative interviews in a subset of participants, selected using quota sampling methods. DISCUSSION This study has the potential to add importantly to our understanding of the prevalence and determinants of the DD, MAiD requests and completions in patients with advanced or metastatic cancer and of the experience of both patients and caregivers in this circumstance. The findings from this study may also assist healthcare providers in their conversations about MAiD and the DD with patients and caregivers, inform healthcare providers to ensure appropriate access to MAiD, and guide modifications being considered to broaden MAiD legislation and policy.
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Affiliation(s)
- Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Gilla K. Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Roberta Klein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
| | - Anne Barbeau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
| | - Jennifer A. H. Bell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario Canada
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario Canada
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Rebecca K. S. Wong
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 620 University Avenue, 12th Floor, Toronto, Ontario M5G 2C1 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario Canada
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30
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Rose S, Boyes A, Kelly B, Cox M, Palazzi K, Paul C. Lung cancer stigma is a predictor for psychological distress: A longitudinal study. Lung cancer stigma is a predictor for psychological distress. Psychooncology 2021; 30:1137-1144. [PMID: 33624377 DOI: 10.1002/pon.5665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To examine if baseline stigma predicts psychological distress at 3 and 6 months follow-up among patients newly diagnosed with lung cancer. METHODS This longitudinal study was nested within a larger randomised controlled trial. Eligible participants were recruited via respiratory and oncology out-patient clinics in Australia (n = 194). Consenting participants were asked to complete surveys at baseline, 3 and 6 months post-recruitment. Measures included lung cancer stigma (Cataldo Lung Cancer Stigma Scale) and psychological distress (General Health Questionnaire-12 [GHQ-12]). RESULTS One-hundred and ninety-four participants were included for analysis. Most were male (57.7%) with a mean age of 68 years (SD = 8.8). A significant relationship between baseline lung cancer stigma and psychological distress at 6 months was found, where a one unit increase in lung cancer stigma increases psychological distress by 0.044 when adjusting for age, gender, smoking status, baseline GHQ-12 scores and intervention allocation (as part of the larger trial; p = 0.001; β = 0.044, 95% CI = 0.010, 0.079). CONCLUSION Temporal links between lung cancer stigma and psychological distress was found at 6 months, suggesting stigma-related experiences may have a delayed impact. Development of routine lung cancer stigma assessments is recommended to identify those at risk of psychological distress.
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Affiliation(s)
- Shiho Rose
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Allison Boyes
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Brian Kelly
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Centre for Brain and Mental Health Research, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Martine Cox
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Kerrin Palazzi
- Clinical Research, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Hunter Cancer Research Alliance, University of Newcastle, Callaghan, New South Wales, Australia
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31
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Vogt J, Beyer F, Sistermanns J, Kuon J, Kahl C, Alt-Epping B, Stevens S, Ahlborn M, George C, Heider A, Tienken M, Loquai C, Stahlhut K, Ruellan A, Kubin T, Dietz A, Oechsle K, Mehnert-Theuerkauf A, van Oorschot B, Thomas M, Ortmann O, Engel C, Lordick F. Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course. Oncologist 2021; 26:e1058-e1065. [PMID: 33687742 PMCID: PMC8176980 DOI: 10.1002/onco.13751] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/24/2021] [Indexed: 12/25/2022] Open
Abstract
Background Although current guidelines advocate early integration of palliative care, symptom burden and palliative care needs of patients at diagnosis of incurable cancer and along the disease trajectory are understudied. Material and Methods We assessed distress, symptom burden, quality of life, and supportive care needs in patients with newly diagnosed incurable cancer in a prospective longitudinal observational multicenter study. Patients were evaluated using validated self‐report measures (National Comprehensive Cancer Network Distress Thermometer [DT], Functional Assessment of Cancer Therapy [FACT], Schedule for the Evaluation of Individual Quality of Life [SEIQoL‐Q], Patients Health Questionnaire‐4 [PHQ‐4], modified Supportive Care Needs Survey [SCNS‐SF‐34]) at baseline (T0) and at 3 (T1), 6 (T2), and 12 months (T3) follow‐up. Results From October 2014 to October 2016, 500 patients (219 women, 281 men; mean age 64.2 years) were recruited at 20 study sites in Germany following diagnosis of incurable metastatic, locally advanced, or recurrent lung (217), gastrointestinal (156), head and neck (55), gynecological (57), and skin (15) cancer. Patients reported significant distress (DT