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Faris MM, Dhillon HM, Campbell R, Halkett GKB, Miller A, Chan RJ, Haydon HM, Sansom-Daly UM, Koh ES, Ownsworth T, Nowak AK, Kelly B, Leonard R, Pike KE, Legge DM, Pinkham MB, Agar MR. Unmet needs in people with high-grade glioma: defining criteria for stepped care intervention. JNCI Cancer Spectr 2024; 8:pkae034. [PMID: 38730547 PMCID: PMC11218915 DOI: 10.1093/jncics/pkae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/03/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND We aimed to define levels of unmet supportive care needs in people with primary brain tumor and to reach expert consensus on feasibility of addressing patients' needs in clinical practice. METHODS We conducted secondary analysis of a prospective cohort study of people diagnosed with high-grade glioma (n = 116) who completed the Supportive Care Needs Survey-Short Form during adjuvant chemoradiation therapy. Participants were allocated to 1 of 3 categories: no need ("no need" for help on all items), low need ("low need" for help on at least 1 item, but no "moderate" or "high" need), or moderate/high need (at least 1 "moderate" or "high" need indicated). Clinical capacity to respond to the proportion of patients needing to be prioritized was assessed. RESULTS Overall, 13% (n = 5) were categorized as no need, 23% (n = 27) low need, and 64% (n = 74) moderate/high need. At least 1 moderate/high need was reported in the physical and daily living domain (42%) and the psychological (34%) domain. In recognition of health system capacity, the moderate/high need category was modified to distinguish between moderate need ("moderate" need indicated for at least 1 item but "high" need was not selected for any item) and high need (at least 1 "high" need indicated). Results revealed 24% (n = 28) moderate need and 40% (n = 46) high need. Those categorized as high need indicated needing assistance navigating the health system and information. CONCLUSIONS Using four step allocations resulted in 40% of patients indicating high need. Categories may facilitate appropriate triaging and guide stepped models of healthcare delivery.
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Affiliation(s)
- Mona M Faris
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Centre for Medical Psychology & Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rachel Campbell
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Annie Miller
- Community advisory group, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ursula M Sansom-Daly
- School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales, Kensington, NSW, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Eng-Siew Koh
- South West Sydney Clinical School, UNSW Medicine, University of New South Wales, Liverpool, NSW, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Tamara Ownsworth
- School of Applied Psychology & Menzies Health Institute of Queensland, Brisbane, QLD, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Robyn Leonard
- Brain Cancer Collective, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Kerryn E Pike
- School of Applied Psychology & Menzies Health Institute of Queensland, Brisbane, QLD, Australia
- Griffith Centre for Mental Health, Griffith University, Queensland, Australia
- School of Psychology & Public Health and John Richards Centre for Rural Ageing Research, La Trobe University, Victoria, Australia
| | - Dianne M Legge
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, Heidelberg, VIC, Australia
| | - Mark B Pinkham
- Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) Research Centre, Faculty of Health, University of Technology, Sydney, NSW, Australia
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Knabbe J, Kowalski T, Seliger C. Pharmacological treatment of depression in patients with brain tumors. Int J Cancer 2024. [PMID: 38943227 DOI: 10.1002/ijc.35058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 07/01/2024]
Abstract
Patients with brain tumors suffer from intense psychosocial distress. Although the prevalence of depressive symptoms in patients with brain tumors is high, the pharmacological antidepressant treatment of those patients is not well defined and results from clinical trials are largely missing. In this review, we describe the current standard of evidence and clinical guidelines for the pharmacological treatment of depression in brain tumor patients. We present specific side effects and interactions that should guide treatment decisions. Furthermore, we provide evidence for the diagnosis, screening and risk factors for depression in brain tumor patients and we elaborate on potential antineoplastic effects of antidepressant drugs and ongoing clinical trials. Antidepressant drugs should not be withheld from patients with brain tumors. Future clinical trials should explore the effectiveness and side effects of antidepressants in this specific patient population.
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Affiliation(s)
- Johannes Knabbe
- Department of Psychiatry and Psychotherapy, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Kowalski
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Corinna Seliger
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
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3
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Lion KM, Jamieson A, Billin A, Jones S, Pinkham MB, Ownsworth T. 'It was never about me': A qualitative inquiry into the experiences of psychological support and perceived support needs of family caregivers of people with high-grade glioma. Palliat Med 2024:2692163241261211. [PMID: 38916277 DOI: 10.1177/02692163241261211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Family caregivers of people with high-grade glioma often report high rates of psychological distress, which has been attributed to the unique aspects of the disease and onerous care demands. Clinical practice guidelines advocate for caregiver support from diagnosis through to end-of-life and bereavement. Yet, research has identified that caregivers' support needs are often overlooked. AIM To explore caregivers' experiences of psychological support and perceptions of what constitutes optimal psychological support for caregivers in the context of high-grade glioma. DESIGN Qualitative study involving semi-structured interviews with data analysed using reflexive thematic analysis. SETTING/PARTICIPANTS Eighteen current (n = 11) and bereaved (n = 7) family caregivers (73% female, aged 33-69 years) of adults with high-grade glioma participated. Interviews explored caregivers' perceptions of psychological support. RESULTS Two major themes were generated. The first theme, 'It was never about me', reflected caregivers prioritise for people with high-grade glioma to be well supported despite experiencing their own unmet psychological support needs. The second theme, 'Continuous, coordinated and personalised support', highlighted the importance of timely and tailored interventions addressing caregivers' practical, educational and emotional support needs throughout the illness journey. CONCLUSIONS Caregivers commonly prioritise the support needs of people with high-grade gliomas; yet, have their own distinct needs that vary throughout the illness. Primary care providers have a potential role in facilitating timely access to palliative care, practical support and brain tumour-specific psychological support to meet caregivers' diverse needs across the care continuum in the context of high-grade glioma.
