Use of Medications for Treating Anxiety and Depression in Cancer Survivors in the United States

Transitional Changes of Anxiety, Pain and Other Symptoms in Cancer Patients Admitted to a Palliative Care Unit, Evaluated Using the Support Team Assessment Schedule - Japanese Version

Objective: Association between physical symptoms and psychosocial difficulties of cancer patients has been reported widely. Nevertheless, the effects of pain and other symptom control on anxiety in such patients have not been investigated well. We investigated the association of improvement of pain and other symptoms with patient anxiety, and assessed factors associated with improvement of such symptoms. Methods: Data of patients with advanced cancer admitted to a palliative care unit during August 2018 - June 2022 were analyzed retrospectively. Severity of pain, other symptoms, and anxiety was assessed by the Support Team Assessment Schedule Japanese version (STAS-J) administered at admission and after 2 weeks. Patients' physical data, their Palliative Prognostic Index (PPI) at admission, and their overall survival were collected and recorded. Results: Data of 701 patients were analyzed. Improvement of pain or other symptoms after 2 weeks was not associated with the PPI total score or actual survival (P = .105 and .999). Patients with higher anxiety on admission experienced improvement of pain or other symptoms more frequently (P = .005). Worsening of anxiety was observed less in patients who experienced improvement in pain or other symptoms after 2 weeks (P = .027). Conclusion: Pain or other symptoms of patients with advanced cancer was improved irrespective of the general condition indicated with actual survival and prognosis-predictive factors. These findings suggest the importance of pain and other symptoms' improvement and its important roles in the management of patient psychosocial problems such as anxiety.

Understanding Barriers and Distress Experienced Among Cancer Patients: Analysis from an Urban Academic Emergency Department

The purpose of this study was to examine barriers and facilitators to compliance for cancer care in patients utilizing an emergency department (ED)-based assessment. Adult ED patients who either had active cancer or a history of cancer were enrolled between August 2020 and Jan 2022 for this prospective cohort study. We piloted the National Comprehensive Cancer Network (NCCN) Distress Thermometer. Multivariable regression analyses were used to assess the predictors of high distress. Of the 152 patients enrolled, 73% were Black patients, 11% were non-Hispanic White, and 16% included patients from other racial and ethnic groups (including 10.5% Hispanic patients); 73% of the sample had active cancer. The current ED visit was cancer related for 44%. The mean score on the Distress Thermometer was 4 (SD = 2; range 0-8) with 30% having a high distress level of ≥ 6. Having an active cancer and race/ethnicity were significant predictors of high distress. Patients who had active cancer had three times (aOR = 3.01; 95% CI 1.12-8.10) higher odds of experiencing high distress in the past week compared to those who did not have active cancer, after adjusting for race/ethnicity and reason for visit. Practical problems and physical problems were the most common, with 43% (n = 66) and 40% (n = 61) of the patients reporting these problems, respectively. Despite significant progress in cancer care, cancer patients/survivors face difficulty in transitioning between care environments and end up seeking episodic care in the ED and experience a high level of distress.

Factors associated with health-related quality of life on mental and oral health in patients with cancer and cancer survivors using the Korea National Health and Nutrition Examination Survey (2005-2018)

Objective

To investigate the association of mental and oral health with the health-related quality of life (HRQOL) in patients with cancer and cancer survivors.

Methods

This cross-sectional study involved 1643 patients with cancer and 1628 individuals who survived cancer (aged ≥ 19 years) using data from the 2005-2018 Korean National Health and Nutrition Examination Survey. The data were analyzed using SAS survey procedures (version 9.4), t-tests, χ2 test, and multiple regression.

Results

Regarding differences in mental and oral health factors by group, the results revealed significant differences between depression, suicidal ideation, subjective oral health, chewing problems, and speaking problems due to oral issues. The HRQOL of patients with cancer was lower than that of cancer survivors. The factors influencing HRQOL in both patients with cancer and cancer survivors were education status, economic activity, subjective health, suicidal ideation, and speaking problems due to oral issues. HRQOL was also associated with depression in patients with cancer.

Conclusions

Patients with cancer had a lower HRQOL than cancer survivors. The two groups of patients showed significant differences in the factors associated with HRQOL. Therefore, customized health programs and policies should be developed and implemented for each group to improve their QOL.

Patterns and predictors of antidepressant prescribing among adults with cancer and depression in ambulatory care settings in the United States

OBJECTIVE

Despite depression being a common comorbidity among adults with cancer, limited literature is available regarding pharmacologic depression treatment patterns and predictors in this population. This study aims to examine patterns and predictors of antidepressant prescribing among adults with cancer and depression in ambulatory care settings in the United States (US).

METHODS

This retrospective, cross-sectional study utilized data collected from the 2014 to 2015 National Ambulatory Medical Care Survey (NAMCS). The study sample consisted of adults (age ≥ 18 years) with cancer and depression (unweighted N = 539; weighted N = 11,361,000). A multivariable logistic regression analysis was used to adjust for individual-level factors to identify predictors of antidepressant prescribing.

RESULTS

Most patients were adults aged ≥ 65 years, female, and non-Hispanic whites. Thirty-seven percent of the study sample received antidepressant treatment. Multivariable logistic regression analysis revealed that race/ethnicity, physician specialty, and number of medications were significantly associated with receiving antidepressant(s). For example, non-Hispanic whites were two-and-half times more likely to receive an antidepressant [OR 2.43, 95% confidence interval 1.13-5.23] compared to other race/ethnic groups. Every unit increase in the number of prescribed medications increased the likelihood of receiving an antidepressant by 6% (OR 1.06, 95% CI: 1.01-1.11).

CONCLUSION

Among adults with a comorbid cancer and depression diagnosis and a recorded U.S. ambulatory care visit in 2014-2015, 37% received antidepressant treatment. This suggests most patients with cancer and depression do not receive pharmacologic treatment for depression. Future studies are needed to investigate the impact of antidepressant treatment on health outcomes in this patient population.

Prevalence, patterns, and determinants of multimorbidity among childhood and adult cancer survivors: A systematic review

Development of multimorbidity is common among cancer survivors due to their previous cancer, treatments, or changes in lifestyle. We summarized evidence on the prevalence, patterns, and determinants of multimorbidity among childhood and adult cancer survivors. We searched PubMed and EMBASE databases for articles reporting prevalence, patterns, and determinants of multimorbidity in cancer survivors. Finally, 23/500 articles were included. There was a large variation in the prevalence of multimorbidity (13-89%) among cancer survivors. Bone marrow transplantation, radiation, female sex, lower level of physical activity, increasing age, minority ethnicity, low-income, and low-education were associated with a higher prevalence of multimorbidity. Patterns of multimorbidity were both concordant and discordant. In conclusion, multimorbidity is highly prevalent and a major concern among cancer survivors. A personalized care plan that takes into account the identified risk may be beneficial to reduce the burden of multimorbidity and improve the quality of life among cancer survivors.

Cancer outpatients during the COVID-19 pandemic: what Oncoral has to teach us about medical drug use and the perception of telemedicine

PURPOSE

The COVID-19 pandemic has disrupted healthcare access and telemedicine has been widely deployed. The aim of this study is to assess the impact of this health crisis on treatment consumption and telemedicine development in outpatients treated by oral anti-cancer agents and followed by the Oncoral hospital/community multidisciplinary program where continuity care is maintained by a pharmacist/nurse pair.

METHODS

A prospective monocentric study was conducted among cancer patients who received Oncoral telephone follow-up during the 1st lockdown in France using a 56-item questionnaire which covered sociodemographic data, patient medication management, and telehealth.

