Risk factors for developing depression in women with cervical cancer: a nationwide population-based study in Taiwan

Worse Depression Profiles Are Associated With Higher Symptom Burden and Poorer Quality of Life in Patients With Gynecologic Cancer

BACKGROUND

Depression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy.

OBJECTIVES

Purposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups.

METHODS

Patients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies-Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests.

RESULTS

Three distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a "dose-response effect" (ie, as the depression profile worsened, the severity of these symptoms increased).

CONCLUSIONS

Almost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy.

IMPLICATIONS FOR PRACTICE

Clinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.

Abdominal Parietal Metastasis from Cervical Cancer: A Review of One of the Most Uncommon Sites of Recurrence Including a Report of a New Case

INTRODUCTION

Cervical cancer is the fourth most common cancer in women, the highest mortality being found in low- and middle-income countries. Abdominal parietal metastases in cervical cancer are a very rare entity, with an incidence of 0.1-1.3%, and represent an unfavorable prognostic factor with the survival rate falling to 17%. Here, we present a review of cases of abdominal parietal metastasis in recent decades, including a new case of a 4.5 cm abdominal parietal metastasis at the site of the scar of the former drain tube 28 months after diagnosis of stage IIB cervical cancer (adenosquamous carcinoma), treated by external radiotherapy with concurrent chemotherapy and intracavitary brachytherapy and subsequent surgery (type B radical hysterectomy). The tumor was resected within oncological limits with the histopathological result of adenosquamous carcinoma. The case study highlights the importance of early detection and appropriate treatment of metastases in patients with cervical cancer. The discussion explores the potential pathways for parietal metastasis and the impact of incomplete surgical procedures on the development of metastases. The conclusion emphasizes the poor prognosis associated with this type of metastasis in cervical cancer patients and the potential benefits of surgical resection associated with systemic therapy in improving survival rates.

Frequency and duration of suffering of cervical cancer patients and caregivers: Results from an international Delphi study

This paper describes a Delphi process executed between August and September, 2020, to identify types of physical, psychological, social and spiritual suffering and their severity, prevalence and duration associated with cervical cancer to enable estimation of the global and regional palliative care needs of these cervical cancer patients and their family caregivers. Patients were dichotomized into decedents (those who died of cervical cancer in any given year) and non-decedents (those who had cervical cancer in any given year but did not die in that year). A two-round web-based Delphi study was conducted using a panel of 12 experts with first-hand experience taking care of cervical cancer patients and their family caregivers, two from each World Health Organization (WHO) region. We identified thirteen types of physical suffering, six psychological types, three social types and three spiritual types. Frequencies and durations were given for each of the suffering types for a decedent, a non-decedent and a primary family caregiver. Our findings of the types, severity, frequency and duration of suffering associated with cervical cancer should inform global, regional, national and local health care strategic planning so that the health investments can be better aligned with the needs.

Anxiety and depression risk in Taiwan women with breast cancer and cervical cancer

Background

Studies comparing mental disorder risks between women with breast cancer and cervical cancer are lacking. This study compared risks of developing anxiety and depression between women with breast cancer (BC cohort) and women with cervical cancer (CC cohort) using insurance claims data of Taiwan.

Methods

From the 2000 to 2016 data, we identified a BC cohort and BC controls (N = 96,862) and a CC cohort and CC controls (N = 26,703), matched by propensity scores. Incident mental disorders and the Cox method estimated the related cancer cohort to control cohort hazard ratios (HRs), and 95% confidence intervals (CIs) were estimated by the end of 2016.

Results

Compared to the CC cohort, the BC cohort had slightly higher incident anxiety (15.9 versus 15.5 per 1,000 person-years) and depression (6.92 vs. 6.28 per 1,000 person-years). These mental disorders were higher in respective cancer cohorts than controls. The BC cohort to BC control adjusted HRs of anxiety and depression were 1.29 (95% CI = 1.25-1.33) and 1.78 (95% CI = 1.69-1.87), respectively. The corresponding adjusted HRs for the CC cohort were 1.12 (95% CI = 1.06-1.18) and 1.29 (95% CI = 1.18-1.41). The combined incidence rates of both disorders were 1.4-fold greater in the BC cohort than in BC controls (22.8 vs. 15.8 per 1,000 person-years), and 1.2-fold greater in the CC cohort than in the CC controls (21.7 vs. 18.3 per 1,000 person-years).