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Affiliation(s)
- Katarzyna M Lion
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Anthony Jamieson
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Abigail Billin
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Stephanie Jones
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Mark B Pinkham
- School of Medicine, University of Queensland, Saint Lucia, QLD, Australia
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
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4
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Ejem D, Stockdill M, Edwards R, Dionne-Odom JN, Taylor R, Baehr W, Nabors LB, Bakitas M, Warren P. “It's Not Just the Seizures”: Brain Tumor Caregivers’ Experiences and Educational Needs in Out-of-Hospital Seizure Management. J Palliat Care 2023:8258597231165898. [PMID: 36972511 DOI: 10.1177/08258597231165898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objective: Family caregivers (FCGs) of persons with primary brain tumors (PBTs) report high levels of distress related to concerns about out-of-hospital seizures. This study aims to explore their experiences and needs with seizure management. Methods: Semi-structured interviews were held with 15 FCGs of persons with PBTs, both those who have and those who have not experienced a seizure, to elicit their concerns about out-of-hospital seizure management and related information needs. A qualitative descriptive study using thematic analysis was conducted based on interview data. Results: Three primary themes were identified relative to FCG experiences and needs related to care of PBTs patients, especially seizure management: (1) FCGs’ experiences with caring for persons with PBTs; (2) FCGs’ educational needs for seizure preparation and resources; and (3) FCGs’ desired type of educational resources and information about seizures. Often FCGs were reported being fearful of seizures and nearly all expressed difficulty knowing when to call emergency services. FCGs equally desired written and online resources, and most preferred graphics or videos detailing seizures. Most FCGs thought that seizure-related training should come after rather than at the time of PBTs diagnosis. FCGs of patients who have not experienced seizures were significantly less prepared to manage seizures than those with a prior seizure. Conclusions: Recognizing and managing out-of-hospital seizures can be a difficult and distressing task for FCGs of patients with PBTs and seizure-related resources are needed. Our results suggest that FCGs of care recipients with PBTs need early supportive interventions to provide self-care strategies and problem-solving skills to manage their roles as caregivers. Interventions should include educational components to assist them in understanding the best mechanisms to maintain a safe environment for their care recipients, and those that deepen knowledge about when to contact EMS.
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Affiliation(s)
- Deborah Ejem
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Macy Stockdill
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca Edwards
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Richard Taylor
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Walter Baehr
- Division of Geriatrics, Gerontology, and Palliative Care, School of Medicine, The University of Alabama, Birmingham, AL, USA
| | - L Burt Nabors
- Department of Neurology, School of Medicine, The University of Alabama, Birmingham, AL, USA
| | - Marie Bakitas
- School of Nursing, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paula Warren
- Department of Neurology, School of Medicine, The University of Alabama, Birmingham, AL, USA
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5
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Figuracion KCF, Halasz LM, Lam NY, Goldberg M, Stuckey J, Failor RA, Knowles LM, Artherholt S, Chou B, Francis CE, Knight K, Kaur M, Sadak T, McGranahan T. Surveillance of long-term complications after treatment of adult brain tumor survivors—review and evidence-based recommendations. Neurooncol Pract 2022; 9:475-486. [DOI: 10.1093/nop/npac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
AbstractAs a result of treatment and diagnosis, adults with primary or metastatic brain tumors experience comorbidities that impacts their health and well-being. The Children’s Oncology Group has guideline recommendations for childhood survivors of brain tumors; however, guidelines for monitoring long-term sequela among adult brain tumor survivors are lacking. The purpose of this review is to present the screening recommendations for the long-term complications after brain tumor treatment from a multidisciplinary panel of healthcare professionals. Chronic complications identified include cognitive dysfunction, vasculopathy, endocrinopathy, ophthalmic, ototoxicity, physical disability, sleep disturbance, mood disorder, unemployment, financial toxicity, and secondary malignancy. We invited specialists across disciplines to perform a literature search and provide expert recommendations for surveillance for long-term complications for adult brain tumor survivors. The Brain Tumor Center Survivorship Committee recommends routine screening using laboratory testing, subjective assessment of symptoms, and objective evaluations to appropriately monitor the complications of brain tumor treatments. Effective monitoring and treatment should involve collaboration with primary care providers and may require referral to other specialties and support services to provide patient-centered care during neuro-oncology survivorship. Further research is necessary to document the incidence and prevalence of medical complications as well as evaluate the efficacy of screening and neuro-oncology survivorship programs.
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Affiliation(s)
- Karl Cristie F Figuracion
- ITHS TL1 Training Program University of Washington School of Nursing , Seattle, Washington 98105 , USA
- Alvord Brain Tumor Center, Department of Radiation Oncology, University of Washington , Seattle, Washington 98105 , USA
| | - Lia M Halasz
- Department of Radiation Oncology, School of Medicine, University of Washington , Seattle, Washington 98105 , USA
| | - Ny-Ying Lam
- Department of Rehabilitation Medicine, School of Medicine, University of Washington , Seattle, Washington 98105 , USA
| | - Myron Goldberg
- Department of Rehabilitation Medicine, School of Medicine, University of Washington , Seattle, Washington 98105 , USA
| | - Joe Stuckey
- Department of Rehabilitation Medicine, School of Medicine, 98105 University of Washington , Seattle, Washington 98105 , USA
| | - Richard A Failor
- Department of Metabolism, Endocrinology and Nutrition, University of Washington , Seattle, Washington, 98105 , USA
| | - Lindsey M Knowles
- Department of Rehabilitation Medicine, University of Washington , Seattle, Washington 98105 , USA
| | - Samantha Artherholt
- Department of Rehabilitation Medicine, University of Washington , Seattle, Washington 98105 , USA
| | - Brian Chou
- Department of Ophthalmology, School of Medicine, University of Washington , Seattle, Washington 98105 , USA
| | - Courtney E Francis
- Department of Ophthalmology, School of Medicine, University of Washington , Seattle, Washington 98105 , USA
| | - Kristin Knight
- Oregon Health and Science University , Portland, Oregon 97239 , USA
| | - Maninder Kaur
- Loma Linda University Health , Loma Linda, California , USA
| | - Tatiana Sadak
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington , Seattle, Washington 98105 , USA
| | - Tresa McGranahan
- Department of Neurology, School of Medicine, University of Washington , Seattle, Washington 98105 , USA
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6
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McMahon DJ, Gleeson JP, O'Reilly S, Bambury RM. Management of newly diagnosed glioblastoma multiforme: current state of the art and emerging therapeutic approaches. Med Oncol 2022; 39:129. [PMID: 35716200 DOI: 10.1007/s12032-022-01708-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/14/2022] [Indexed: 12/21/2022]
Abstract
Glioblastoma multiforme represent > 50% of primary gliomas and have five year survival rates of ~ 5%. Maximal safe surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide remains the standard treatment since published by Stupp et al. (in N Engl J Med 352:987-996, 2005), with additional benefit for patients with MGMT-methylated tumors. We review the current treatment landscape and ongoing efforts to improve these outcomes. An extensive literature search of Pubmed and Google Scholar involving the search terms "glioblastoma," "glioblastoma multiforme," or "GBM" for papers published to July 2021 was conducted and papers evaluated for relevance. As well as current data that informs clinical practice, we review ongoing clinical research in both newly diagnosed and recurrent settings that provides hope for a breakthrough. The Stupp protocol remains standard of care in 2021. Addition of tumor treating fields improved mOS modestly, with benefit seen in MGMT-methylated and unmethylated cohorts and also improved time to cognitive decline but has not been widely adopted. The addition of lomustine to temozolomide, in MGMT-methylated patients, also showed a mOS benefit but further investigation is required. Other promising therapeutic strategies including anti-angiogenic therapy, targeted therapy, and immunotherapy have yet to show a survival advantage. Improvements in the multidisciplinary management, surgical techniques and equipment, early palliative care, carrier support, and psychological support may be responsible for improving survival over time. Despite promising preclinical rationale, immunotherapy and targeted therapy are struggling to impact survival. A number of ongoing clinical trials provide hope for a breakthrough.