score ≥ 5) after diagnosis, which significantly decreased over time (T0: 67.2%, T1: 51.7%, T2: 47.9%, T3: 48.7%). The spectrum of reported symptoms was broad, with considerable variety between and within the cancer groups. Anxiety and depressiveness were most prevalent early in the disease course (T0: 30.8%, T1: 20.1%, T2: 14.7%, T3: 16.9%). The number of patients reporting unmet supportive care needs decreased over time (T0: 71.8 %, T1: 61.6%, T2: 58.1%, T3: 55.3%). Conclusion Our study confirms a variable and mostly high symptom burden at the time of diagnosis of incurable cancer, suggesting early screening by using standardized tools and underlining the usefulness of early palliative care. Implications for Practice A better understanding of symptom burden and palliative care needs of patients with newly diagnosed incurable cancer may guide clinical practice and help to improve the quality of palliative care services. The results of this study provide important information for establishing palliative care programs and related guidelines. Distress, symptom burden, and the need for support vary and are often high at the time of diagnosis. These findings underscore the need for implementation of symptom screening as well as early palliative care services, starting at the time of diagnosis of incurable cancer and tailored according to patients’ needs. Guidelines recommend early integration of palliative care in the treatment of patients with advanced cancer. This study assessed distress, symptom burden, quality of life, and supportive care needs in patients with newly diagnosed incurable cancer to facilitate future implementation of more effective palliative care services.
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Affiliation(s)
- Jeannette Vogt
- Leipzig University Medical Center, University Cancer Center Leipzig, Leipzig, Germany
| | - Franziska Beyer
- Leipzig University Medical Center, University Cancer Center Leipzig, Leipzig, Germany
| | - Jochen Sistermanns
- Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Jonas Kuon
- Department of Thoracic Oncology, Translational Lung Research Center Heidelberg TLRC-H, Thoraxklinik at Heidelberg University Hospital, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Christoph Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg, Magdeburg, Germany
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Stevens
- Department of Medical Oncology, Kliniken Essen Mitte, Essen, Germany
| | - Miriam Ahlborn
- Department of Oncology and Hematology, Klinikum Braunschweig, Braunschweig, Germany
| | - Christian George
- Department of Gynecology, Klinikum Südstadt Rostock, Rostock, Germany
| | - Andrea Heider
- 3rd Department of Medicine, Klinikum Leverkusen, Leverkusen, Germany
| | - Maria Tienken
- Leipzig University Medical Center, University Cancer Center Leipzig, Leipzig, Germany
| | - Carmen Loquai
- Skin Cancer Center Rhein-Main, University Medical Center Mainz, Mainz, Germany
| | - Kerstin Stahlhut
- Hematology Oncology and Palliative Care Clinic, Immanuel Klinik und Poliklinik Rüdersdorf, Rüdersdorf, Berlin, Germany
| | - Anne Ruellan
- Department of Hematology, Oncology and Palliative Care, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Thomas Kubin
- Department of Hematology, Oncology and Palliative Care, Klinikum Traunstein, Traunstein, Germany
| | - Andreas Dietz
- ENT Department, Leipzig University Medical Center, Leipzig, Germany
| | - Karin Oechsle
- Department of Oncology and Hematology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Leipzig University Medical Center, Leipzig, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Department of Palliative Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Translational Lung Research Center Heidelberg TLRC-H, Thoraxklinik at Heidelberg University Hospital, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Olaf Ortmann
- Department for Gynecology and Obstetrics, University of Regensburg, Caritas Hospital St. Josef, Regensburg, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Florian Lordick
- Leipzig University Medical Center, University Cancer Center Leipzig, Leipzig, Germany
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Philipp R, Mehnert-Theuerkauf A, Koranyi S, Härter M, Vehling S. The role of attachment avoidance: A longitudinal mediation model predicting existential distress in patients with advanced cancer. Psychooncology 2021; 30:1059-1067. [PMID: 33507601 DOI: 10.1002/pon.5640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Although a protective effect of reliable interpersonal relationships on existential distress has been established, evidence remains inconclusive for attachment insecurity as an underlying factor of persistent psychological distress. We tested a longitudinal model hypothesizing attachment avoidance as a mediator of high demoralization and anxiety over time. METHODS We studied 206 patients with advanced cancer (mean age = 59.6, 61% female) participating in an intervention trial. Patients completed self-report measures for demoralization, anxiety, perceived relatedness, attachment insecurity, and death anxiety. Our mediated path model included perceived relatedness and death anxiety at baseline as predictors, attachment avoidance at baseline as mediator, and demoralization and anxiety at 6-month follow-up (N = 125) as outcomes. RESULTS Attachment avoidance partially mediated the relationship between death anxiety and demoralization (β = 0.07, 95% CI 0.02-0.12) and anxiety (β = 0.05, 95% CI 0.001-0.10). Findings for perceived relatedness were less conclusive. Its indirect effects through attachment avoidance were significant for both outcomes (demoralization: β = -0.07, 95% CI -0.13 to -0.02, anxiety: β = -0.05, 95% CI -0.11 to -0.003). CONCLUSIONS Due to its trait-like quality, attachment avoidance may play a less central role in explaining the course of existential distress over time than previous research indicated. Addressing change-sensitive relational concerns in psychosocial interventions may be more effective to alleviate existential distress.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Susan Koranyi