Conclusion

Women with breast cancer or cervical cancer are at an elevated likelihood of developing anxiety and depression disorders. These incident disorders are slightly higher in those with breast cancer.

Adjunctive Chinese Herbal Medicine Treatment is Associated With an Improved Survival Rate in Patients With Cervical Cancer in Taiwan: A Matched Cohort Study

Background

Cervical cancer is one of the most common cancers in Taiwan. Some patients take Chinese herbal medicine (CHM). However, very few current studies have ascertained the usage and efficacy of CHM in patients with cervical cancer. The aim of this study was to investigate the benefits of complementary CHM among patients with cervical cancer in Taiwan.

Methods

We included the newly diagnosed cervical cancer patients who were registered in the Taiwanese Registry for Catastrophic Illness Patients Database between 2000 and 2010. The end of follow-up period was December 31, 2011. Patients who were less than 20 years old, had missing information for age, withdrew from the National Health Insurance (NHI) program during the follow-up period, or only received other TCM interventions such as acupuncture or tuina massage were excluded from our study. After performing 1:1 frequency matching by age and index date, we enrolled 7521 patients in both CHM and non-CHM user groups. A Cox regression model was used to compare the hazard ratios (HRs) of the risk of mortality. The Kaplan-Meier curve was used to compare the difference in survival time.

Results

According to the Cox hazard ratio model mutually adjusted for CHM use, age, comorbidity, treatment, and chemotherapeutic agents used, we found that CHM users had a lower hazard ratio of mortality risk (adjusted HR = 0.29, 95%CI = 0.27-0.31). The survival probability was higher for patients in the CHM group. Bai-Hua-She-She-Cao (Herba Oldenlandiae, synonym Herba Hedyotis diffusae) and Jia-Wei-Xiao-Yao-San were the most commonly prescribed single herb and Chinese herbal formula, respectively.

Conclusions

Adjunctive CHM may have positive effects of reducing mortality rate and improving the survival probability for cervical cancer patients. Further evidence-based pharmacological investigations and clinical trials are warranted to confirm the findings in our study.

Reducing Depression, Anxiety, and Fatigue Level in Cervical Cancer through Physical Exercise Intervention

Background: To identify the effect of physical exercise on depression, anxiety, and fatigue in cervical cancer patients. Methods: A quasi-experimental study ith a pretest-posttest with control group design was used. 30 respondents were selected using purposive sampling. The data were gathered by a focus group discussion. The Piper Fatigue Scale (PFS) was used to measure fatigue levels. Hospital Anxiety and Depression Scale (HADS) were used to measure anxiety and depression level. Paired t-test was used for data analysis. Results: There was a significant difference between depression level after physical exercise with t=3.552 (p<0.05). There was a significant difference between anxiety level after physical exercise with t=11.297 (p<0.05). There was a significant difference between fatigue level after physical exercise with t=17.457 (p<0.05). Conclusion: Physical exercise reduces anxiety, depression, and fatigue in patients with cervical cancer that will improve the quality of life of patients.

The prevalence of depressive disorder and its association in Thai cervical cancer patients

PURPOSE

The purpose of this study is to examine the prevalence, associated factors and quality of life associated with depressive disorder in cervical cancer patients.

PATIENTS AND METHODS

This cross-sectional study was carried out in a gynecologic oncology clinic of a university hospital in Northern Thailand from October 2018 to August 2019. Two-hundred cervical cancer patients were screened for depressive disorder using the nine-item Patient Health Questionnaire (PHQ-9), and psychiatrists interviewed eligible patients to confirm diagnoses. We measured the quality of life using questionnaires from the European Organisation for the Research and Treatment of Cancer: Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Cervical Cancer Module 24 (EORTC QLQ-Cx24). Associated factors, including comorbidity, fatigue, and pain, were collected using the Charlson Comorbidity Index (CCI), the eleven-item Chalder Fatigue Scale (CFQ 11), and the visual analog scale (VAS) for pain, respectively.

RESULTS

Twenty-seven (13.5%) cervical cancer patients were diagnosed with depressive disorder by psychiatrists according to the DSM-5. Depressive disorder was related to a worse quality of life in these patients. A binary logistic regression analysis revealed that depressive disorder among these patients was linked with these factors: high fatigue score (aOR: 1.35; CI: 1.18-1.53), high pain score (aOR: 1.25; CI: 1.02-1.54), no perception of social support, (aOR: 3.12; CI: 1.11-8.81), and no previous surgical treatment for cervical cancer (aOR: 2.99; CI: 1.08-8.29).