RESULTS

178 patients received Oncoral follow-up during the 1st lockdown and 67.4% responded to the questionnaire. During lockdown, 9.2% of patients took medication or CAM for fatigue, 6.7% for mood alteration, 10.8% for sleep disorder, 11.7% for stress and anxiety, and 12.5% to get more energy. Homeopathy consumption was triggered by the pandemic. Habits about getting drugs from the pharmacy changed significantly (p < 0.001), while other treatment habits did not. 83% of patients were satisfied by the telephone follow-up established, 69% would be in favor of repeating this in case of a new epidemic wave. Those most in favor of using telemedicine seemed to be the youngest (p < 0.001), with several dependent children (p < 0.007), high school degree or higher education (p = 0.023), and in work (p < 0.001).

CONCLUSION

Health system reorganization enables to limit the impact of the crisis on patients' drug use in oncology care. Telemedicine is a promising public health tool.

Patterns of mental health service utilisation in people with cancer compared with people without cancer: analysis of the Australian National Study of Mental Health and Wellbeing

PURPOSE

To compare the patterns of mental health service utilisation between people with and without cancer.

METHODS

We performed a cross-sectional study using data of all respondents aged ≥ 25 years from the Australian National Study of Mental Health and Wellbeing 2020-2021 conducted during the COVID-19 pandemic. Comparisons were made between the two groups (cancer versus non-cancer) using logistic regression models.

RESULTS

The study comprised 318 people with cancer (55% female) and 4628 people without cancer (54% female). Cancer survivors had a higher prevalence of reporting poor health (38% versus 16%) and mental distress (18% versus 14%) than people without cancer. There were no significant differences between people with and without cancer in the odds of consulting general practitioner, psychiatrist and other health professionals for mental health, although people with cancer were significantly more likely to consult a psychologist than people without cancer (adjusted odds ratio (aOR) = 1.64, 95%CI = 1.05-2.48). While the odds of being hospitalised for physical health was significantly higher in cancer survivors than people without cancer (aOR = 2.32, 95%CI = 1.78-3.01), there was only a negligible number of people reported being hospitalised for mental health between the two groups. Several factors were associated with higher odds of mental health service utilisation including younger age, unpartnered marital status and presence of a current mental condition.

CONCLUSIONS

Alarmingly, despite experiencing higher prevalence of poor health status and mental distress, cancer survivors did not utilise more mental health services than the general population. That is, there is a higher degree of untreated, or undertreated, distress in cancer than in the general population.

IMPLICATIONS FOR CANCER SURVIVORS

Further research to identify optimal approaches of mental health care delivery for cancer survivors are urgently needed.

Association between e-cigarette use and depression in US cancer survivors: a cross-sectional study

PURPOSE

Though prior studies have observed significant association between e-cigarette use and mental health outcomes including depression in the general population, the relationship between e-cigarette use and clinical depression in the cancer survivor subpopulation is unknown. The purpose of this study was to examine the cross-sectional association between e-cigarette use and self-reported clinical depression among cancer survivors.

METHODS

Pooled data from the 2017 and 2018 Behavioral Risk Factor Surveillance Survey were used. Multivariable logistic regression was used to analyze the independent association between e-cigarette use and self-reported clinical depression in a sample of 7,498 cancer survivors.

RESULTS

Among cancer survivors in this study, 22.1% reported a history of clinical diagnosis of depression. The overall prevalence rates for current and former e-cigarette use were 2.6% and 10.5%, respectively. Analysis showed 51.3% of current users, 40% of former users, and 19.1% of those who had never used e-cigarettes self-reported a history of clinical depression. In the multivariable analysis, the odds of self-reported clinical depression were significantly higher for survivors who were current users (OR = 2.85; 95% CI: 1.38-5.90) and former users (OR = 1.63; 95% CI: 1.05-2.55) compared to never e-cigarette users.

CONCLUSION

Findings from this study suggest a statistically significant association between e-cigarette use and depression in cancer survivors. Future studies should focus on examining the longitudinal association between e-cigarette use and depression in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Study findings reemphasized the need for interventions to support cancer survivors with evidence-based treatments for depression as well as the need for clinicians to screen for psychological distress and/or e-cigarette use and make appropriate recommendations.

Home-Based Reiki by Informal Caregivers: A Mixed-Methods Pilot Study

This pilot study explored whether Reiki delivered by family caregivers to cancer patients in a home setting was feasible in reducing cancer symptoms and enhancing health-related outcomes. An explanatory sequential mixed-methods study design was applied using pre-/post-Reiki questionnaires and post-Reiki interviews. Six patient-caregiver dyads from an outpatient clinic and cancer support facilities in northeast America performed daily Reiki at home for 3 weeks. Differences with symptoms, mental well-being, health-related quality of life, and satisfaction with at-home Reiki as well as qualitative content analyses were evaluated. Positive feedback was reported after at-home Reiki practice. Large statistical effects were identified for improving fatigue, memory, mood, nausea, and emotional well-being ( P < .10, r = 0.51-0.59). All participants were satisfied and 83.3% of them would recommend self-practice home Reiki. High involvement and adherence to the intervention protocol illustrated intervention fidelity. The qualitative data revealed 2 major categories, perceived benefits and barriers. Overall Reiki benefits outweighed barriers in relation to time commitment and place distractions/positioning. Our preliminary findings support that the at-home Reiki protocol had potential benefits and was feasible and acceptable by both community-dwelling patients and their family caregivers in promoting cancer-related outcomes. Further studies with larger samples are warranted to examine the effectiveness of home-based Reiki for a patient-centered cancer care modality.

A Sequential Multiple Assignment Randomized Trial of Symptom Management After Chemotherapy

CONTEXT

Many cancer survivors experience a lingering symptom burden after chemotherapy.

OBJECTIVES

In this sequential multiple assignment randomized trial, we tested optimal sequencing of two evidence-based interventions for symptom management.

METHODS

Survivors of solid tumors (N = 451) were interviewed at baseline and stratified as high or low need for symptom management based on comorbidity and depressive symptoms. High need survivors were randomized initially to the 12-week Symptom Management and Survivorship Handbook (SMSH, N = 282) or 12-week SMSH with eight weeks of Telephone Interpersonal Counseling (TIPC, N = 93) added during weeks one to eight. After four weeks of the SMSH alone, non-responders on depression were re-randomized to continue with SMSH alone (N = 30) or add TIPC (N = 31). Severity of depression and summed severity index of 17 other symptoms over weeks one to13 were compared between randomized groups and among three dynamic treatment regimes (DTRs): 1) SMSH for 12 weeks; 2) SMSH for 12 weeks with eight weeks of TIPC from week one; 3) SMSH for four weeks followed by SMSH+TIPC for eight weeks if no response to the SMSH alone on depression at week four.

RESULTS

There were no main effects for randomized arms or DTRs, but there was a significant interaction of trial arm with baseline depression favoring SMSH alone during weeks one to four in the first randomization and SMSH+TIPC in the second randomization.

CONCLUSION

The SMSH may represent a simple effective option for symptom management, adding TIPC only when there is no response to SMSH alone for people with elevated depression and multiple co-morbidities.

Exploring different research questions via complex multi-state models when using registry-based repeated prescriptions of antidepressants in women with breast cancer and a matched population comparison group

BACKGROUND

Multi-state models are used to study several clinically meaningful research questions. Depending on the research question of interest and the information contained in the data, different multi-state structures and modelling choices can be applied. We aim to explore different research questions using a series of multi-state models of increasing complexity when studying repeated prescriptions data, while also evaluating different modelling choices.

METHODS

We develop a series of research questions regarding the probability of being under antidepressant medication across time using multi-state models, among Swedish women diagnosed with breast cancer (n = 18,313) and an age-matched population comparison group of cancer-free women (n = 92,454) using a register-based database (Breast Cancer Data Base Sweden 2.0). Research questions were formulated ranging from simple to more composite ones. Depending on the research question, multi-state models were built with structures ranging from simpler ones, like single-event survival analysis and competing risks, up to complex bidirectional and recurrent multi-state structures that take into account the recurring start and stop of medication. We also investigate modelling choices, such as choosing a time-scale for the transition rates and borrowing information across transitions.