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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33
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Gallagher R, Passmore MJ. Canada needs equitable, earlier access to palliative care. CMAJ 2021; 192:E559. [PMID: 32575036 DOI: 10.1503/cmaj.74961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Romayne Gallagher
- Palliative care physician (retired), Providence Health Care, Vancouver, BC
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Morse JM, Kent-Marvick J, Barry LA, Harvey J, Okang EN, Rudd EA, Wang CY, Williams MR. Developing the Resilience Framework for Nursing and Healthcare. Glob Qual Nurs Res 2021; 8:23333936211005475. [PMID: 33869667 PMCID: PMC8020405 DOI: 10.1177/23333936211005475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022] Open
Abstract
Despite four decades of resilience research, resilience remains a poor fit for practice as a scientific construct. Using the literature, we explored the concepts attributed to the development of resilience, identifying those that mitigate symptoms of distress caused by adversity and facilitate coping in seven classes of illness: transplants, cancer, mental illness, episodic illness, chronic and painful illness, unexpected events, and illness within a dyadic relationship. We identified protective, compensatory, and challenge-related coping-concept strategies that healthcare workers and patients use during the adversity experience. Healthcare-worker assessment and selection of appropriate coping concepts enable the individual to control their distress, resulting in attainment of equanimity and the state of resilience, permitting the resilient individual to work toward recovery, recalibration, and readjustment. We inductively developed and linked these conceptual components into a dynamic framework, The Resilience Framework for Nursing and Healthcare, making it widely applicable for healthcare across a variety of patients.
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Affiliation(s)
- Janice M. Morse
- University of Utah, Salt Lake City, USA
- University of Alberta
| | | | - Lisa A. Barry
- University of Utah, Salt Lake City, USA
- Intermountain Healthcare, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Jennifer Harvey
- University of Utah, Salt Lake City, USA
- Alaska Native Medical Center, Anchorage, Alaska
| | | | | | | | - Marcia R. Williams
- University of Utah, Salt Lake City, USA
- Cedarville University, Ohio
- Kettering Health Network, Cedarville, Ohio
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35
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Tang L, Zhang Y, Pang Y, Zhou Y, Li J, Song L, He Y, Li Z, Wang Y. Validation of Death and Dying Distress Scale-Chinese Version and Prevalence of Death Anxiety Among Patients With Advanced Cancer. Front Psychiatry 2021; 12:715756. [PMID: 34744816 PMCID: PMC8564352 DOI: 10.3389/fpsyt.2021.715756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/13/2021] [Indexed: 01/25/2023] Open
Abstract
Purpose: Death anxiety is commonly experienced by individuals with advanced cancer who have a limited life expectancy. The Death and Dying Distress Scale (DADDS) is a validated measure that was created to capture this experience; but no Chinese version is available to date. We conducted a cross-sectional study to explore the psychometric properties of a Chinese version DADDS (DADDS-C) and address prevalence of death anxiety among patients with advanced cancer. Methods: Patients with advanced cancer were recruited from Peking University Cancer Hospital. Measures administered included: DADDS-C, Patient Health Questionnaire (PHQ-9), General Anxiety Disorder-7(GAD-7), Quality of Life at End of Life in Cancer (QUAL-EC), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-sp). McDonald's Omega, Cronbach's alpha, Exploratory Factor Analysis and Confirmatory Factor Analysis were used to test DADDS-C's reliability and validity. Logistic regression analysis was used to identify risk factors for death anxiety. Results: Of 300 patients approached, 256 (85%) provided informed consent and completed the questionnaires. Of these participants, 43 (16.8%) had moderate death anxiety based on scores of ≥45 on the DADDS-C. Three factors (feeling shortness of time, dying and death distress, being a burden to others) explained 71.643% of shared variation with factor loadings ranging from 0.629 to 0.822. Cronbach's alpha was 0.939; Omega total was 0.959. DADDS-C had acceptable convergent and discriminant validity. Logistic regression analysis indicated that two factors (better relationship with healthcare providers and preparation for end of life) protected patients from death anxiety. Conclusion: DADDS-C is a valid tool for measuring death anxiety in Chinese patients with advanced cancer. The presence of at least moderate death anxiety in a substantial minority of these patients calls for screening for this symptom and for more routine psychological interventions to alleviate and prevent such distress in this population.
