Anxiety, fatigue, and attentional bias toward threat in patients with hematopoietic tumors

Effects of remote dignity therapy on mental health among patients with hematologic neoplasms and their significant others: A randomized controlled trial

BACKGROUND

Families of patients with hematologic neoplasms involved in dignity therapy have exhibited a remarkable improvement in psychological well-being and family functioning. However, the applicability and generalizability of family participatory dignity therapy are limited as it is influenced by factors such as intervention time, place, and participants. Whether remote support from significant others is feasible and effective remains unknown.

OBJECTIVES

This study aimed to confirm the efficacy of significant others participating in remote dignity therapy (r-DT) on hope, dignity loss, meaning of life, and sense of stigma among patients with hematologic neoplasms as well as their significant others' depression and anxiety.

DESIGN

A randomized, single-blinded, two-arm, parallel-group controlled trial.

SETTING(S) AND PARTICIPANTS

Participants included patients with hematologic neoplasms and their significant others, who were recruited from Fujian Medical University Union Hospital from May 2021 to January 2022.

METHODS

A total of 72 eligible participants (patients and significant others) agreed to participate, and were randomly assigned to an intervention group (n = 35) or a control group (n = 37). Each pair of participants in the intervention group participated in two or three conversations based on the online video function of the WeChat platform, performed by one therapist in accordance with a specific communication outline. To evaluate the effects of the intervention, we assessed the patients' degree of dignity loss, hope level, meaning of life, and sense of stigma, as well as their significant others' depression, anxiety, and intimacy at baseline (T0), 15 days (T1), 30 days (T2), and 60 days (T3), and compared the scores between the two groups after the completion of the intervention. The Generalized Estimation Equation Model (GEE) was used to examine the effects of time, group, and their interaction.

RESULTS

The intervention group statistically significantly differed in lower dignity loss (t = 2.190, p = 0.032), higher hope level (t = -2.010, p = 0.049), and higher meaning of life (t = -2.066, p = 0.043) than the control group at T1. Regarding their significant others, the results of the comparison between the two groups showed that significant others in the intervention group had reduced levels of anxiety and depression at T1 and T2 (p < 0.05). The majority of patients (84.38 %) and significant others (75.00 %) provided positive evaluations of the program.

CONCLUSIONS

The r-DT showed a short-term positive effect on decreasing patients' dignity loss and promoting patients' hope and meaning of life; among their significant others, it decreased anxiety and depression.

TRIAL REGISTRATION

Registered in the China Clinical Trial Registry on 17 March 2021(ChiCTR2100044374).

TWEETABLE ABSTRACT

Remote dignity therapy decreased patients' dignity loss and promoted their hope and meaning of life; among their significant others, it decreased anxiety and depression.

Neural mechanisms of attentional bias to emotional faces in patients with chronic insomnia disorder

OBJECTIVE

This study used event-related potential (ERP) and resting-state functional connectivity (rs-FC) approaches to investigate the neural mechanisms underlying the emotional attention bias in patients with chronic insomnia disorder (CID).

METHODS

Twenty-five patients with CID and thirty-three demographically matched healthy controls (HCs) completed clinical questionnaires and underwent electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) scans. EEG analysis examined the group differences in terms of reaction times, P3 amplitudes, event-related spectral perturbations, and inter-trial phase synchrony. Subsequently, seed-based rs-FC analysis of the amygdala nuclei (including the central-medial amygdala [CMA] and basolateral amygdala [BLA]) was performed. The relationship between P3 amplitude, rs-FC and clinical symptom severity in patients with CID was further investigated by correlation analysis.

RESULTS

CID patients exhibited shorter reaction times than HCs in both standard and deviant stimuli, with the abnormalities becoming more pronounced as attention allocation increased. Compared to HCs, ERP analysis revealed increased P3 amplitude, theta wave power, and inter-trial synchrony in CID patients. The rs-FC analysis showed increased connectivity of the BLA-occipital pole, CMA-precuneus, and CMA-angular gyrus and decreased connectivity of the CMA-thalamus in CID patients. Notably, correlation analysis of the EEG and fMRI measurements showed a significant positive correlation between the P3 amplitude and the rs-FC of the CMA-PCU.

CONCLUSION

This study confirms an emotional attention bias in CID, specifically in the neural mechanisms of attention processing that vary depending on the allocation of attentional resources. Abnormal connectivity in the emotion-cognition networks may constitute the neural basis of the abnormal scalp activation pattern.

Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: A systematic review and meta-analysis

INTRODUCTION

The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients under treatment and patients under watchful waiting.