CONCLUSION

The depressive disorder prevalence was 13.5% in Northern Thai cervical cancer patients. In this demographic, cervical cancer patients-who reported high fatigue or pain scores, did not perceive social support, or had no previous cervical cancer surgery- were more likely to have depressive disorder.

Regulatory effects of comprehensive psychological intervention on adverse emotions and immune status of cervical cancer patients during the perioperative period

OBJECTIVE

To compare and evaluate the regulatory effects of comprehensive psychological intervention on adverse emotions and immune status of cervical cancer patients during the perioperative period.

METHODS

A total of 109 cervical cancer patients admitted to our hospital were selected and divided into the conventional group (n=54) and the comprehensive group (n=55). The conventional group received conventional nursing intervention, while the comprehensive group received comprehensive psychological and conventional nursing intervention. The adverse emotions, social support degrees, level of hope, sleep quality, immune functions and nursing satisfaction were compared between the two groups.

RESULTS

On Day 10 after surgery, the comprehensive group had lower scores of hospital anxiety and depression scale-anxiety (HADS-A), and hospital anxiety and depression scale-depression (HADS-D), higher scores of social support rating scale (SSRS), intimate relationship, positive attitude, and attitude for actions, a higher excellent and good rate of social support degree (92.73% vs 75.93%), a lower Cortisol (Cor) level, and a higher level of interleukin-2 (IL-2) than the conventional group (P < 0.05). On Days 1, 3, 5, 7 and 10 after surgery, the scores of Pittsburgh sleep quality index (PSQI) in the comprehensive group were lower than those in the conventional group (P < 0.05). The overall degree of nursing satisfaction in comprehensive group (94.55%) was higher than that in the conventional group (79.63%) (P < 0.05).

CONCLUSION

Comprehensive psychological intervention can remarkably improve the negative emotions, social support degree, level of hope, sleep quality, immune functions, and satisfaction of cervical cancer patients receiving conventional nursing intervention during the perioperative period.

Benefit-finding experiences of cervical cancer survivors in rural Yunnan province, China: A qualitative study

AIM

To explore and describe cervical cancer patients' benefit-finding experiences in rural China.

DESIGN

The phenomenological approach was used in this qualitative study.

METHODS

In-depth, semi-structured interviews were conducted with 21 patients, from July to August of 2019. The data, which were collected, were analysed using the Colaizzi analysis procedure.

RESULTS

According to the analysis results, the four benefit-finding experience themes of the cervical cancer patients were, respectively, determined to be as follows: Health cognition and behaviour changes; reshaping of personal strength; focussing on relationships with others; and facing life positively.

CONCLUSIONS

The individual's cognition of health and their own strong qualities, and their external social support systems and information obtained and transmitted through interpersonal interactions, can promote the benefit finding. The findings suggest that medical staff should understand the traditional concepts of their patients, use their positive psychological potential, and build targeted nursing measures.

The Adaptability of Cervical Cancer Patients

BACKGROUND: The problems that arise in patients with cervical cancer are not only physical, but also include other aspects such as psychological, social, and spiritual. The ability of cervical cancer patients in dealing with these problems is very diverse and cannot be generalized. AIM: The purpose of this study was to identify the adaptability of cervical cancer sufferers to physical, psychological, social, and spiritual issues. METHODS: A cross-sectional design study was conducted in this study. The number of samples was 96 respondents from a referral hospital in Bandung, West Java. The adaptability instrument was developed by researchers to assess physical, psychological, social, and spiritual adaptability. Statistical data analysis used univariate analysis for adaptive ability variable. RESULTS: All components of adaptability were quite low, including general (14.6%), physical (2.1%), psychological (19.7%), social (27.1%), and spiritual (27.1%). CONCLUSION: Findings regarding factors that could affect the ability of adaptation are highly recommended. This is to determine the right type of intervention in helping adaptability of cervical cancer patients in various aspects so that patients can get the appropriate implementation from health workers.

Association of supportive care needs and quality of patient-centered cancer care with depression in women with breast and cervical cancer in Mexico

OBJECTIVE

To compare the prevalence of depression, supportive care needs (SC-needs), and quality of patient-centered cancer care (PCC-quality) between women with breast cancer and women with cervical cancer and to assess the association of SC-needs and PCC-quality with depression.