RESULTS

Each structure has its own utility and answers a specific research question. However, the more complex structures (bidirectional, recurrent) enable accounting for the intermittent nature of prescribed medication data. These structures deliver estimates of the probability of being under medication and total time spent under medication over the follow-up period. Sensitivity analyses over different definitions of the medication cycle and different choices of timescale when modelling the transition intensity rates show that the estimates of total probabilities of being in a medication cycle over follow-up derived from the complex structures are quite stable.

CONCLUSIONS

Each research question requires the definition of an appropriate multi-state structure, with more composite ones requiring such an increase in the complexity of the multi-state structure. When a research question is related with an outcome of interest that repeatedly changes over time, such as the medication status based on prescribed medication, the use of novel multi-state models of adequate complexity coupled with sensible modelling choices can successfully address composite, more realistic research questions.

Neuropsychiatric disorders in adults undergoing chimeric antigen receptor T cells therapy for aggressive lymphomas and acute lymphoblastic leukemia

Objective

To evaluate risk factors for neuropsychiatric disorders (NPD) in recipients of CART therapy.

Methods

Patients ≥ 18 years with acute lymphoblastic leukemia (ALL), and aggressive B-cell lymphomas who received CART in 2018 were evaluated. Patients with and without NPD were compared.

Results

NPD was diagnosed in 31.2% of patients. Compared to patients without NPD, patients with NPD were likely to be females (P = 0.035) and have ALL (P = 0.039). NPD was significantly associated with female gender (OR = 2.03) and diagnosis of ALL (OR = 2.76). No association between NPD and outcomes.

Conclusions

Female gender and ALL were risk factors for NPD.

Antidepressant use pattern and disparities among cancer patients in the United States

Many cancer patients also suffer from depression, however, pharmacotherapy of depression and related disparities in US cancer survivors have not been examined in a nationally representative sample. In the present study, 2,590 adult cancer survivors participating in the National Health and Nutrition Examination Survey 2011-2020 were included and antidepressant use pattern was investigated. To examine disparities by social-demographic characteristics and access to healthcare, multivariate logistic regression analysis was conducted in 422 cancer patients who were using antidepressants and 230 cancer patients who were not using antidepressants but were diagnosed with depression. Results suggested that 21% of adult cancer survivors were using antidepressants and selective serotonin reuptake inhibitors were the most common type of antidepressants used. Antidepressant users were more likely to be female, non-Hispanic white, those who were married or living with partner. In addition, those without a routine place to go for healthcare were less likely to use antidepressants. Disparities were not found by age, family income levels, education, or health insurance coverage. The findings highlight disparities in antidepressant use in cancer patients in the US. Policy makers need to better allocate healthcare resources and facilitate availabilities of affordable care to every patient in need.

Assessment of anxiety/depression among cancer patients before and during the COVID-19 pandemic

OBJECTIVE

To assess differences in the prevalence of anxiety/depression symptoms among cancer patients before (2019) and during the COVID-19 pandemic (2020); and the associations between anxiety/depression and sociodemographic and health behavior factors among cancer patients before and during the pandemic.

METHODS

We analyzed data from the 2019 (n = 856) and 2020 (n = 626) Health Information National Trends Survey, a nationally representative survey of United States adults aged ≥18 years. Only adults with a cancer diagnosis were used in the analyses. Anxiety/depression was assessed using the Patient Health Questionnaire-4 (low/none [0-2], mild [3-5], moderate [6-8], and severe [9-12]) and dichotomized as low/none and current anxiety/depression (mild/moderate/severe). Multivariate analysis was performed.

RESULTS

The prevalence of anxiety/depression symptoms among cancer patients was 32.7% before the COVID-19 pandemic and 31.1% during the pandemic. The odds of anxiety/depression among patients with fair/poor health status was higher during the pandemic relative to before (before: odds ratio [OR] = 1.85 vs. during: OR = 3.89). Participants aged 50-64 years (before: OR = 0.29, 95% confidence interval [95% CI] = 0.11-0.76; during: OR = 0.33, 95% CI = 0.11-0.97) and ≥65 years (before: OR = 0.13, 95% CI = 0.05-0.34; during: OR = 0.18, 95% CI = 0.07-0.47) had lower odds of anxiety/depression before and during the pandemic compared to those aged 35-49 years. Hispanics/Latinos had higher odds of anxiety/depression (OR = 2.70, 95% CI = 1.11-6.57) before the pandemic and lower odds of anxiety/depression during the pandemic (OR = 0.2, 95% CI = 0.05-1.01) compared to non-Hispanic Whites. Those who completed high school (before: OR = 0.08, 95% CI = 0.01-0.42), some college (before: OR = 0.10, 95% CI = 0.02-0.42), ≥college degree had lower odds of anxiety/depression symptoms (before: OR = 0.05, 95% CI = 0.01-0.26; during: OR = 0.06, 95% CI = 0.01-0.61) compared to those with less than a high school education.

CONCLUSION

Our results suggest the need to increase the provision of mental health services to cancer patients at high risk of developing anxiety/depression symptoms, particularly during public health emergencies, to alleviate further health burdens.

Osteoporosis in Childhood Cancer Survivors: Physiopathology, Prevention, Therapy and Future Perspectives

Simple Summary

Anti-cancer treatments induced an increase in the childhood cancer survival rate. However, they are responsible for several long-term side effects in childhood cancer survivors, including osteoporosis. Cancer itself, a sedentary lifestyle, and an unhealthy diet might adversely affect bone health. Early identification and adequate management of bone fragility in childhood cancer survivors could be useful to prevent osteoporosis onset and consequently fragility fractures.

Abstract

The improvement of chemotherapy, radiotherapy, and surgical interventions, together with hematopoietic stem cell transplantation, increased childhood cancer survival rate in the last decades, reaching 80% in Europe. Nevertheless, anti-cancer treatments are mainly responsible for the onset of long-term side effects in childhood cancer survivors (CCS), including alterations of the endocrine system function and activity. In particular, the most frequent dysfunction in CCS is a metabolic bone disorder characterized by low bone mineral density (BMD) with increased skeletal fragility. BMD loss is also a consequence of a sedentary lifestyle, malnutrition, and cancer itself could affect BMD, thus inducing osteopenia and osteoporosis. In this paper, we provide an overview of possible causes of bone impairment in CCS in order to propose management strategies for early identification and treatment of skeletal fragility in this population.

American Cancer Society nutrition and physical activity guideline for cancer survivors

The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.

Sleep moderates the effects of Tibetan yoga for women with breast cancer undergoing chemotherapy

This study examined self-reported and actigraphy-assessed sleep and depression as moderators of the effect of a Tibetan yoga intervention on sleep and depression among women undergoing chemotherapy for breast cancer. This is a secondary analysis of an RCT examining a 4-session Tibetan yoga program (TYP; n = 74) versus stretching program (STP; n = 68) or usual care (UC; n = 85) on self-reported sleep (Pittsburgh Sleep Quality Index (PSQI), actigraphy-assessed sleep efficiency (SE)) and depression (Centers for Epidemiological Studies Depression Scale; CES-D) for women undergoing chemotherapy for breast cancer. Data were collected at baseline and 1-week and 3-month post-intervention. Baseline PSQI, actigraphy-SE, and CES-D were examined as moderators of the effect of group on PSQI, actigraphy-SE, and CES-D 1 week and 3 months after treatment. There was a significant baseline actigraphy-SE × group effect on PSQI at 1 week (p < .001) and 3 months (p = .002) and on CES-D at 3 months (p = .049). Specifically, the negative association of baseline actigraphy-SE with subsequent PSQI and CES-D was buffered for women in the TYP and, to a lesser extent in STP, compared to those in the UC. Baseline PSQI and CES-D were not significant moderators of the effect of group on any outcome. Behaviorally assessed sleep may be a more robust indicator of which patients are most appropriate for a yoga intervention than self-reported sleep quality. Women with poor sleep efficiency may derive the greatest benefit in terms of sleep quality and mood from a yoga intervention.

Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population

Background

Multimorbidity is common in patients with breast cancer, thus increasing the complexity of cancer care and economic burden, worsening their prognosis and quality of life. The prevalence of multimorbidity and its influence on psychological distress among patients with breast cancer have not been well characterized.

Objectives

To examine the prevalence of multimorbidity and its associations with anxiety and depression among newly diagnosed patients with breast cancer.

Methods

We conducted a retrospective observational cohort study using a large administrative claims database. Patients with breast cancer (ICD-10-CM: C50.x) were identified during the study period (1/1/2017-12/31/2020). The index date was defined as the diagnosis date of breast cancer. Demographics and comorbid conditions were assessed using data within 12 months prior to the index date. Multimorbidity was defined as the presence of ≥2 comorbid conditions. Anxiety and depression were examined using data within 12 months after the index date. Multivariable logistic regressions were performed to examine the associations between multimorbidity and anxiety and depression, adjusting for sociodemographic factors.

Results

Of the 6392 patients with newly diagnosed breast cancer, 86.9% had multimorbidity at the time of breast cancer diagnosis. The median number of comorbid conditions was 5. Overall, 27.7% experienced anxiety, and 21.9% experienced depression in the first year following breast cancer diagnosis. An increased number of comorbid conditions was associated with elevated prevalence of both anxiety and depression. After adjusting for possible confounding factors, number of comorbid conditions was significantly associated with risk of anxiety (adjusted odds ratio [95% confidence interval (CI)]: 1.17 [1.15-1.19]), and depression (1.24 [1.21-1.26]); all P < .0001.

Conclusions

Multimorbidity was highly prevalent among patients with breast cancer and was strongly associated with increased risk of anxiety and depression in the first year following breast cancer diagnosis. The presence of multimorbidity, anxiety, and depression should be considered in the context of clinical decision making to optimize cancer care and improve mental health and quality of life.

The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context

Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.

Experience of symptom control, anxiety and associating factors in a palliative care unit evaluated with Support Team Assessment Schedule Japanese version

Various physical and psychosocial difficulties including anxiety affect cancer patients. Patient surroundings also have psychological effects on caregiving. Assessing the current status of palliative care intervention, specifically examining anxiety and its associated factors, is important to improve palliative care unit (PCU) patient quality of life (QOL). This study retrospectively assessed 199 patients admitted to a PCU during August 2018–June 2019. Data for symptom control, anxiety level, disease insight, and communication level obtained using Support Team Assessment Schedule Japanese version (STAS-J) were evaluated on admission and after 2 weeks. Palliative Prognostic Index (PPI) and laboratory data were collected at admission. Patient anxiety was significantly severer and more frequent in groups with severer functional impairment (p = 0.003) and those requiring symptom control (p = 0.006). Nevertheless, no relation was found between dyspnea and anxiety (p = 0.135). Patients with edema more frequently experienced anxiety (p = 0.068). Patient survival was significantly shorter when family anxiety was higher after 2 weeks (p = 0.021). Symptoms, edema, and disabilities in daily living correlate with patient anxiety. Dyspnea is associated with anxiety, but its emergence might be attributable mainly to physical factors in this population. Family members might sensitize changes reflecting worsened general conditions earlier than the patients.

Factors Correlated With Fear of Cancer Recurrence in Cancer Survivors: A Meta-analysis

BACKGROUND

Fear of cancer recurrence (FCR) is one of the most common and aversive psychological phenomena among cancer survivors. Understanding the independent and potentially modifiable risk factors that contribute toward FCR seen in cancer survivors would inform future interventional trials aimed at reducing this risk.

OBJECTIVE

The aim of this study was to provide an evidence synthesis of factors correlated with FCR to inform the development of preventive interventions.

METHODS

A literature search was performed of the PsycINFO, EMBASE, and MEDLINE (PubMed) databases. Reports published from inception to 2020 focusing on the correlates of FCR with physical, psychological, and social factors were identified. Authors assessed the studies' risk of bias in accordance with the Standard Quality Assessment Criteria for Quantitative Studies (QualSyst criteria) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After extracting data and assessing the quality of the included studies, meta-analysis was conducted using RevMan 5.3 software.

RESULTS

Thirty-four articles were included in this study with a total sample of more than 13 000 cancer patients. Fear of cancer recurrence was positively correlated with anxiety, depression, avoidance, chemotherapy, distress, intrusive thoughts, fatigue, rumination, and neuroticism. It was negatively correlated with optimism, age, social support, quality of life, time since diagnosis, well-being, and self-efficacy.

CONCLUSIONS

We identified 16 factors that are correlated with FCR, 9 positively correlated with FCR and 7 negatively correlated with FCR.

IMPLICATIONS FOR PRACTICE

The findings of this study provide direction for the development of precise interventions for FCR in cancer survivors and lay the foundation for the further construction of an FCR-related nursing theoretical framework.

Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work

Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization-inner setting (the context of the clinic, hospital, or health care system); and 5) organization-outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges.

Antidepressants use is associated with overall survival improvement of patients with gastric cancer after surgery and adjuvant chemotherapy in Taiwan: A large population-based cohort study

To determine whether exposure to antidepressants (ATDs) results in improved overall survival (OS) of patients with gastric cancer (GC) after surgery, we conducted a large cohort study and considered confounding factors that might affect the research outcomes.Patients who received a new diagnosis of GC and received surgery and chemotherapy between 1999 and 2008 were recruited and were classified into different groups based on the ATD level used. The association between the OS of patients with GC after surgery with different levels of ATD use, and the hazard ratio with comorbidities at different ATD use levels were compared.According to Kaplan-Meier method, the more of an ATD was taken, the longer the OS and a dose-dependent relationship was discovered in the OS curve; the adjusted HRs were 0.76 (95% confidence interval [CI] = 0.68-0.84) and 0.48 (95% CI = 0.41-0.57) for ATD users taking a cumulative defined daily dose (cDDD) of 28-167 and ≧168, respectively. Sensitivity analyzes were performed to investigate the effect of various comorbidities on OS with different degrees of ATD use and the results remained consistent among the varying models. Additionally, the effect of ATD use still exhibited a dose-dependent relationship in distinct stratifications for sex and age.The OS for patients with GC after surgery and chemotherapy improved with ATD use, and a dose-dependent relationship was discovered in this study. Further studies on the association between OS of GC and ATD use are required.

Use of Medications for Treating Anxiety or Depression among Testicular Cancer Survivors: A Multi-Institutional Study

BACKGROUND

This study examined sociodemographic factors, cisplatin-related adverse health outcomes (AHO), and cumulative burden of morbidity (CBM_Pt) scores associated with medication use for anxiety and/or depression in testicular cancer survivors (TCS).

METHODS

A total of 1,802 TCS who completed cisplatin-based chemotherapy ≥12 months previously completed questionnaires regarding sociodemographic features and cisplatin-related AHOs [hearing impairment, tinnitus, peripheral sensory neuropathy (PSN), and kidney disease]. A CBM_Pt score encompassed the number and severity of cisplatin-related AHOs. Multivariable logistic regression models assessed the relationship of individual AHOs and CBM_Pt with medication use for anxiety and/or depression.