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Affiliation(s)
- Lili Tang
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yening Zhang
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Ying Pang
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yuhe Zhou
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jinjiang Li
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lili Song
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yi He
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zimeng Li
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan Wang
- Department of Psycho-Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
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36
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Kim GD. Impact of Symptom Clusters on the Quality of Life in Lung Cancer Patients Undergoing Chemotherapy. ASIAN ONCOLOGY NURSING 2021. [DOI: 10.5388/aon.2021.21.4.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gyung Duck Kim
- Department of Nursing, Dongyang University, Yeongju, Korea
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37
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Shapiro GK, Mah K, de Vries F, Li M, Zimmermann C, Hales S, Rodin G. A cross-sectional gender-sensitive analysis of depressive symptoms in patients with advanced cancer. Palliat Med 2020; 34:1436-1446. [PMID: 32781931 DOI: 10.1177/0269216320947961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with advanced cancer commonly report depressive symptoms. Examinations of gender differences in depressive symptoms in patients with advanced cancer have yielded inconsistent findings. AIM The objective of this study was to investigate whether the severity and correlates of depressive symptoms differ by gender in patients with advanced cancer. DESIGN Participants completed measures assessing sociodemographic and medical characteristics, disease burden, and psychosocial factors. Depressive symptoms were examined using the Patient Health Questionnaire, and other measures included physical functioning, symptom burden, general anxiety, death related distress, and dimensions of demoralization. A cross-sectional analysis examined the univariate and multivariate relationships between gender and depressive symptoms, while controlling for important covariates in multivariate analyses. SETTING/PARTICIPANTS Patients with advanced cancer (N = 305, 40% males and 60% females) were recruited for a psychotherapy trial from outpatient oncology clinics at a comprehensive cancer center in Canada. RESULTS Severity of depressive symptoms was similar for males (M = 7.09, SD = 4.59) and females (M = 7.66, SD = 5.01), t(303) = 1.01, p = 0.314. Greater general anxiety and number of cancer symptoms were associated with depressive symptoms in both males and females. Feeling like a failure (β = 0.192), less death anxiety (β = -0.188), severity of cancer symptoms (β = 0.166), and older age (β = 0.161) were associated with depressive symptoms only in males, while disheartenment (β = 0.216) and worse physical functioning (β = 0.275), were associated with depressive symptoms only in females. CONCLUSIONS Males and females report similar levels of depressive symptoms but the pathways to depression may differ by gender. These differences suggest the potential for gender-based preventive and therapeutic interventions in this population.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | - Froukje de Vries
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Sethi R, Rodin G, Hales S. Psychotherapeutic Approach for Advanced Illness: Managing Cancer and Living Meaningfully (CALM) Therapy. Am J Psychother 2020; 73:119-124. [PMID: 33203228 DOI: 10.1176/appi.psychotherapy.20190050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
With advances in medical treatment and an aging population, there is an increasing global burden of advanced and life-limiting illnesses. Individuals living with these conditions may experience substantial distress related to disease progression, changes in important roles and life goals, loss of meaning, and uncertainty about the future, but there has been limited evidence to inform their psychotherapeutic care. Managing cancer and living meaningfully (CALM) therapy is a brief, evidence-based, semistructured intervention that provides a framework to address practical issues, such as navigating the health care system and treatment decisions, and existential issues, including finding meaning and hope in the face of mortality. CALM has been shown to alleviate and prevent depression and to facilitate preparation for the end of life among patients with advanced cancer. It is being adapted to other life-threatening illnesses and different cultural contexts and health care settings. Advocacy is needed to support such approaches for individuals living with advanced and life-threatening illness.