METHODS

We conducted a cross-sectional survey in a public oncology hospital in Mexico City with 247 breast cancer and 165 cervical cancer ambulatory patients aged ≥18 years with at least one hospitalization and ≤5 years since diagnosis. Participants completed the short-form Supportive Care Needs Survey, the Patient-Centered Quality of Cancer Care Questionnaire, and the Hospital Anxiety and Depression Scale. We performed multiple logistic regression analyses to evaluate the association between SC-needs, PCC-quality, and probable presence of depression.

RESULTS

Nearly all women reported SC-needs-mainly health system and information needs, followed by physical and psychological needs. PCC-quality was substandard in both groups. PCC-quality was lowest when addressing biopsychosocial needs, followed by information for treatment decision-making needs. Cervical cancer patients had probable depression more often (41.2%) than those with breast cancer (29.5%). Having unmet psychological and care needs was associated with increased odds of probable depression, while high-quality timely care was associated with reduced odds of probable depression.

CONCLUSION

In Mexico, women with cervical and breast cancer face unmet SC-needs, probable depression, and substandard PCC-quality, pointing to priority areas for improvements in cancer care.

Risk of major depressive disorder in Japanese cancer patients: A matched cohort study using employer-based health insurance claims data

Objective

Patients with cancer are at high risk of depression. However, the risk of major depressive disorder (MDD) after cancer diagnosis has not been studied in a population setting in Japan. This cohort study used a Japanese medical claims database to examine time to MDD in cancer patients and the risk of MDD (hazard ratio; HR) compared with matched cancer‐free controls.

Methods

Primary endpoint was time to MDD (starting 6 months before cancer diagnosis) in adult (18–74 years) cancer patients; secondary endpoint was time to MDD (6 months before to 12 months after cancer diagnosis) in a matched cohort of cancer patients and cancer‐free controls. Multivariate analyses were performed to determine HRs for all cancers and for each cancer site.

Results

Of 35 008 cancer patients (mean age, 53.3 years), 2201 (6.3%) were diagnosed with MDD within 66 months. Matched cancer patients (n = 30 372) had an elevated risk of MDD compared with cancer‐free controls (n = 303 720; HR [95% confidence interval] 2.96 [2.77–3.16]). MDD risk was highest in patients with multiple cancers, pancreatic cancer, and brain cancer. Compared with middle‐aged patients, risk was higher in patients <40 years old and lower in patients ≥65 years old; risk tended to be higher in women than in men.

Conclusions

Compared with cancer‐free individuals, Japanese patients with cancer, mostly <65 years old, had an almost threefold higher risk of developing MDD within 12 months of cancer diagnosis. Physicians should watch for MDD in cancer patients and treat when necessary.

The impact of depressive symptoms on health value in patients with gynecologic cancer: A comparison with physical symptoms and performance status

OBJECTIVE

The importance of managing depressive symptoms is frequently underestimated in the clinic. In this study, the effects of depressive symptoms on health utility value (HUV) in gynecologic cancer patients are evaluated. In addition, the effects were compared with those of performance status and physical symptoms.

METHODS

Patient-reported outcome data from 274 gynecologic cancer patients were prospectively collected. HUV was measured using the 3-level version of the EuroQoL 5-dimension descriptive system (EQ-5D-3L) and the EuroQoL visual analog scale (EQ-VAS). The Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depressive symptoms. The impact of depressive symptoms on HUV was analyzed using the generalized linear model.

RESULTS

Moderate-severe depressive symptoms were significantly associated with a decrease in HUV in gynecologic cancer patients (p < 0.0001 for the EQ-5D-3L and EQ-VAS). Severe fatigue and severe pain were also associated with a decrease in HUV (p = 0.018 and p < 0.0001 for the EQ-5D-3L and EQ-VAS; p < 0.0001 for the EQ-5D-3L, respectively), and the effect sizes were comparable to that of moderate-severe depressive symptoms. In addition to the patients with moderate-severe depressive symptoms, the patients with mild depressive symptoms also experienced a significant decrease in HUV (p < 0.0001 for the EQ-5D-3L and EQ-VAS). The effect size for mild depressive symptoms was comparable to those for mild fatigue or mild pain.

CONCLUSIONS

Even mild depressive symptoms may significantly compromise HUV in gynecologic cancer patients, and the effect is comparable to that of performance status or physical symptoms. Gynecologic oncologists should put more effort into properly preventing, detecting, and managing depressive symptoms.