RESULTS

A total of 151 TCS (8.4%) used medications for anxiety and/or depression. No cisplatin-related AHOs were reported by 511 (28.4%) participants, whereas 622 (34.5%), 334 (18.5%), 287 (15.9%), and 48 (2.7%), respectively, had very low, low, medium, and high CBM_Pt scores. In the multivariable model, higher CBM_Pt scores were significantly associated with medication use for anxiety and/or depression (P < 0.0001). In addition, tinnitus (P = 0.0009), PSN (P = 0.02), and having health insurance (P = 0.05) were significantly associated with greater use of these medications, whereas being employed (P = 0.0005) and vigorous physical activity (P = 0.01) were significantly associated with diminished use.

CONCLUSIONS

TCS with higher CBM_Pt scores had a higher probability of using medications for anxiety and/or depression, and conversely, those who were employed and physically active tended to have reduced use of these medications.

IMPACT

Healthcare providers should encourage TCS to increase physical activity to improve both physical and mental health. Rehabilitation programs should assess work-related skills and provide career development counseling/training.

Factors affecting antidepressant use by patients requiring home parenteral nutrition

BACKGROUND

Home parenteral nutrition (HPN) is a life-saving therapy for patients with chronic intestinal failure but can be associated with a degree of psychological distress. The factors associated with the need for antidepressants (ADs) in this cohort have not yet been described.

METHODS

The study involved prospective data collection from patients attending an HPN clinic at a national intestinal failure referral center. Patients requiring HPN as a result of active malignancy were excluded. Patients were divided in 2 groups according to AD usage; demographic, anthropometric, socioeconomic characteristics, and intravenous supplementation (IVS) regimens were compared between groups.

RESULTS

A total of 184 patients were recruited between July 2018 and April 2019, with an overall prevalence of AD use of 41.7% (70/168 patients). Daily mean IVS volume was significantly higher among patients taking AD ("AD" group; 2125.48 ± 991.8 ml/day, "no-AD" group; 1828.54 ± 847.0 ml/day, P = .039), with the proportion of patients needing high-volume IVS (≥3000 ml/day) being 3 times higher in the AD group (20.0%(14/70 patients) vs 6.1% (6/98 patients), P = .006). The average energy IVS infusion per day was similar between the groups.

CONCLUSION

This is the first study to demonstrate that AD use correlates with higher IVS volume rather than energy requirements in HPN patients, suggesting that high IVS volume requirements may be better associated with the patient's disease burden. Early and tailored mental health intervention may be beneficial in those with high IVS volume requirements.

Free of malignancy but not of fears: A closer look at Damocles syndrome in survivors of hematologic malignancies

Fear of cancer recurrence (FoR) is an important yet underestimated long term sequela that many cancer survivors suffer from. The continuous state of uncertainty the survivors might go through can lead to a serious impact on their quality of life (QoL), which is collectively referred to as Damocles syndrome. Given the increasing numbers of cancer survivors, it is crucial to understand the different psychological issues that face them, including Damocles syndrome. Herein, we review the current literature of Damocles syndrome specifically in hematologic cancer survivors. Although with inconsistent terms, current literature demonstrates the impact and the prevalence of Damocles syndrome on QoL of survivors of leukemia, lymphoma, and hematopoietic cell transplant. Interventional studies are very limited in this area. Moreover, hematologic malignancy survivors can also meet the diagnostic criteria of other psychiatric diseases, including depression, anxiety, and post-traumatic stress disorder, wherein they should be managed accordingly. It is important to increase the awareness about Damocles syndrome and screen patients for it and other related psychological disorders. Additionally, this review has shown the need for standardization of Damocles syndrome definitions. Finally, the lack of interventional studies that target survivors' psychosocial challenges calls for prospective research to better address this rising problem.

Psychotropic medication utilisation in adult cancer patients in China: A cross-sectional study based on national health insurance database

Background

Psychotropic medications are useful to treat psychiatric disorders which are frequently underdiagnosed and undertreated in cancer patients. Evidence on utilisation of psychotropic medications in cancer patients was absent in China. This study aimed to analyse the prevalence and the potential predictors of psychotropic medication use in adult cancer patients in China.

Methods

We analysed cross-sectional data from the China Health Insurance Association database in 2015-2017, which contained health care utilisation information for a national representative sample of basic medical insurance beneficiaries. Cancer patients aged above 18 were identified by International Classification of Disease 10th revision code C00-C97. Psychotropic medications were defined following the Anatomical Therapeutic Chemical codes: antipsychotics (N05A), anxiolytics (N05B), hypnotics and sedatives (N05C), and antidepressants (N06A, N06CA). We calculated the prevalence of psychotropic medication use in cancer patients, and applied multivariable logistic regression to identify its potential predictors.

Findings

A total of 260,364 adults with cancer were identified in the database, of which 48,111 (18•5%) were prescribed at least one psychotropic medication comprising antipsychotics (3763, 1•4%), anxiolytics (15,902, 6•1%), hypnotics and sedatives (37,040, 14•2%), and antidepressants (2379, 0•9%). Patients with solid tumours had higher prevalence of psychotropic medication use than patients with lymphoid and hematopoietic malignancies (e.g. female genital organs, adjusted odds ratio (OR)=2•25, 95%CI=2•09-2•44). The prevalence of psychotropic medication use in cancer patients in the Eastern region was significantly higher than those of cancer patients in the Western regions (OR=2•33, 95%CI=2•27-2•40). Compared with the Urban Rural Resident Basic Medical Insurance beneficiaries, cancer patients covered by the Urban Employee Basic Medical Insurance were more likely to use psychotropic medications (OR=1•18, 95%CI=1•15-1•20). Midazolam was the most frequently used psychotropic (21,728, 45•2%), and flupentixol-melitracen was the most commonly used antidepressant (1176, 2•4%) among all psychotropic medication users in the sample.

Interpretation

The prevalence of psychotropic medication use in Chinese adult cancer patients was inequitable. Further attention will be needed to be paid to the mental health of cancer patients in China.

Funding

No funding.

Paroxetine combined with fluorouracil plays a therapeutic role in mouse models of colorectal cancer with depression through inhibiting IL-22 expression to regulate the MAPK signaling pathway

The objective of the present study was to observe the therapeutic effect of paroxetine combined with fluorouracil on mice with colorectal cancer (CRC) complicated with depression and to explore its mechanism of action. Using chronic mild stress and xenograft tumor methods to model CRC complicated with depression, 60 BALB/c mice were randomly divided into control, tumor model, tumor depression model, tumor depression antidepressant, tumor depression chemotherapy and tumor depression antidepressant plus chemotherapeutic drug groups. Changes in mouse sucrose preference and forced swimming tests were tracked. Changes in tumor volume and weight were compared, the tumor inhibition rate was calculated, Ki-67 expression in tumor tissues was detected using immunohistochemistry and IL-22 levels in peripheral blood were detected using ELISAs. Additionally, protein expression levels of IL-22, Bcl-2, Bax, caspase-3, p38, phosphorylated (p)-p38, ERK, p-ERK, JNK and p-JNK in tumor tissue were detected using western blotting. Following treatment with paroxetine and chemotherapy drugs, the sucrose preference index was increased, autonomic behavior dysfunction was alleviated and tumor growth was significantly inhibited. Furthermore, the expression levels of Ki-67 and apoptosis-related proteins, Bax and caspase-3, increased in tumor tissues, anti-apoptosis protein Bcl2 expression levels decreased significantly, IL-22 levels in the blood and tumor tissues were reduced and p-p38, p-ERK and p-JNK proteins were significantly reduced. It was concluded that paroxetine combined with chemotherapy drugs improved depressive behavior and promoted the survival state in a mouse model of CRC and depression, possibly through inhibiting IL-22 expression to regulate the activity of the MAPK signaling pathway.

Depression among older adults with gastrointestinal malignancies

BACKGROUND

Depression among older adults with cancer is under recognized and under treated. This study characterizes the burden of depression in older adults with gastrointestinal (GI) malignancies prior to chemotherapy and its relationship with geriatric assessment (GA) domains, health-related quality of life (HRQOL), and self-reported healthcare utilization.