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Affiliation(s)
- Rickinder Sethi
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto (all authors); Department of Psychiatry (all authors) and Global Institute of Psychosocial, Palliative, and End-of-Life Care (Rodin), University of Toronto, Toronto
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto (all authors); Department of Psychiatry (all authors) and Global Institute of Psychosocial, Palliative, and End-of-Life Care (Rodin), University of Toronto, Toronto
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto (all authors); Department of Psychiatry (all authors) and Global Institute of Psychosocial, Palliative, and End-of-Life Care (Rodin), University of Toronto, Toronto
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39
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Rodin GM. Psychotherapeutic Interventions Near the End of Life: Theory, Evidence, and Future Directions. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gary M. Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network,
- Department of Psychiatry, University of Toronto,
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40
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Williamson TJ, Ostroff JS, Haque N, Martin CM, Hamann HA, Banerjee SC, Shen MJ. Dispositional shame and guilt as predictors of depressive symptoms and anxiety among adults with lung cancer: The mediational role of internalized stigma. STIGMA AND HEALTH 2020; 5:425-433. [PMID: 34027060 PMCID: PMC8132596 DOI: 10.1037/sah0000214] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The current study investigated whether dispositional tendencies to experience shame and guilt (i.e., shame- and guilt- proneness) were associated with higher levels of internalized stigma and, in turn, higher depressive symptoms and anxiety in adults with lung cancer. METHOD Participants (N = 50, 56.0% female) were men and women who received a clinical consultation for lung cancer and completed validated questionnaires. Mediation modeling using bootstrapping was used to characterize relationships between shame- and guilt-proneness, lung cancer stigma, depressive symptoms, and anxiety. RESULTS Higher guilt-proneness was associated significantly with higher anxiety (b = 0.69, SE=0.28, 95% CI [0.13, 1.26]) and higher shame-proneness was associated significantly with higher depressive symptoms (b = 0.56, SE = 0.19, 95% CI [0.18, 0.93]), beyond sociodemographic, medical, and smoking-related characteristics. Higher lung cancer stigma also significantly mediated the relationship between guilt-proneness and anxiety (indirect effect = 0.43, SE = .20, 95% CI [0.08, 0.89]) but not between shame-proneness and depressive symptoms. CONCLUSIONS Shame- and guilt-proneness are associated significantly with depressive symptoms and anxiety, respectively, and the relationship between guilt-proneness and anxiety is explained in part by internalized stigma in a sample of newly diagnosed lung cancer patients. Findings carry implications for the early identification of lung cancer patients in need of additional supportive care services and highlight internalized stigma as a target for psychosocial intervention.
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Affiliation(s)
- Timothy J. Williamson
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jamie S. Ostroff
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Noshin Haque
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Chloe M. Martin
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Smita C. Banerjee
- Department of Psychiatry & Biobehavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Megan J. Shen
- Department of Medicine, Weill Cornell Medical College, New York, NY
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Hiratsuka Y, Suh SY, Maeda I, Morita T, Mori M, Ito S, Nishi T, Hisanaga T, Iriyama T, Kaneishi K, Ikari T, Tagami K, Inoue A. Factors influencing spiritual well-being in terminally ill cancer inpatients in Japan. Support Care Cancer 2020; 29:2795-2802. [DOI: 10.1007/s00520-020-05802-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
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Mehnert A, Koranyi S, Philipp R, Scheffold K, Kriston L, Lehmann-Laue A, Engelmann D, Vehling S, Eisenecker C, Oechsle K, Schulz-Kindermann F, Rodin G, Härter M. Efficacy of the Managing Cancer and Living Meaningfully (CALM) individual psychotherapy for patients with advanced cancer: A single-blind randomized controlled trial. Psychooncology 2020; 29:1895-1904. [PMID: 32803815 DOI: 10.1002/pon.5521] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We aimed to determine whether the Managing Cancer and Living Meaningfully (CALM) therapy is superior to a non-manualized supportive psycho-oncological counselling intervention (SPI). METHODS Adult patients with advanced cancer and ≥9 points on the PHQ-9 and/or ≥5 points on the DT were randomized to CALM or SPI. We hypothesized that CALM patients would report significantly less depression (primary outcome) on the BDI-II and the PHQ-9 6 months after baseline compared to SPI patients. RESULTS From 329 eligible patients, 206 participated (61.2% female; age: M = 57.9 [SD = 11.7]; 84.5% UICC IV stage). Of them, 99 were assigned to CALM and 107 to SPI. Intention-to-treat analyses revealed significantly less depressive symptoms at 6 months than at baseline (P < .001 for BDI-II and PHQ-9), but participants in the CALM and SPI group did not differ in depression severity (BDI-II: P = .62, PHQ-9: P = .998). Group differences on secondary outcomes were statistically not significant either. CONCLUSIONS CALM therapy was associated with reduction in depressive symptoms over time but this improvement was not statistically significant different than that obtained within SPI group.