METHOD

Five databases (Scopus, Medline, PsycINFO, EThOS, CINAHL) were searched throughout June 2021. Key search terms included haematology cancer, anxiety, depression, in treatment and watchful waiting. Study and sample characteristics, prevalence rates and mean self-reported scores of anxiety and depression data were extracted.

RESULTS

A total of 18 eligible papers were included in the review. Quality appraisal indicated papers were of adequate standard. Depression data from 2720 participants (14.5% under watchful waiting) and anxiety data from 2520 participants (15.9% under watchful waiting) were analysed through subgroup meta-analyses. The prevalence of anxiety was 34% amongst adults receiving treatment and 24.5% amongst those under watchful waiting. The prevalence of depression amongst adults receiving treatment was 31.3%, significantly higher than 16.1% of adults under watchful waiting.

CONCLUSION

Overall, adults with haematology cancer were at greater risk of experiencing anxiety and depression than the general population, with greatest risk in those under treatment. The findings indicate the need for future research to examine availability and effectiveness of targeted psychological interventions.

Attentional Bias Toward Reproduction-Related Stimuli and Fertility Concerns Among Breast Cancer Survivors

The current study examined whether an attentional bias exists for reproduction-related visual cues among breast cancer survivors and its relationship with fertility concerns and emotional distress. Breast cancer survivors (n = 38) aged 18-40 were compared to 37 healthy women recruited from the general population. Attentional bias was investigated using a visual dot-probe task and response times (RT) were measured. Participants also completed several questionnaires, including the Reproductive Concerns After Cancer Scale (RCACS) and the Hospital Anxiety and Depression Scale (HADS). Biased cognitive processing toward reproduction-related stimuli was observed for all young women. However, attentional bias was a significant predictor of concerns about partner disclosure of fertility status, with higher bias scores associated with higher levels of concern only for breast cancer survivors. The desire to have a (or another) biological child was also a significant predictor of higher concerns related with fertility potential for all young women. Higher vigilance regarding reproduction-related cues seems to lead to higher concerns among women with breast cancer history whose fertility is threatened. This result may have important research and clinical implications. Interventions focused on goal-oriented attention self-regulation and problem-solving can help to manage fertility concerns and distress in the course of the disease.

Association Between Anxiety and Descending Pain Modulation of Thermal Stimuli in Patients with Burning Mouth Syndrome: A Cross-Sectional Study

AIMS

To investigate the predictive power of depression and anxiety for conditioned pain modulation (CPM) and to examine the relationships of CPM at 40°C and CPM at 47°C with age, disease-related pain, pain duration, and psychosocial factors in burning mouth syndrome (BMS).

METHODS

A total of 22 patients with BMS and 22 healthy female controls participated in this study. Temporal summation was used as the test stimulus for CPM, and subsequent exposure either to a nonpainful (40°C) or a painful (47°C) Peltier thermode was used as the conditioning stimulus. CPM was calculated as the difference in pain perception following the conditioning stimulus. Psychosocial factors were examined using the Profile of Mood States (POMS) and the State-Trait Anxiety Inventory (STAI).

RESULTS

State anxiety and tension-anxiety scores were significantly higher for patients with BMS than for control participants. Multiple regression analyses showed that CPM47°C was affected by vigor, fatigue, confusion, and trait anxiety (adjusted R2 = 0.685, F = 5.147, P = .098). The corresponding analysis for CPM40°C showed that the model was not predictive for the following variables: disease-related pain, pain duration, or components of the POMS or STAI. A significant positive correlation was found between CPM47°C and trait anxiety, suggesting that trait anxiety negatively affected the endogenous pain modulation system.

CONCLUSION

Increases in trait anxiety reduced the CPM effect. These findings suggest that CPM impairments and increases in trait anxiety are involved in the development of BMS.

Factors Associated With Unplanned Acute Care Services for Patients With Newly Diagnosed Hematologic Malignancies

PURPOSE

This study evaluated risk factors predicting unplanned 30-day acute service utilization among adults subsequent to hospitalization for a new diagnosis of leukemia, lymphoma, or myeloma. This study explored the prevalence of medical complications (aligned with OP-35 measure specifications from the Centers for Medicare & Medicaid Services [CMS] Hospital Outpatient Quality Reporting Program) and the potential impact of psychosocial factors on unplanned acute care utilization.

METHODS

This study included 933 unique patients admitted to three acute care inpatient facilities within a nonprofit community-based health care system in southern California from 2012 to 2017. Integrated comprehensive data elements from electronic medical records and facility oncology registries were leveraged for univariate statistics, predictive models constructed using multivariable logistic regression, and further exploratory data mining, with predictive accuracy of the models measured with c-statistics.