METHODS

Patients ≥60 years in GI oncology clinics at UAB were asked to complete a GA entitled the Cancer & Aging Resilience Evaluation (CARE). We examined depression using the Patient-Reported Outcomes Measurement Information System (PROMIS®) Depression four-item short form; moderate/severe depression was defined by a t-score ≥ 60. Multivariate analysis was used to examine associations between those with and without moderate/severe depression.

RESULTS

Of 355 included patients, 46 had mild depression (13%) and an additional 46 patients had moderate/severe depression (13%). After adjustment for age, sex, education, cancer type, and cancer stage, those who reported moderate/severe depression had a significantly increased odds of reporting falls (adjusted odds ratio [aOR] 4.01, 95% confidence interval [CI] 1.94-8.26), dependence in IADLs (aOR 7.06,CI 2.91-17.1), dependence in ADLs (aOR 6.23, CI 2.89-13.4), malnutrition (aOR 5.86, CI 2.40-14.3), frailty (aOR 13.7, CI 5.80-32.1), and fatigue (aOR 11.2, CI 3.31-37.6). Moderate/severe depression was also significantly associated with worse physical (aOR 7.58, CI 3.30-17.4) and mental (aOR 26.3, CI 10.1-68.8) HRQOL sub-scores, without significant differences in healthcare utilization.

CONCLUSIONS

More than one out of eight older adults with a GI malignancy reported moderate/severe depression prior to chemotherapy, which was associated with impairments in several GA domains and HRQOL.

Preliminary assessment of medical cannabis consumption by cancer survivors

OBJECTIVES

To assess the motivation of cancer survivors to consume medical cannabis and to assess the patterns of use, perceived efficacy, as well as side and adverse effects.

METHODS

Cross-sectional survey among 190 Israeli cancer survivors who were licensed to use medical cannabis in a single institution. In addition to demographic information, the questionnaire examined patterns of use (including dosage, type of cannabis and way of administration), motivation for medical cannabis consumption, perceived efficacy, adverse and side effects, motivation for ceasing cannabis consumption, and tobacco smoking.

RESULTS

The mean monthly dosage of cannabis consumed was 42.4 grams; 95.8% of respondents reported not consuming cannabis regularly before being diagnosed with cancer; the most common way of administration was smoking, and most of the participants reported taking cannabis throughout the day. The most common symptoms for which participants took medical cannabis were pain (n = 169, 88.9%), sleeping disorder (n = 144, 75.8%) and anxiety (n = 79, 41.6%). Twenty patients (10.5%) reported on mild side (or adverse) effects.

CONCLUSIONS

This study indicates that cancer survivors may indeed consume cannabis for symptom relief, and not merely for recreational purposes. Although our findings point to perceived safety and efficacy of medical cannabis for cancer survivors, more research is needed to study the adequate role that cannabis may have for treating symptoms associated with cancer survivorship.

Financial Toxicity: A Review of the Literature and Nursing Opportunities

BACKGROUND

Studies have demonstrated the negative effects of the costs of cancer care on the health and well-being of patients with cancer. Nurses require knowledge of the risk factors, experiences, and outcomes associated with financial toxicity prior to designing evidence-based studies and protocols to address financial toxicity.

OBJECTIVES

This article summarizes the state of the science in financial toxicity among patients with cancer, with the goal of guiding nurses in leading research and evidence-based practice efforts to decrease the impact of financial toxicity on patient outcomes.

METHODS

The authors reviewed published research, theoretical models, and research grants that focus on financial toxicity among patients with cancer. The authors also synthesized study findings and project goals while emphasizing opportunities for nurses to meaningfully engage within this area as researchers and clinicians.

FINDINGS

Substantial cross-sectional descriptive work documents the risk factors, experiences, and outcomes of financial toxicity. Future work should address methodologic concerns by using comprehensive, validated measures and applying conceptual models to design and test financial toxicity interventions using prospective, rigorous methodologies. The authors propose a conceptual model to assist researchers and clinicians.

Healthcare services and medication use among cancer survivors and their partners: a cross-sectional analysis of 16 European countries

PURPOSE

To estimate the association between a cancer diagnosis and the use of healthcare services and medication among cancer survivors (CS) and their partners (PCS), particularly in the first years after diagnosis.

METHODS

This is a cross-sectional study based on data from the Fourth Wave of the Survey of Health, Ageing and Retirement in Europe-SHARE (2010-2011); it included individuals aged ≥ 50 years and their partners, from 16 European countries. All CS diagnosed with a first primary cancer within 10 years (n = 1174) and corresponding PCS (n = 1174) were country-, sex-, age- and education-matched (1:3) with non-cancer individuals (NC) and partners of non-cancer individuals (PNC), respectively. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were computed.

RESULTS

Healthcare use in the previous 12 months and current medication intake were more frequent among CS than NC; the ORs (95% CIs) were 2.56 (2.23-2.94) for ≥ 8 medical contacts, 3.07 (2.62-3.59) for hospital stays and 1.75 (1.52-2.03) for use of ≥ 3 drugs indicated for different health problems. Medical contacts (OR = 5.74, 95% CI 4.31-7.65) and hospitals stays (OR = 13.88, 95% CI 10.15-18.98) were more frequent among CS diagnosed in the last 2 years. Contacts with medical doctors (≥ 8; OR = 1.23, 95% CI 1.06-1.42) were also more common among PCS than PNC.

CONCLUSION

When compared to individuals without cancer, CS diagnosed in the last 10 years, as well as their partners, had an increased healthcare use.

IMPLICATION FOR CANCER SURVIVORS

These findings highlight the importance of family-focused care in oncological settings, in order to support patients as well as their partners, who are frequently their closest significant person.

Are Leading Risk Factors for Cancer and Mental Disorders Multimorbidity Shared by These Two Individual Conditions in Community-Dwelling Middle-Aged Adults?

Data on the leading shared risk factors of cancer and mental disorders are limited. We included 98,958 participants (54.8% women) aged 45-64 years from the 45 and Up Study who were free of cancer, depression, and anxiety at baseline (2006-2009). The incidence of cancer, mental disorders, and multimorbidity (concurrent cancer and mental disorders) was identified using claim databases during follow-up until 31 December 2016. During a nine-year follow-up, the cumulative incidence of cancer, mental disorders, and multimorbidity was 8.8%, 17.4%, and 2.2%, respectively. Participants with cancer were 3.41 times more likely to develop mental disorders, while individuals with mental disorders were 3.06 times more likely to develop cancer than people without these conditions. The shared risk factors for cancer and mental disorders were older age, female gender, smoking, psychological distress, low fruit intake, poor/fair self-rated health, hypertension, arthritis, asthma, and diabetes. Low education, low income, overweight/obesity, and family history of depression were risk factors for mental disorders and multimorbidity but not cancer. In conclusion, smoking, low fruit intake, and obesity are key modifiable factors for the prevention of cancer and mental disorders. Individuals with poor/fair self-rated health, high psychological distress, asthma, hypertension, arthritis, or diabetes should be targeted for the prevention and screening of cancer and mental disorders.

Incidence of Medication-Treated Depression and Anxiety Associated with Long-Term Cancer, Cardiovascular Disease, Diabetes and Osteoarthritis in Community-dwelling Women and Men

BACKGROUND

Long-term cancer, cardiovascular disease, diabetes and osteoarthritis may increase the risk of mental disorders, but which was more harmful and whether the associations differed between genders is unclear.

METHODS

We included 115,094 participants (54.3% women) aged 45-64 years from the 45 and Up Study who were free of depression, anxiety, and Parkinson's disease at baseline (2006-2009). The incidence of depression and anxiety was identified using claim databases during follow-up until December 2016. Cox regression models were used to examine the association of cancer, cardiovascular disease, diabetes, and osteoarthritis at baseline with incident depression and anxiety.