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Affiliation(s)
- D J McMahon
- Cork University Hospital, Cork, Ireland, UK.
| | | | - S O'Reilly
- Cork University Hospital, Cork, Ireland, UK
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7
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Heinsch M, Cootes H, Wells H, Tickner C, Wilson J, Sultani G, Kay-Lambkin F. Supporting friends and family of adults with a primary brain tumour: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:869-887. [PMID: 34633723 DOI: 10.1111/hsc.13586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
Expanding on the limited work in supportive care for friends and family caregivers of adults with a primary brain tumour, this review sought to examine all available evidence since 2010 on the efficacy and feasibility of supportive interventions for this population including non-controlled studies. A systematic review of the literature was conducted on the feasibility and effectiveness/efficacy of supportive interventions for brain cancer caregivers in line with PRISMA guidelines. 13 studies met the eligibility criteria and were identified for inclusion. Most interventions employed tailored psychoeducation, and expert involvement via psychotherapy or care coordination. Only two interventions demonstrated clinically significant improvements. Findings indicate that dyadic yoga programs, and programs that enhance caregiver mastery to manage patient behavioural problems, may lead to improvements in some clinical outcomes. Results highlight the diverse nature of supportive interventions and indicate that support for primary brain tumour caregivers is currently suboptimal. Our findings illustrate an overall low certainty of evidence, with a need for more adequately powered randomised controlled trials. As the complexities of brain cancer care-giving are an obstacle to standardised interventions, this review underscores the need for future trials to incorporate complimentary qualitative research methodologies.
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Affiliation(s)
- Milena Heinsch
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Hannah Cootes
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Hannah Wells
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Campbell Tickner
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jessica Wilson
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Grace Sultani
- Social Work, School of Humanities and Social Science, University of Newcastle, Callaghan, NSW, Australia
| | - Frances Kay-Lambkin
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
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8
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Tamara O, Katarzyna L, Ursula M SD, Kerryn P, Eng-Siew K, Georgia Kb H, Mark B P, Raymond J C, Haryana D. Scoping the psychological support practices of Australian health professionals working with people with primary brain tumor and their families Short heading: psychological support for brain tumor. Psychooncology 2022; 31:1313-1321. [PMID: 35332965 PMCID: PMC9543201 DOI: 10.1002/pon.5929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/12/2022]
Abstract
Objectives This study aimed to scope the psychological support practices of Australian health professionals providing supportive care to adults with primary brain tumor. Method Health professionals from multidisciplinary organizations and cancer support services completed an online survey focused on psychological support for people with brain tumor (PwBT) and family members, and perceived barriers or gaps in support provision. Results 107 professionals, mainly from psychology (45%), nursing (20%), and social work (10%) backgrounds, completed the survey. Scope of practice differed according to discipline, with psychologists and nurses most likely to screen for psychological distress (71%–76%), and psychologists more typically providing at least one psychological support session (78%). Psychologists were more likely to screen for cognitive impairment (31%), whereas nurses and social workers more commonly provided family‐based support (62%–73%). Psychological support was more frequently provided in the long‐term management phase (78%) than early post‐diagnosis/treatment (45%). System‐level barriers to accessing psychological support were most frequently identified, which included limited resources and funding, insufficient staff time, lengthy waitlists and costs, poor service coordination, and lack of staff with brain tumor‐specific training. Conclusions The provision of psychological support for PwBT varies according to discipline, setting and management phase. Further research on different models of psychosocial care is needed to inform strategies to address organizational and policy factors impacting professionals' scope of practice.