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Affiliation(s)
- Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Susan Koranyi
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Scheffold
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antje Lehmann-Laue
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Dorit Engelmann
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Eisenecker
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Schulz-Kindermann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gary Rodin
- Department of Supportive Care, 16-724, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Berghmans T, Lievens Y, Aapro M, Baird AM, Beishon M, Calabrese F, Dégi C, Delgado Bolton RC, Gaga M, Lövey J, Luciani A, Pereira P, Prosch H, Saar M, Shackcloth M, Tabak-Houwaard G, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer. Lung Cancer 2020; 150:221-239. [PMID: 33227525 DOI: 10.1016/j.lungcan.2020.08.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Thierry Berghmans
- European Organisation for Research and Treatment of Cancer (EORTC); Thoracic Oncology Clinic, Institut Jules Bordet, Brussels, Belgium
| | - Yolande Lievens
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Ghent University Hospital, Belgium
| | - Matti Aapro
- European Cancer Organisation; Genolier Cancer Center, Genolier, Switzerland
| | - Anne-Marie Baird
- European Cancer Organisation Patient Advisory Committee; Central Pathology Laboratory, St James's Hospital, Dublin, Ireland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Fiorella Calabrese
- European Society of Pathology (ESP); Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR); University of La Rioja, Logroño, La Rioja, Spain
| | - Mina Gaga
- European Respiratory Society (ERS); 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Andrea Luciani
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Ospedale S. Paolo, Milan, Italy
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
| | - Helmut Prosch
- European Society of Radiology (ESR); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Marika Saar
- European Society of Oncology Pharmacy (ESOP); Tartu University Hospital, Tartu, Estonia
| | - Michael Shackcloth
- European Society of Surgical Oncology (ESSO); Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Philip Poortmans
- European Cancer Organisation; Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
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Gallagher R, Passmore MJ, Baldwin C. Hastened death due to disease burden and distress that has not received timely, quality palliative care is a medical error. Med Hypotheses 2020; 142:109727. [DOI: 10.1016/j.mehy.2020.109727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022]
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Andersen BL, Valentine TR, Lo SB, Carbone DP, Presley CJ, Shields PG. Newly diagnosed patients with advanced non-small cell lung cancer: A clinical description of those with moderate to severe depressive symptoms. Lung Cancer 2020; 145:195-204. [PMID: 31806360 PMCID: PMC7239743 DOI: 10.1016/j.lungcan.2019.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aims of this observational study were to 1) accrue newly diagnosed patients with advanced-stage non-small cell lung cancer (NSCLC) awaiting the start of first-line treatment and identify those with moderate to severe depressive symptoms and, 2) provide a clinical description of the multiple, co-occurring psychological and behavioral difficulties and physical symptoms that potentially exacerbate and maintain depressive symptoms. MATERIALS AND METHODS Patients with stage IV NSCLC (N = 186) were enrolled in an observational study (ClinicalTrials.gov Identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended screening measure for depression (Patient Health Questionnaire-9 [PHQ-9]). Individuals with none/mild (n = 119; 64 %), moderate (n = 52; 28 %), and severe (n = 15; 8 %) depressive symptoms were identified. Patients also completed measures of hopelessness, generalized anxiety disorder (GAD) symptoms, stress, illness perceptions, functional status, and symptoms. RESULTS Patients with severe depressive symptoms reported concomitant feelings of hopelessness (elevating risk for suicidal behavior), anxiety symptoms suggestive of GAD, and traumatic, cancer-specific stress. They perceived lung cancer as consequential for their lives and not controllable with treatment. Pain and multiple severe symptoms were present along with substantial functional impairment. Patients with moderate depressive symptoms had generally lower levels of disturbance, though still substantial. The most salient differences were low GAD symptom severity and fewer functional impairments for those with moderate symptoms. CONCLUSIONS Depressive symptoms of moderate to severe levels co-occur in a matrix of clinical levels of anxiety symptoms, traumatic stress, impaired functional status, and pain and other physical symptoms. All of the latter factors have been shown, individually and collectively, to contribute to the maintenance or exacerbation of depressive symptoms. As life-extending targeted and immunotherapy use expands, prompt identification of patients with moderate to severe depressive symptoms, referral for evaluation, and psychological/behavioral treatment are key to maximizing treatment outcomes and quality of life for individuals with advanced NSCLC.