RESULTS

The mean age of study participants was 65 years, and 55.1% were male. Specific diagnoses were lymphoma (48.7%), leukemia (35.2%), myeloma (14.0%), and mixed types (2.1%). Approximately one fifth of patients received unplanned acute care services within 30 days postdischarge, and over half of these patients presented with one or more symptoms associated with the CMS medical complication measure. The predictive models, with c-statistics ranging from 0.7 and above for each type of hematologic malignancy, indicated good predictive qualities with the impact of psychosocial functioning on the use of acute care services (P values < .05), including lack of consult for social work during initial admission (lymphoma or myeloma), history of counseling or use of psychotropic medications (lymphoma), and past substance use (myeloma).

CONCLUSION

This study provides insights into patient-related factors that may inform a proactive approach to improve health outcomes, such as enhanced care transition, monitoring, and support interventions.

A Preliminary Exploration of Landscape Preferences Based on Naturalness and Visual Openness for College Students With Different Moods

The interaction between man and nature causes people to have different preferences for their surrounding environment, and pleasant landscapes can bring both physical and mental benefits to people. Previous studies have demonstrated the relationship between moods and landscape preferences, and this study sought to explore the landscape preferences of college students under different moods. A total of 1,034 students participated in the survey, recovering 1,022 valid questionnaires. The Profile of Mood States (POMS) scale was used to evaluate the mental status of each respondent. The study on landscape characteristics proceeded in two steps (comprising four gradients): landscape naturalness and landscape visual openness. The research results show that under natural landscape conditions, college students in a fatigued state have a greater preference for the second-gradient (higher naturalness) landscape environment; under the conditions of landscape visual openness, college students in an indignant state have a greater preference for the second-gradient (relatively private) landscapes. These findings have significance for exploring the rehabilitation function of landscape architecture and have a guiding role for future landscape design.

Recommendations for supportive care and best supportive care in NCCN clinical practice guidelines for treatment of cancer: Differences between solid tumor and hematologic malignancy guidelines

PURPOSE

It is unclear how NCCN guidelines recommend "supportive care" and "best supportive care" in oncology practice. We examined the usage of "supportive care" and "best supportive care" in NCCN guidelines and compared between solid tumor and hematologic malignancy guidelines.

METHODS

We reviewed all updated NCCN Guidelines for Treatment of Cancer in October 2019. We documented the frequency of occurrence, definition, and timing of introduction of each term. We compared between solid tumor and hematologic malignancy guidelines.

RESULTS

We identified a total of 37 solid tumor and 16 hematologic guidelines. Thirty-seven (70%) guidelines mentioned "supportive care" and 36 (68%) mentioned "best supportive care." Hematologic guidelines were significantly more likely than solid tumor guidelines to use the term "supportive care" (median occurrence 19 vs. 2; P = 0.001) and to describe "supportive care" as management of cancer-related complications (N = 11/15, 73% vs. N = 2/22, 9%; P < 0.001). Domains of specialist palliative care were infrequently mentioned (N = 10/37, 27%). In contrast, solid tumor guidelines were significantly more likely than hematologic guidelines to mention "best supportive care" (median occurrence 6 vs. 0; P = 0.016). This term was rarely defined and mostly used in the advanced disease setting.

CONCLUSION

"Supportive care" and "best supportive care" were frequently used in NCCN guidelines, with significant variations in usage between solid tumor and hematologic oncologists. "Supportive care" was mostly limited to management of cancer-related complications and treatment adverse effects in NCCN guidelines, highlighting the need to go beyond the traditional biomedical model to more a patient-centered care model with greater integration of palliative care.

The Generalization of Conscious Attentional Avoidance in Response to Threat Among Breast Cancer Women With Persistent Distress

Objectives

A sample of women with persistent distress following breast cancer (BC) previously exhibited attentional bias (AB) away from supraliminally presented cancer-or threat-related information, responses consistent with avoidance coping, and showed negative interpretation bias. Here, we attempt to characterize the nature of supraliminal AB and interpretation bias in that sample of women by comparing against healthy controls.

Methods

Extending our previous work, we compared AB patterns for supraliminally presented negatively valenced words and cancer-related information (CRI) assessed by modified dot-probe tasks and negative interpretation bias assessed by an ambiguous cue task between 140 BC women previously identified as featuring low-stable or persistent high anxiety and 150 age-matched non-BC healthy controls having HADS-defined low or high anxiety (HADS-anxiety scores = 8).

Results

Attentional avoidance of non-cancer-related negatively valenced words was seen among the anxious BC group, while heightened attention toward such words was seen in anxious healthy controls, F(3, 282) = 3.97, p = 0.009. However, all anxious women in both BC and healthy groups directed attention away from CRI under supraliminal conditions. Interpretation bias scores were significantly higher in BC women with high anxiety vs. healthy controls with high anxiety, F(3, 282) = 13.26, p < 0.001.