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Affiliation(s)
- Ownsworth Tamara
- School of Applied Psychology & The Hopkins Centre, Menzies Health Institute QueenslandGriffith University, Queensland, Australia
| | - Lion Katarzyna
- School of Applied Psychology & The Hopkins Centre, Menzies Health Institute QueenslandGriffith University, Queensland, Australia
| | - Sansom-Daly Ursula M
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Pike Kerryn
- School of Psychology & Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Victoria, Australia
| | - Koh Eng-Siew
- South Western Sydney Clinical School, University of New South Wales, Faculty of Medicine, NSW.,Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Halkett Georgia Kb
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, WA
| | - Pinkham Mark B
- School of Medicine, University of Queensland, QLD.,Department of Radiation Oncology, Princess Alexandra Hospital, QLD
| | - Chan Raymond J
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA
| | - Dhillon Haryana
- School of Psychology, Psycho-Oncology Cooperative Research Group, Faculty of Science, University of Sydney, NSW.,School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making, Faculty of Science, University of Sydney, NSW
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9
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Psychooncological distress in low-grade glioma patients-a monocentric study. Acta Neurochir (Wien) 2022; 164:713-722. [PMID: 34159449 PMCID: PMC8913453 DOI: 10.1007/s00701-021-04863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/22/2021] [Indexed: 12/05/2022]
Abstract
Background Patients diagnosed with low-grade glioma (LGG) must live with constant knowledge of an upcoming malignant tumor transformation which may lead to increased anxiety and reduced quality of life. Here, we (1) analyzed the prevalence and risk factors for distress in LGG patients using (2) different screening tools to subsequently (3) evaluate their need for psychological support. Method Patients with LGG-suspicious findings in MRI studies as well as patients with histopathological confirmed LGG were screened using three established self-assessment instruments (Hospital Anxiety and Depression Scale, Distress Thermometer, EORTC-QLQ-C30-BN20). Screening results were correlated with sociodemographic factors. Results One hundred forty-nine patients (74 men and 75 women) were prospectively included. Patients were further divided into different subgroups regarding the time of screening and diagnosis. An increased level of distress was observed in 20.8% (mean score 1.21, 95% CI 1.15–1.28) of all patients screened by HADS. Significant associated factors were pre-existing psychiatric disorders (p = 0.003) and psychotropic medication (p = 0.029). HRQoL (p = 0.022) and global health item (p = 0.015), as well as future uncertainty (p = 0.047), assessed by the EORTC-QLQ-C30-BN20 were significantly higher in those patients without histopathological diagnosis. Increased distress was significantly correlated with results in chosen sub-items of the HRQoL questionnaire (p < 0.001). Conclusions Our results demonstrate the need for frequent distress screening. If specific tools are not available, HRQoL questionnaires can also be used. Patients with pre-existing psychological stress should be offered additional psychooncological support, irrespectively of the time of screening or tumor diagnosis. Clinical trial registration number: 4087
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10
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Correlation between preoperative psychological personality traits of glioma patients and psychological distress in their primary caregivers. Clin Neurol Neurosurg 2022; 214:107144. [DOI: 10.1016/j.clineuro.2022.107144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 11/18/2022]
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11
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Menke C, Lohmann S, Baehr A, Grauer O, Holling M, Brokinkel B, Schwake M, Stummer W, Schipmann S. Classical and disease-specific quality indicators in glioma surgery—Development of a quality checklist to improve treatment quality in glioma patients. Neurooncol Pract 2021; 9:59-67. [DOI: 10.1093/nop/npab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
There is a pressing demand for more accurate, disease-specific quality measures in the field of neurosurgery. Aiming at most adequately measuring and reflecting the quality of glioma therapy, we developed a novel quality indicator bundle in form of a checklist for all patients that are treated operatively for glioma.
Methods
On the basis of possible glioma-specific quality indicators retrieved from the literature and quality guidelines, a multidisciplinary team developed a checklist containing 13 patient-need-specific outcome measures. Subsequently, the checklist was prospectively applied to a total of 78 patients compared with a control group consisting of 322 patients. A score was generated based on the maximum of quality measures achieved.
Results
Significant improvements in quality after prospectively introducing the checklist were achieved for supplemental physical and occupational therapy during inpatient stay (89.4% vs 100%, P = .002), consultation of a social worker during inpatient stay (64% vs 92.3%, P < .001), psycho-oncological screening (14.3% vs 70.5%, P < .001), psycho-oncological consultation (31.1% vs 82.1%, P < .001), and consultation of the palliative care team (20% vs 40%, P = .031). Overall, after introduction of the checklist one-third (n = 23) of patients reached best-practice measures in all categories, and over half of the patients (n = 44) achieved above 90% with respect to the outcome measures.
Conclusions
Aiming at ensuring comprehensive, consistent, and timely care of glioma patients, the implementation of the checklist for routine use in glioma surgery represents an efficient, easily reproducible, and powerful tool for significant improvements.
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Affiliation(s)
- Christiane Menke
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Sebastian Lohmann
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Andrea Baehr
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Oliver Grauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, Haukeland University Hospital Bergen, Bergen, Norway
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12
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Fear, worry and sadness: an exploratory study of psychological wellbeing in men caring for their partner with ovarian cancer. Support Care Cancer 2021; 30:825-833. [PMID: 34389907 DOI: 10.1007/s00520-021-06488-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Ovarian cancer is the leading cause of death from female cancers in Australia with the majority of women presenting with advanced disease. The burden of caregiving is largely borne by male carers; however, little research has examined the challenges male ovarian cancer caregivers (MOCC) experience. This study aimed to explore the psychosocial wellbeing and cancer-related challenges experienced by MOCC. METHODS A cross-sectional small-scale exploratory online survey study recruited 36 MOCC. The study questionnaire was comprised of the Generalised Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire Depression Module (PHQ-9), Functional Assessment of Cancer Therapy Scale (FACT-G) Family Member, Fear of Cancer Recurrence Scale, Insomnia Severity Index (ISI), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACTIT-F) and Cancer-Related Challenges Scale (CRCS). RESULTS The most common challenges ever experienced were worry about the future (91%), fear of metastasis (90%) and feeling worried or uncertain (88%). The most common current challenges were fear of cancer recurrence (75%), fear of metastasis (68%) and changes in sexual relationships (64%). Depression and anxiety were significantly correlated with all psychosocial variables highlighting the relationships between elements of wellbeing for MOCC. Clinical levels of fear of cancer recurrence were reported by 89% of MOCC. CONCLUSIONS The challenges faced by MOCC are psychosocial in nature. There is a high correlation between anxiety and depression, and this coupled with the fear of disease recurrence indicates a greater need for screening of these issues, appropriate referral and development of support resources for this high-risk group of cancer carers.