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Affiliation(s)
- B L Andersen
- Department of Psychology, The Ohio State University, United States.
| | - T R Valentine
- Department of Psychology, The Ohio State University, United States
| | - S B Lo
- Department of Psychology, The Ohio State University, United States
| | - D P Carbone
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
| | - C J Presley
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
| | - P G Shields
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
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Lee Y, Hung CF, Chien CY, Lin PY, Lin MC, Wang CC, Lu HI, Chen YC, Chong MY, Wang LJ. Comparison of prevalence and associated factors of depressive disorder between patients with head and neck cancer and those with lung cancer at a tertiary hospital in Taiwan: a cross-sectional study. BMJ Open 2020; 10:e037918. [PMID: 32601116 PMCID: PMC7328812 DOI: 10.1136/bmjopen-2020-037918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Depression is a common comorbidity in cancer patients. This study aimed to compare the prevalence and associated factors of depressive disorder between patients with head and neck cancer (HNC) and those with lung cancer (LC). DESIGN This study used a cross-sectional design with consecutive sampling. SETTING A medical centre (Kaohsiung Chang Gung Memorial Hospital, Taiwan). PARTICIPANTS Patients for the study were recruited from the HNC and LC outpatient clinic and inpatient ward from March 2016 to February 2018. Patients with HNC and LC were enrolled and assessed using the Mini International Neuropsychiatric Interview (MINI). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was psychiatric diagnoses assessed using the MINI. The secondary outcomes were psychological well-being assessed using the Beck Anxiety Inventory, Taiwanese Depression Questionnaire, Brief Fatigue Inventory, Numeric Pain Rating Scale and the List of Threatening Experiences Questionnaire. RESULTS In total, 113 HNC patients and 104 LC patients were recruited for the study. The most common psychiatric comorbidity of HNC patients was alcohol use disorder (49.6%), followed by adjustment disorder (20.4%) and depressive disorder (11.5%). The most common psychiatric comorbidity of LC patients was depressive disorder (25.0%), followed by adjustment disorder (17.3%), alcohol use disorder (3.8%) and insomnia disorder (3.8%). Among HNC patients, a self-harm history was positively associated with depression (OR=11.91; 95% CI, 1.47 to 96.83), and a higher educational level was negatively associated with depression (OR=0.77; 95% CI, 0.66 to 0.91). Among LC patients, severity of stressor (OR=2.78; 95% CI, 1.50 to 5.15) and severity of anxiety (OR=1.18; 95% CI, 1.04 to 1.34) were two significant factors associated with depression. CONCLUSION We reported the prevalence and associated factors of depression between patients with HNC and those with LC. Clinicians should be aware of this comorbidity and the associated risk factors, and conduct intervention programmes to prevent these cancer patients from developing depression.
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Affiliation(s)
- Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Chou Wang
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-I Lu
- Department of Cardiothoracic Vascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Che Chen
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Kang Y, Meghani SH, Bruner DW, Yeager KA. Factors Associated with Depression in African American Patients Being Treated for Cancer Pain. Pain Manag Nurs 2020; 21:410-415. [PMID: 32513560 DOI: 10.1016/j.pmn.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Among cancer patients in the United States, African American cancer patients have the highest mortality rate and shortest survival rate. Although depression is known as a predictor of mortality in cancer and a potential barrier to health care utilization, research on depression in African American patients is limited. Cancer pain can interfere with an individual's ability to cope with depression. AIMS To identify factors that are associated with a positive screening of depressive symptoms assessed by the PHQ-8 in African American patients treated for cancer pain. DESIGN Secondary data analysis of a cross-sectional study of opioid adherence. SETTING Medical oncology, palliative care, and radiation oncology clinics in Atlanta, Georgia. PARTICIPANTS/SUBJECTS African American patients with cancer pain in the parent study. METHODS Independent samples t-test was used to assess variable correlations with and without depressive symptoms. Adjusted logistic regression was conducted to identify factors that were associated with presence of depressive symptoms. RESULTS Mean patient age was 55.6 years, and nearly 38% had a PHQ-8 score of >10 indicating presence of moderate to severe depressive symptoms. Participants with depressive symptoms had significantly higher means for anxiety and pain interference with mood than those without depressive symptoms. Factors that were significantly associated with depressive symptoms were anxiety, pain interfering with mood, and lack of involvement with a religious congregation. CONCLUSIONS The findings of this study help to identify African American cancer patients at risk for depression and demonstrates the need for increased screening for depression in this underserved population.