FINDINGS

During a mean eight-year follow-up (958,785 person-year), the cumulative incidence of depression and anxiety was 12.5% and 5.9% in the healthy population. Hazard ratios ([HRs] (95% CI) versus healthy population) for incident depression associated with long-term cancer, cardiovascular disease, diabetes, and osteoarthritis were 1.19 (95% CI: 1.13-1.25), 1.08 (1.00-1.16)), 1.18 (1.09-1.28), and 1.94 (1.80-2.10), respectively. The corresponding HRs (95% CIs) for incident anxiety were 1.11 (1.03-1.20), 1.26 (1.14-1.39), 1.10 (0.98-1.24), and 2.01 (1.80-2.23), respectively. The positive association between cancer and incident depression was more evident in men (HR (95% CI): 1.24 (1.13-1.35) than in women (1.14 (1.07-1.21). Long-term diabetes was an independent risk factor for incident anxiety in men (1.21 (1.02-1.44) but not in women (1.09 (0.93-1.28)).

INTERPRETATION

Long-term osteoarthritis, cardiovascular disease, and cancer were independent risk factors for incident depression and anxiety in both genders with osteoarthritis having the highest relative risk.

Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

Distress is defined in the NCCN Guidelines for Distress Management as a multifactorial, unpleasant experience of a psychologic (ie, cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Early evaluation and screening for distress leads to early and timely management of psychologic distress, which in turn improves medical management. The panel for the Distress Management Guidelines recently added a new principles section including guidance on implementation of standards of psychosocial care for patients with cancer.

Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act

Importance

Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking.

Objectives

To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate temporal trends during implementation of the Affordable Care Act.

Design, Setting, and Participants

We used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study of 30 364 participants aged 18 years or older. We grouped participants as cancer survivors (n = 15 182) and those with no reported history of cancer, whom we refer to as control respondents (n = 15 182), matched on age. We excluded individuals reporting a cancer diagnosis prior to age 18 years and those with nonmelanoma skin cancers.

Main Outcomes and Measures

We compared issues with health care access (eg, delayed or forgone care) and affordability (eg, unable to afford medications or health care services) between cancer survivors and control respondents. We also explored trends over time in the proportion of cancer survivors reporting these difficulties.

Results

Of the 30 364 participants, 18 356 (57.4%) were women. The mean (SD) age was 63.5 (23.5) years. Cancer survivors were more likely to be insured (14 412 [94.8%] vs 13 978 [92.2%], P < .001) and to have government-sponsored insurance (7266 [44.3%] vs 6513 [38.8%], P < .001) compared with control respondents. In multivariable models, cancer survivors were more likely than control respondents to report delayed care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63), forgone medical care (OR, 1.76; 95% CI, 1.45-2.12), and/or inability to afford medications (OR, 1.77; 95% CI, 1.46-2.14) and health care services (OR, 1.46; 95% CI, 1.27-1.68) (P < .001 for all). From 2010 to 2016, the proportion of survivors reporting delayed medical care decreased each year (B = 0.47; P = .047), and the proportion of those needing and not getting medical care also decreased each year (B = 0.35; P = .04). In addition, the proportion of cancer survivors who reported being unable to afford prescription medication decreased each year (B=0.66; P = .004) and the proportion of those unable to afford at least 1 of 6 services decreased each year (B = 0.51; P = .01).

Conclusions and Relevance

Despite higher rates of insurance coverage, cancer survivors reported greater difficulties accessing and affording health care compared with adults without cancer. Importantly, the proportion of survivors reporting these issues continued a downward trend throughout our observation period in the years following the implementation of the Affordable Care Act. Our findings suggest incremental improvement in health care access and affordability after recent health care reform and provide an important benchmark as additional changes are likely to occur in the coming years.

Quality of Life and Coping in Multiple Endocrine Neoplasia Type 2

Scarce data are available on the quality of life and psychosocial distress of patients with multiple endocrine neoplasia type 2 (MEN2), a genetic cancer syndrome caused by RET germline mutations. Carriers of RET mutations can face several challenges, including fear for the future, guilt for transmission of a germline mutation to an offspring, side effects of cancer treatment, coping behaviors in the face of a chronic and frequently incurable cancer, and difficulties in access to adequate health care. We have addressed the effects of genetic testing on the quality of life of patients with MEN2 and the lifelong physical and psychosocial challenges experienced by these patients. We have also suggested strategies to minimize the burden of living with this chronic condition and the perspectives on future studies to improve the health-related quality of life of the patients.

Preventive care service use among cancer survivors with serious psychological distress: An analysis of the medical expenditure panel survey data

Serious psychological distress (SPD) can adversely impact health and quality of life after cancer. The purpose of this study is to examine the association between SPD and the receipt of preventive care services and cancer screening among survivors and adults without a cancer history. A total of 12,564 cancer survivors and 160,023 adults without a cancer history as comparison group were identified from the population-based Medical Expenditure Panel Survey (2008-2015). SPD was assessed using the 6-item Kessler Psychological Distress Scale. We examined use of preventive care and cancer screening services in cancer survivors and comparison adults with/without SPD. Multivariable logistic regression models were conducted for each outcome: preventive service (i.e. blood pressure, cholesterol, influenza vaccination, routine and dental check-up) or cancer screening (i.e. mammography, Papanicolau test, colorectal cancer screening) adjusting for demographic, comorbidity, usual source of care covariates. Adjusted odds ratios and 95% confidence intervals were calculated. Prevalence of SPD was 9.8% in cancer survivors compared to 4.6% in comparison adults. Survivors with SPD were more frequent utilizers of medical care, reporting 10 or more visits to the doctor's office in the past 12 months (29.3% vs. 14.1% without SPD). Having SPD was associated with lower odds of being up-to-date with preventive service use and cancer screening among age- and gender-eligible individuals. The magnitude of the effect was greater in adults' age ≥65 years. Better coordination of care and patient-physician discussions are likely needed to improve delivery of recommended preventive services for persons with SPD.

The use of antidepressants in oncology: a review and practical tips for oncologists

Background

The use of psychotropic drugs, namely those with an antidepressant profile (ADs), is a mandatory part of an integrated treatment of psychiatric disorders among cancer patients. We aimed to synthetize the most relevant data emerging from published studies to provide tips about the use of ADs in oncology.

Design

A search was made of the major databases over the last 30 years (Embase/Medline, PsycLIT, PsycINFO, the Cochrane Library), including narrative reviews, systematic reviews and meta-analyses summarizing the results from observational studies and randomized clinical trials assessing effectiveness, safety profile, interactions, contraindications and use of ADs in oncology with regard to both psychiatric (depressive spectrum, stress-related, anxiety disorders) and cancer-related symptoms (e.g. pain, hot flashes and fatigue).

Results

The weight of evidence supports the efficacy of ADs for more severe major depression in individuals with cancer and as an adjuvant treatment in cancer-related symptoms, although the methodological limitations of reported randomized controlled trials do not permit definite conclusions. Data also indicate that there should be caution in the use of ADs in cancer patients in terms of their safety profile and potential clinically significant interactions with other prescribed medications. Practical recommendations that have been made for the use of ADs in cancer patients, in the context of a multimodal approach to depression treatment, have been summarized here.

Conclusions

ADs are a relatively safe and effective treatment for more severe major depression in cancer patients. However, more research is urgently needed regarding the efficacy of ADs in different cancer types and cancer settings, their interactions with anticancer agents and their additive benefit when integrated with psychosocial interventions.

Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer

BACKGROUND

Among patients with cancer, depressive symptoms are associated with worse clinical outcomes, including greater health care utilization. As use of antidepressant medications can improve depressive symptoms, we sought to examine relationships among depressive symptoms, antidepressant medications, and hospital length of stay (LOS) in patients with advanced cancer.