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13
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Mayer S, Fuchs S, Fink M, Schäffeler N, Zipfel S, Geiser F, Reichmann H, Falkenburger B, Skardelly M, Teufel M. Hope and Distress Are Not Associated With the Brain Tumor Stage. Front Psychol 2021; 12:642345. [PMID: 34122231 PMCID: PMC8192812 DOI: 10.3389/fpsyg.2021.642345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Hopelessness and depression are strongly associated with suicidality. Given that physical and psychological outcomes can be altered with hope, hope is a therapeutic goal of increasing importance in the treatment of brain tumor patients. Moreover, it is not yet understood which factors affect the perception of hope in brain tumor patients. In addition, it remains uncertain whether lower-grade brain tumor patients suffer less from psycho-oncological distress than higher-grade brain tumor patients. Methods Neuro-oncological patients were examined perioperatively with the Distress Thermometer (DT) and the Herth Hope Index (HHI). In addition, psychological comorbidities (anxiety GAD-2, depression PHQ-2) and an assessment of general psycho-oncological distress were recorded. Results Sixty-six brain tumor patients were included (median age 53 years, 35% higher-grade brain tumors, i.e., WHO grade III/IV). No differences between higher- and lower-grade brain tumor patients were observed for general psycho-oncological distress and hope. However, higher-grade brain tumor patients showed a significantly higher level of depression (p ≤ 0.001) and more negative expectations regarding therapeutic success (H = 4.873, p ≤ 0.050). The extent of depression correlated negatively with hope. Conclusion Unexpectedly, higher-grade brain tumor patients remained as hopeful as lower-grade brain tumor patients despite the devastating diagnosis, higher levels of depression, and a worse expectation of therapeutic success. Conversely, lower-grade brain tumor patients experience as much psycho-oncological distress as patients with a higher-grade brain tumor, underpinning the imperative need for comprehensive psycho-oncological screening. For all brain tumor patients, considering hope is important to avoid suicides resulting from hopelessness and depression.
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Affiliation(s)
- Simone Mayer
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stefanie Fuchs
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Madeleine Fink
- Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital Essen, Essen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Björn Falkenburger
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Marco Skardelly
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany.,Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany.,Department of Neurosurgery, District Hospital Reutlingen, Reutlingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital Essen, Essen, Germany.,Section of Psycho-Oncology, West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
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14
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O'Keeffe D, Bambury RM, O'Reilly S. High grade glioma and caregiver burden. J Neurooncol 2021; 153:181. [PMID: 33856616 DOI: 10.1007/s11060-021-03754-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- David O'Keeffe
- School of Medicine, University College Cork, Cork, Ireland
| | - Richard M Bambury
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland.
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15
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Development of screening questions for doctor-patient consultation assessing the quality of life and psychosocial burden of glioma patients: an explorative study. Qual Life Res 2021; 30:1513-1522. [PMID: 33517524 PMCID: PMC8068662 DOI: 10.1007/s11136-021-02756-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE Psychosocial screening for glioma patients is challenging because many patients suffer from neurocognitive deficits, which may impair assessment. This study's aim was to exploratively develop three screening questions for unmet needs to prospectively be applicable in patient-doctor consultation. METHODS Patient interviews, a survey for health-care professionals and a weighted scoring procedure were developed for this study. Six main areas were defined according to main areas of validated questionnaires (psyche, cognition, body, role functioning, social support, unmet needs). Patients and health-care professionals rated the importance of these areas and corresponding items, patients additionally stated whether the issues addressed affected them. RESULTS A total of 50 patients were included, and 36 health-care professionals participated in the online survey. The three areas (psyche, body and cognition) considered to be most relevant by both, health-care professionals and patients, generated three screening questions. If the patient was affected by the issue addressed with a screening question, a subordinate question from that area that our patient sample considered most important could additionally be asked. The elaborated screening questions are the following: (1) main area psyche: "Has your mood worsened?", (2) main area body: "Do physical changes put a strain on you?", and (3) main area cognition: "Has your memory capacity worsened?" CONCLUSION These questions represent a basis for further research regarding their application in neuro-oncological clinical routine.
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16
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Dinapoli L, Chiesa S, Dinapoli N, Gatta R, Beghella Bartoli F, Bracci S, Mazzarella C, Sanfilippo MZ, Sabatino G, Gaudino S, Della Pepa GM, Frascino V, Valentini V, Balducci M. Personalised support of brain tumour patients during radiotherapy based on psychological profile and quality of life. Support Care Cancer 2021; 29:4555-4563. [PMID: 33479794 DOI: 10.1007/s00520-021-06000-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 01/12/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Psychological distress in primary malignant brain tumour (PMBT) patients is associated with poorer outcomes. Radiotherapy (RT) often induces side effects that significantly influence patients' quality of life (QoL), with potential impact on survival. We evaluated distress, anxiety, depression, and QoL over time to identify patients with difficulties in these areas who required more intense psychological support. METHODS Psychological questionnaires-Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy (FACT-G and FACT-Br)-were completed at the beginning (T0), in the middle (T1), directly after RT (T2), and 3 months after RT (T3). We personalised the psychological support provided for each patient with a minimum of three sessions ('typical' schedule) and a maximum of eight sessions ('intensive' schedule), depending on the patients' psychological profiles, clinical evaluations, and requests. Patients' survival was evaluated in the glioblastoma multiforme (GBM) patients, with an explorative intent. RESULTS Fifty-nine consecutive PMBT patients receiving post-operative RT were included. For patients who were reported as 'not distressed' at T0, no statistically significant changes were noted. In contrast, patients who were 'distressed' at T0 showed statistically significant improvements in DT, HADS, FACT-G, and FACT-Br scores over time. 'Not distressed' patients required less psychological sessions over the study duration than 'distressed' patients. Interestingly, 'not distressed' GBM patients survived longer than 'distressed' GBM patients. CONCLUSIONS Increased psychological support improved distress, mood, and QoL for patients identified as 'distressed', whereas psychological well-being was maintained with typical psychological support in patients who were identified as being 'not distressed'. These results encourage a standardisation of psychological support for all RT patients.