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Affiliation(s)
- Youjeong Kang
- University of Utah College of Nursing, Salt Lake City, Utah.
| | - Salimah H Meghani
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Abstract
BACKGROUND Quality of life (QOL) is important for cancer patients, even for survival. However, factors affecting QOL of non-small cell lung cancer (NSCLC) patients have not been studied sufficiently. OBJECTIVE The aims of this study were to understand the relationships among social support, resilience, distress, and symptom and to identify predictors of QOL for NSCLC patients. METHODS Participants were 212 adult patients who visited an outpatient department at a tertiary hospital located in Seoul, Korea. Data were collected using self-reported questionnaires and clinical records. RESULTS Social support, resilience, distress, symptom burden, and QOL explained 99.9% of the variance in QOL. Social support was not a significant predictor of distress and QOL, but a significant predictor of resilience. Resilience was a significant predictor of both distress and QOL. Distress was not a significant predictor of QOL, but a significant predictor of symptom burden. Symptom burden was a significant predictor of QOL and had the largest direct effect on QOL. Resilience also had an important impact on QOL because resilience influenced QOL in various paths. CONCLUSION This study suggests that social support, resilience, distress, and symptom burden are predictors of QOL in an NSCLC population. These predictors had direct and indirect effects on each other and on QOL. IMPLICATIONS FOR PRACTICE Developing an interventional program to increase resilience and social support as well as to decrease symptom burden and distress may be necessary to improve QOL of NSCLC patients.
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49
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Rosenblat JD, Kurdyak P, Cosci F, Berk M, Maes M, Brunoni AR, Li M, Rodin G, McIntyre RS, Carvalho AF. Depression in the medically ill. Aust N Z J Psychiatry 2020; 54:346-366. [PMID: 31749372 DOI: 10.1177/0004867419888576] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. METHODS Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. RESULTS Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug-drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. LIMITATIONS Non-systematic review of the literature. CONCLUSION Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.,Centre of Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Madeline Li
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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50
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Rodin G, An E, Shnall J, Malfitano C. Psychological Interventions for Patients With Advanced Disease: Implications for Oncology and Palliative Care. J Clin Oncol 2020; 38:885-904. [PMID: 32023159 DOI: 10.1200/jco.19.00058] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A growing body of research demonstrates the feasibility and efficacy of psychological interventions for adult patients with advanced cancer. Findings from quantitative studies of psychotherapeutic interventions with primary psychological outcomes for such patients are reviewed here and recommendations for best practice are made. We consider these interventions according to three broad phases in which they are most commonly applied: soon after diagnosis of advanced cancer, when living with the disease, and at or near the end of life. Cumulative evidence from well-designed studies demonstrates the efficacy of psychosocial interventions for patients with advanced disease to relieve and prevent depression, anxiety, and distress related to dying and death, as well as to enhance the sense of meaning and preparation for end of life. Individual and couple-based interventions have been proven to be most feasible, and the development and use of tailored and validated measures has enhanced the rigor of research and clinical care. Palliative care nurses and physicians can be trained to deliver many such interventions, but a core of psychosocial clinicians, including social workers, psychologists, and psychiatrists, is usually required to train other health professionals in their delivery and to ensure their quality. Few of the interventions for which there is evidence of effectiveness have been routinely incorporated into oncology or palliative care. Advocacy on the basis of this evidence is required to build psychosocial resources in cancer treatment settings and to ensure that psychological care receives the same priority as other aspects of palliative care in oncology.
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Affiliation(s)
- Gary Rodin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina An
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joanna Shnall
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Carmine Malfitano
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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