Conclusion

Women with high anxiety generalized conscious attentional avoidance responses to negatively valenced stimuli, indicating a likely hypersensitivity to potential threat in ambiguous cues and exaggerated threat perception. This may cause (or reflect) maladaptive emotional regulation. Attention focus training, reducing threat salience or modifying threat appraisal, may help women alleviate anxiety levels after BC.

A Cross-sectional Study of Attention Bias for Facial Expression Stimulation in Patients with Stroke at the Convalescence Stage

BACKGROUND

Post-stroke depression increases the likelihood of adverse physical symptoms. Attentional bias (AB) for negative stimuli is important in depression onset, maintenance, and remission. Stroke is more likely in older adults, who can have reduced cognitive function. Individuals with mild cognitive impairment (MCI) can have delayed reaction times (RTs). We hypothesized that RT to select neutral facial expression is affected by depressive symptoms and cognitive function in patients with stroke.

METHODS

This study analyzed 61 patients with stroke. Beck Depression Inventory-Second Edition (BDI-II) and Profile of Mood States (short version) scores were determined. Task stimuli comprised eight pairs of facial expressions containing affective (angry) and neutral faces. AB was measured as the RT to select the neutral face in two simultaneously presented images using attention bias modification (ABM) software. Patients were grouped according to depressive symptoms using BDI-II scores. Between-subject factors of depressive symptoms and cognitive function were determined by ANCOVA.

RESULTS

No significant interaction was found between depressive symptoms and cognitive function on RT. There was a main effect of cognitive function, but not depressive symptoms. In patients with hemiparesis and depressive symptoms, RT was significantly shorter in patients without MCI compared with patients with MCI.

CONCLUSIONS

People with stroke and elevated depression symptoms with hemiparesis but without MCI quickly selected neutral facial expressions from neutral and aversive expressions, and thus do not need ABM to escape aversive stimuli. ABM in response to aversive stimuli may be useful in evaluating negative emotions in individuals with post-stroke depression without MCI.

Analgesic effect of gum chewing in patients with burning mouth syndrome

The cause of burning mouth syndrome (BMS) is unknown. Although no effective treatment has been established, BMS patients frequently chew gum to alleviate pain. To identify the cause and new treatments for BMS, this study investigated the psychophysical and pharmacological properties of gum chewing to better understand its pain-relieving effects. In this prospective, blinded study, plasma catecholamine and serotonin levels and Profile of Mood States (POMS) scores were assessed after gum chewing or simulated chewing in 40 women (20 BMS patients and 20 age-matched controls). Visual analogue scale (VAS) scores for pain decreased significantly in BMS patients after gum chewing and simulated chewing. Moreover, resting VAS scores of BMS patients were significantly positively correlated with plasma adrenaline level. Furthermore, gum chewing was significantly correlated with lower plasma adrenaline level, VAS score, and tension-anxiety score. These results suggest that adrenaline is important in the pathogenesis of BMS pain and that the analgesic effect of gum chewing is induced through the potential effects of anxiety reduction, although this effect might not be specific to BMS. In addition, the analgesic effect of gum chewing was not induced solely by chewing motion.

Depression, anxiety and stress among patients with hematological malignancies and the association with quality of life: a cross-sectional study

AIM

To evaluate psychological distress and quality of life of patients with hematological malignancies, as well as to identify the prognostic factors that aggravate their condition.

METHODS

A cross-sectional, descriptive study including 87 patients with Hematological Malignancies was conducted. Data were collected with an anonymous questionnaire consisted by A) a sheet with socio-demographic characteristics, B) the Depression, Stress and Stress Scale (DASS21), and C) World Health Organization Life Quality Scale (WHOQOL - BREF30). The processing and statistical analysis of the empirical material of the research were done using the SPSS (Statistical Package for Social Science) 22.0.

RESULTS

The results showed that the age of the sample averaged 71.22 years (SD = 8.71). Regarding their marital status, single mothers were 9.2%, married 62.1%. With regard to disease-related features, 28.7% of patients had Hodgkin's Lymphoma, 27.6% Chronic Lymphocytic Leukemia, 27.6% MDL and 16.1% of patients had myelodysplastic syndrome Multiple myeloma. In the investigation of the relationship between the Mental health Scale and the Quality of Life, negative correlations of Depression, Stress, Stress and the total DAS Scale with all dimensions of Patient Quality of Life were found.

CONCLUSIONS

Higher levels of psychological distress and poor mental health are associated with a low level of quality of life.