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Affiliation(s)
- Loredana Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Unità Operativa Semplice di Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Nicola Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Roberto Gatta
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Serena Bracci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Ciro Mazzarella
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | - Giovanni Sabatino
- Dipartimento di Neurochirurgia, Ospedale Mater Olbia, Olbia, Italy.,Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Gaudino
- UOC di Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Maria Della Pepa
- UOC di Neurochirurgia, Dipartimento Scienze dell'invecchiamento, Neurologiche, Ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Frascino
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Balducci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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17
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Chen C, Wang H, Zhang L, Wang K, Jiang L, Li S, Xiang W, Song L, Hu S, Yang C, Zhou J. Clinical study of preoperative psychological distress and its related factors in the primary caregivers of patients with glioma. Clin Neurol Neurosurg 2020; 200:106364. [PMID: 33348302 DOI: 10.1016/j.clineuro.2020.106364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/18/2020] [Accepted: 11/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the preoperative psychological distress in the primary caregivers of glioma patients and its influencing factors and to determine the relationship between preoperative psychological states of glioma patients and their caregivers. METHODS Using a mixed methods design, the caregivers of patients with malignant glioma were interviewed and completed questionnaires about anxiety/depression and family function during preoperative period. RESULTS Caregivers of glioma patients had different types of psychological distress before surgery. A total of 46 caregivers (36.5 %) had preoperative psychological depression or anxiety symptom; 30 caregivers (23.8 %) had depression symptoms, 39 caregivers (31.0 %) had anxiety symptoms, and 23 (18.3 %) had both preoperative anxiety and depression symptoms. Female gender was an influential factor for both preoperative depression and anxiety symptoms in caregivers, surgical information was a risk factor for caregivers' preoperative depression symptoms and residence was a risk factor for caregivers' preoperative anxiety symptoms. The preoperative psychological states of patients was positively correlated with the preoperative anxiety and depression symptoms of caregivers. CONCLUSION The rural female caregivers are more likely to experience psychological distress before surgery, and the preoperative psychological states of patients was positively correlated with the psychological distress in caregivers.
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Affiliation(s)
- Chaoyi Chen
- School of Nursing, Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Department of Anorectal, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Chunhui Road 16#, Lu Zhou, 646000, China.
| | - Haorun Wang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Neurosurgery Clinical Medical Research Center of Sichuan Province, Taiping Street 25#, Lu Zhou, 646000, China
| | - Liying Zhang
- School of Nursing, Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China
| | - Ke Wang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Neurosurgery Clinical Medical Research Center of Sichuan Province, Taiping Street 25#, Lu Zhou, 646000, China
| | - Lin Jiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Neurosurgery Clinical Medical Research Center of Sichuan Province, Taiping Street 25#, Lu Zhou, 646000, China
| | - Shenjie Li
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Neurosurgery Clinical Medical Research Center of Sichuan Province, Taiping Street 25#, Lu Zhou, 646000, China
| | - Wei Xiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Neurosurgery Clinical Medical Research Center of Sichuan Province, Taiping Street 25#, Lu Zhou, 646000, China
| | - Li Song
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Neurosurgery Clinical Medical Research Center of Sichuan Province, Taiping Street 25#, Lu Zhou, 646000, China
| | - Shasha Hu
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China
| | - Changmei Yang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Neurosurgery Clinical Medical Research Center of Sichuan Province, Taiping Street 25#, Lu Zhou, 646000, China.
| | - Jie Zhou
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Lu Zhou, 646000, China; Neurosurgery Clinical Medical Research Center of Sichuan Province, Taiping Street 25#, Lu Zhou, 646000, China.
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18
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Goebel S, Knuth C, Damm M, Linden D, Coburger J, Ringel F, Tabatabai G, Mehdorn M, Renovanz M. Towards the targeted assessment of relevant problems: Optimization of the distress Thermometer for adult neuro-oncological patients. Psychooncology 2020; 29:2057-2066. [PMID: 33002245 DOI: 10.1002/pon.5564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Generic psychosocial screening tools may not reflect the unique symptom profile of brain tumour patients (BTPs). The aim was to adapt the problem list of the distress thermometer (DT) for BTPs. METHODS First, items of low relevance for BTPs were identified on basis of retrospective analyses. Second, relevant yet missing problems were identified via an extensive literature search, qualitative interviews with BTPs and experts, as well as an online expert survey. The resulting raw version of the adapted problem list in BTPs was subsequently pretested. RESULTS In the first part, data of n = 657 BTPs were analysed. Twelve items (20%) were excluded in this step as they proved to be less relevant for BTPs (i.e., items were endorsed by less than 10% and without significant correlations to patients' DT score). In the second part, qualitative interviews and the online survey with 102 professionals led to the addition of 21 new and the modification and condensation of 17 relevant problems specific for BTPs. This adapted list was than successfully pretested in n = 19 patients, leading to the 'distress thermometer brain tumour problem list' (DT-BT), consisting of 42 relevant problems. CONCLUSION The adapted problem list for the DT particularly reflects the neurological and psychosocial burden of an intracranial tumour and allows for the targeted assessment of the specific burdens and needs of BTPs. Our revised version of the DTs problem list (DT-BT) should in the next step be widely validated in multinational samples.
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Affiliation(s)
- Simone Goebel
- Department of Psychology, University Kiel, Kiel, Germany
| | - Carina Knuth
- Department of Psychology, University Kiel, Kiel, Germany
| | - Matthias Damm
- Department of Neurology & Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Daniel Linden
- Department of Neurology & Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Jan Coburger
- Department of Neurosurgery, University Medical Center, Ulm, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center, Mainz, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Mirjam Renovanz
- Department of Neurology & Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, University Hospital Tuebingen, Tuebingen, Germany.,Department of Neurosurgery, University Medical Center, Tuebingen, Germany
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19
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Ownsworth T, Cubis L, Prasad T, Foote M, Kendall M, Oram J, Chambers S, Pinkham MB. Feasibility and acceptability of a telehealth platform for delivering the Making Sense of Brain Tumour programme: A mixed-methods pilot study. Neuropsychol Rehabil 2020; 32:378-406. [PMID: 33000690 DOI: 10.1080/09602011.2020.1826331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ABSTRACTGlioma is a common type of brain tumour that is associated with neurocognitive and psychosocial impairments. This study primarily aimed to investigate the feasibility and acceptability of a videoconferencing format of the Making Sense of Brain Tumour (Tele-MAST) programme. Recruited from a multidisciplinary brain tumour clinic, participants were randomly allocated to the 10-session Tele-MAST programme or standard care, with the latter group offered Tele-MAST after re-assessment. Semi-structured interviews explored participants' experiences of receiving psychological support via the videoconferencing platform. Measures of mental health and quality of life were administered at pre-intervention and post-intervention assessments. Of the 35 patients deemed eligible for the study, 14 (40% accrual) with high grade (71%) or low grade (29%) glioma participated. They were randomized to the Tele-MAST condition (n = 8) or standard care/waitlist (n = 6). Ten individuals commenced the Tele-MAST programme, of whom eight completed ≥8 sessions. The major themes that depicted their experience of the Tele-MAST programme were ease of access and benefits of remote delivery, tailored support and immediacy, and sense of connection versus disconnection. Most participants (63%) demonstrated clinically reliable improvement at post-intervention. These preliminary findings support the feasibility and acceptability of remote delivery of psychological support and highlight the need for a larger-scale evaluation of the Tele-MAST programme.