MATERIALS AND METHODS

From September 2014 to May 2016, we prospectively enrolled patients with advanced cancer who had an unplanned hospitalization. We performed chart review to obtain information regarding documented depressive symptoms in the 3 months prior to admission and use of antidepressant medications at the time of admission. We compared differences in hospital LOS by presence or absence of depressive symptoms and used adjusted linear regression to examine if antidepressant medications moderated these outcomes.

RESULTS

Of 1,036 patients, 126 (12.2%) had depressive symptoms documented prior to admission, and 288 (27.8%) were taking antidepressant medications at the time of admission. Patients with depressive symptoms experienced longer hospital LOS (7.25 vs. 6.13 days; p = .036). Use of antidepressant medications moderated this relationship; among patients not on antidepressant medications, depressive symptoms were associated with longer hospital LOS (7.88 vs. 6.11 days; p = .025), but among those on antidepressant medications, depressive symptoms were not associated with hospital LOS (6.57 vs. 6.17 days; p = .578).

CONCLUSION

Documented depressive symptoms prior to hospital admission were associated with longer hospital LOS. This effect was restricted to patients not on antidepressant medications. Future studies are needed to investigate if use of antidepressant medications decreases LOS for patients hospitalized with advanced cancer and the mechanisms by which this may occur.

IMPLICATIONS FOR PRACTICE

This study investigated the prevalence of documented depressive symptoms in patients with advanced cancer in the 3 months prior to an unplanned hospitalization and the prevalence of use of antidepressant medications at time of hospital admission. The relationship of these variables with hospital length of stay was also examined, and it was found that documented depressive symptoms were associated with prolonged hospital length of stay. Interestingly, antidepressant medications moderated the relationship between depressive symptoms and hospital length of stay. These findings support the need to recognize and address depressive symptoms among patients with advanced cancer, with potential implications for optimizing health care utilization.

Polypharmacy and patterns of prescription medication use among cancer survivors

BACKGROUND

The population of cancer survivors is rapidly growing in the United States. Long-term and late effects of cancer, combined with the ongoing management of other chronic conditions, make survivors particularly vulnerable to polypharmacy and its adverse effects. In the current study, the authors examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors.

METHODS

Using data from the Medical Expenditure Panel Survey (MEPS), the authors matched cancer survivors (5216 survivors) with noncancer controls (19,588 controls) by age, sex, and survey year. Polypharmacy was defined as ≥5 unique medications. The authors estimated the percentage of respondents prescribed medications within therapeutic classes and total prescription expenditures.

RESULTS

A higher percentage of cancer survivors were prescribed ≥5 unique medications (64.0%; 95% confidence interval [95% CI], 62.3%-65.8%) compared with noncancer controls (51.5%; 95% CI, 50.4%-52.6%), including drugs with abuse potential. Across all therapeutic classes, a higher percentage of newly (≤1 year since diagnosis) and previously (>1 years since diagnosis) diagnosed survivors were prescribed medications compared with controls, with large differences observed with regard to central nervous system agents (65.8% [95% CI, 62.3%-69.3%] vs 57.4% [95% CI, 55.3%-59.5%] vs 46.0% [95% CI, 45.0%-46.9%]). Specifically, nearly 10% of survivors were prescribed benzodiazepines and/or opioids compared with approximately 5% of controls. Survivors had more than double the prescription expenditures (median of $1633 vs $784 among controls). Findings persisted across age and comorbidity categories.

CONCLUSIONS

Cancer survivors were prescribed a higher number of unique medications, including drugs with abuse potential, thereby increasing their risk of adverse drug events, financial toxicity, poor adherence, and drug-drug interactions. Cancer 2018;124:2850-2857. © 2018 American Cancer Society.

Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer

OBJECTIVES

To evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer.

METHODS

We leveraged a representative 5% national sample of all fee-for-service dual enrollees in the United States (2004-2007) to evaluate the impact of the removal of caps on the number of reimbursable prescriptions per month (drug caps) under Part D on 1) prevalence and 2) average days' supply dispensed for antidepressants, antihypertensives, and lipid-lowering agents overall and by race (white and black).

RESULTS

The removal of drug caps was associated with increased use of lipid-lowering medications (days' supply 3.63; 95% confidence interval [CI] 1.57-5.70). Among blacks in capped states, we observed increased use of lipid-lowering therapy (any use 0.08 percentage points; 95% CI 0.05-0.10; and days' supply 4.01; 95% CI 2.92-5.09) and antidepressants (days' supply 2.20; 95% CI 0.61-3.78) and increasing trends in antihypertensive use (any use 0.01 percentage points; 95% CI 0.004-0.01; and days' supply 1.83; 95% CI 1.25-2.41). The white-black gap in the use of lipid-lowering medications was immediately reduced (-0.09 percentage points; 95% CI -0.15 to -0.04). We also observed a reversal in trends toward widening white-black differences in antihypertensive use (level -0.08 percentage points; 95% CI -0.12 to -0.05; and trend -0.01 percentage points; 95% CI -0.02 to -0.01) and antidepressant use (-0.004 percentage points; 95% CI -0.01 to -0.0004).

CONCLUSIONS

Our findings suggest that the removal of drug caps under Part D had a modest impact on the treatment of hypercholesterolemia overall and may have reduced white-black gaps in the use of lipid-lowering and antidepressant therapies.

Marital status and survival of patients with kidney cancer

Background

The relationship between marital status and prognosis of kidney cancer has not been explored in detail. In this study, we aimed to investigate the impact of marital status on survival outcomes in kidney cancer.

Methods

We used the Surveillance, Epidemiology and End Results (SEER) program to identify 112860 patients with kidney cancer diagnosed in 2004 through 2013. Kaplan-Meier methods and multivariable Cox regression models were used to analyze the influence of marital status on overall survival (OS) and cancer-specific survival (CSS).

Results

Married patients had better 5-year OS and CSS compared with patients who were divorced/separated, widowed, and single. After adjusting for known confounders, unmarried patients were at greater risk of overall and cancer-specific mortality, especially the widowed. Moreover, subgroup analysis showed that married still had better prognosis across different SEER stages, ages and sexes.

Conclusions

Our study revealed that marriage is associated with better outcomes of both OS and CSS in kidney cancer patients.

Psychiatric comorbidities among breast cancer survivors in South Korea: a nationwide population-based study

PURPOSE

The aim of this study was to analyze the prevalence of mental disorders in breast cancer survivors using claims data from the Health Insurance Review and Assessment Service in South Korea. We also analyzed patterns of mental disorders with respect to the time of diagnosis and age.

MATERIALS AND METHODS

We confirmed mental disorders in a nationwide cohort of 87,843 people who were diagnosed with invasive breast cancer and underwent surgery between January 1, 2010 and December 31, 2014. We investigated the prevalence of mental disorders according to the time of diagnosis and age group. We also examined the utilization patterns of medical institutions and medical departments.

RESULT

From one year before a breast cancer diagnosis, 8430 patients were diagnosed with a mental disorder. Of those patients, 3256 were diagnosed with depression (38.6%) and 2739 with anxiety (32.5%). The overall frequency of mental disorders peaked within one month after the cancer diagnosis. The highest rate of increase after diagnosis was noted in stress reaction/adjustment disorders. Depression was relatively high in the young age group, and anxiety was high in the elderly group. In total, there were 59,111 claims for mental disorders. Over 70% (43,788) of claims for mental disorder treatment were from a psychiatry medical department.

CONCLUSION

Mental disorders in breast cancer survivors showed different patterns of prevalence according to time, age, and disease. Early intervention could be effective in controlling symptoms of mental disorder and could increase the quality of life for cancer survivors.