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Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Lee Cubis
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Tali Prasad
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Matthew Foote
- School of Medicine, University of Queensland, Brisbane, Australia.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Melissa Kendall
- Acquired Brain Injury Outreach Service, The Hopkins Centre, Princess Alexandra Hospital, Brisbane, Australia.,Psychology Department, Metro South Health, Princess Alexandra Hospital, Brisbane, Australia
| | - Joanne Oram
- Psychology Department, Metro South Health, Princess Alexandra Hospital, Brisbane, Australia
| | - Suzanne Chambers
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Mark B Pinkham
- School of Medicine, University of Queensland, Brisbane, Australia.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
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20
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Reinert C, Gerken M, Rathberger K, Krueger K, Klinkhammer-Schalke M, Lindberg-Scharf P, Koelbl O, Proescholdt MA, Riemenschneider MJ, Pukrop T, Bumes E, Hutterer M, Hau P. Single-institution cross-sectional study to evaluate need for information and need for referral to psychooncology care in association with depression in brain tumor patients and their family caregivers. BMC Psychol 2020; 8:96. [PMID: 32912313 PMCID: PMC7488319 DOI: 10.1186/s40359-020-00460-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/06/2020] [Indexed: 01/30/2023] Open
Abstract
Background The prognosis of patients with brain tumors is widely varying. Psychooncologic need and depression are high among these patients and their family caregivers. However, the need for counselling and need for referral to psychooncology care is often underestimated. Methods We performed a single-institution cross-sectional study to evaluate psychooncologic need, depression and information need in both patients and their family caregivers. The Hornheider Screening Instrument (HSI) and the Patient Health Questionnaire (PHQ-9) were used to evaluate psychooncologic need and depression, and a study-specific questionnaire was developed to evaluate information need. Multivariable analyses were performed to detect correlations. Results A total of 444 patients and their family caregivers were approached to participate, with a survey completion rate of 35.4%. More than half of the patients and family caregivers were in need for referral to psychooncology care and 31.9% of patients suffered from clinically relevant depression. In multivariable analysis, psychooncologic need were positively associated with mild (odds ratio, OR, 7.077; 95% confidence interval, CI, 2.263–22.137; p = 0.001) or moderate to severe (OR 149.27, 95% CI 26.690–737.20; p < 0.001) depression. Patient information need was associated with depression (OR 3.007, 95% CI 1.175–7.695; p = 0.022). Conclusions Unmet counselling need in brain tumor patients and their family caregivers associate to high psychooncologic need and depression. Adequate information may decrease the need for referral to psychooncology care and treatment of depression in these patients. Future studies should further explore these relations to promote development of supportive structures.
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Affiliation(s)
- Christiane Reinert
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Michael Gerken
- Tumor Center - Institute for Quality Assurance and Health Services Research, University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Katharina Rathberger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Katharina Krueger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center - Institute for Quality Assurance and Health Services Research, University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Patricia Lindberg-Scharf
- Tumor Center - Institute for Quality Assurance and Health Services Research, University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiotherapy and Radiation Oncology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Martin A Proescholdt
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus J Riemenschneider
- Department of Neuropathology, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Markus Hutterer
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany.,Department of Neurology 1, NeuroMed Campus, Kepler University Hospital Linz, Wagner-Jauregg-Weg 15, A-4020, Linz, Austria
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany.
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21
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Feasibility, Safety and Effects of a One-Week, Ski-Based Exercise Intervention in Brain Tumor Patients and Their Relatives: A Pilot Study. J Clin Med 2020; 9:jcm9041006. [PMID: 32252441 PMCID: PMC7231125 DOI: 10.3390/jcm9041006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
A brain tumor diagnosis poses a significant psychological burden and it severely impacts quality of life (QOL), both in patients and relatives. However, comprehensive strategies addressing QOL in this setting remain rare. Here, we aim to share our findings of a one-week ski exercise intervention, with emphasis on feasibility, safety, QOL, and physical exercise. The intervention consisted of week-long daily ski sessions with professional ski guides as well as dedicated physicians present. The participants were handed questionnaires, including distress and QOL items before, during, and after the intervention. Using fitness watches, exercise intensity was also tracked at these timepoints. During the intervention, patients were checked for adverse events daily. Fifteen participants, nine patients after multidisciplinary treatment, and six relatives were included in the study. Additionally, 13 children participated in the exercise, but not in the study. All of the participants completed the entire program. No severe adverse events were documented during daily checks. There was a strong increase in quantified activity and QOL with a corresponding decrease in distress during the intervention, and, partly, afterwards. This prospective brain tumor rehabilitation study demonstrates the feasibility and safety of challenging ski exercise in brain tumor patients. The findings also underline the exercise-mediated QOL benefits, emphasizing the need for more comprehensive brain tumor rehabilitation programs.
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22
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Xia L. The Effects of Continuous Care Model of Information-Based Hospital-Family Integration on Colostomy Patients: a Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:301-311. [PMID: 30685831 DOI: 10.1007/s13187-018-1465-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this research was to examine the effects of continuous care model of information-based hospital-family integration on colostomy patients. Miles' operation is a major operative method for treating low rectal cancer, and this operation results in a permanent colostomy. It is difficult for patients to adapt to their colostomy. Previous studies have applied generally conventional nursing models to colostomy patients. This was a single-blind randomized controlled trial study. The sample of 155 patients who met the inclusion criteria was randomly assigned to either the experimental (n = 81) or control group (n = 74). The control group was provided with a routine standard of care. The experimental group was provided with an experimental treatment that consisted of an information-based (WeChat, blog, QQ, telephone, etc.) hospital-family integration continuous care model. Study variables were collected and instruments were selected as follows: basic information, State-Trait Anxiety Inventory (STAI), a self-efficacy scale, a colostomy complication assessment table, a quality of life scale, and a table of the degree of satisfaction. No statistically significant differences were found in demographic information between the experimental and control groups. In comparison with the control group, subjects in the experimental group had less anxiety and could better cope with anxiety, had a better self-efficacy and quality of life scores, and had fewer complications. The patients in the experimental group were shown to be more satisfied with the care model. In addition, the most useful and popular service is the online social tools WeChat and QQ, because they can communicate with video, and they are more real-time, efficient, and cheap. The continuous care model of information-based hospital-family integration significantly strengthened patients' self-efficacy and confidence, which decreased colostomy complications, ultimately improving the quality of life.
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Affiliation(s)
- Limin Xia
- Colorectal and Anal Surgery, The First Affiliated Hospital of Wenzhou Medical University, New Hospital Area, Nanbaixiang Street, Ouhai District, Wenzhou, 325000, Zhejiang, China.
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23
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Rosenlund L, Degsell E, Jakola AS. Moving from clinician-defined to patient-reported outcome measures for survivors of high-grade glioma. Patient Relat Outcome Meas 2019; 10:267-276. [PMID: 31692481 PMCID: PMC6711557 DOI: 10.2147/prom.s179313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Persons with high-grade glioma face both neurological and cancer-related symptoms from the tumor itself and its treatment affecting their daily lives. Survival alone is not an adequate outcome, the quality of the survivorship experience needs to be regarded with equal importance. Patient-reported outcome (PRO) measures can be used to evaluate treatment effects and symptom management interventions. PURPOSE The aim of this review was to identify the use, challenges, and potential of PRO measures in survivors of high-grade glioma. METHODS A narrative expert opinion review was performed on the subject. In addition to our own experiences we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and PsycINFO for brain tumor-specific PRO measures used in the population of adult patients with high-grade glioma, both original articles and reviews were included. RESULTS There are several PRO measures that have been validated for patients with primary brain tumors including high-grade glioma. PRO measures are used both in clinical trials to evaluate the effect of treatment on health-related quality of life, and in daily clinical practice for holistic needs assessment and symptom management. Common PRO measures used for patients with high-grade glioma are European Organization for Research and Treatment of Cancer general instrument for patients with cancer together with brain tumor module, Functional Assessment of Cancer Therapy-Brain, and MD Anderson Symptom Inventory for Brain Tumor. Neurologic and cognitive disorders often occur in patients with high-grade glioma, which affects patients' ability to self-report over time, making it more challenging in this population. PRO as a primary outcome seems underutilized. CONCLUSION For clinical research, PRO measures need to be used together with other clinical outcome measures rather than replacing traditional outcome measures. Moving to more use of PRO measures in survivorship care has potential to improve patient-caregiver-healthcare team communication, symptom management, and quality of care. Implementing PROs in survivorship care should also involve caregivers and a response based on the results.
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Affiliation(s)
- Lena Rosenlund
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Eskil Degsell
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Malignant Brain Tumor Pathway, Quality and Patient Safety Department, Karolinska University Hospital, Stockholm, Sweden
- The Swedish Brain Tumor Association, Stockholm, Sweden
| | - Asgeir Store Jakola
- Department of Clinical Neurosciences, Institute of Physiology and Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
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24
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Patil VM, Malhotra M, Tonse R, Deodhar J, Chandrasekharan A, Pande N, Bhattacharjee A, Jalali R. A cross-sectional audit of distress in patients undergoing adjuvant therapy or follow-up in central nervous system malignancies. Neurooncol Pract 2019; 6:305-310. [PMID: 31386081 DOI: 10.1093/nop/npy046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Unaddressed high distress leads to noncompliance with treatment, negatively affects quality of life, and may also have a negative impact on the prognosis of cancer patients. Patients with brain tumors have higher levels of distress than the general population and hence we hypothesize that even routine visits during adjuvant treatment or follow-up are likely to be stressful. This analysis was performed to identify the incidence of distress and factors affecting it. Methods This was an audit of 84 consecutive patients seen in an adult neuro-medical oncology outpatient department who were either receiving adjuvant chemotherapy or were on follow-up. Distress screening with the National Comprehensive Cancer Network (NCCN) distress thermometer was performed. Patients in whom distress was scored as 4 or above were considered as having high distress. Descriptive statistics and logistic regression analysis were performed to identify factors affecting distress. Results The median age of the cohort was 40 years (interquartile range, 28.3 to 50 years). Actionable distress defined as a distress score of 4 or more was seen in 52 patients (61.9%, 95% CI 51.2% to 71.5%). Presence of physical deficit (odds ratio [OR] = 3.412, P = .020) and treatment under the private category (OR = 5.273, P = .003) had higher odds of having high distress. Conclusion A high proportion of brain tumor patients either on adjuvant chemotherapy or on follow-up have high distress levels that need to be addressed even during follow-up.
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Affiliation(s)
- Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mridul Malhotra
- Department of Medical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Raees Tonse
- Department of Radiation Oncology, Tata Memorial Hospital and HBNI, Mumbai, India
| | - Jayita Deodhar
- Department of Palliative Medicine and Psychiatry, Tata Memorial Hospital and HBNI, Mumbai, India
| | - Arun Chandrasekharan
- Department of Medical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nikhil Pande
- Department of Medical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Atanu Bhattacharjee
- Department of Cancer Epidemiology Institute, Tata Memorial Hospital and HBNI, Mumbai, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Tata Memorial Hospital and HBNI, Mumbai, India
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25
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Ownsworth T, Chambers S, Aitken JF, Foote M, Pinkham MB, Gordon LG, Lock G, Hanley B, Gardner T, Jones S, Robertson J, Shum D, Conlon E. Evaluation of a telehealth psychological support intervention for people with primary brain tumour and their family members: Study protocol for a randomised controlled trial. Eur J Cancer Care (Engl) 2019; 28:e13132. [DOI: 10.1111/ecc.13132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/30/2019] [Accepted: 06/22/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Suzanne Chambers
- University of Technology Sydney Sydney New South Wales Australia
- Menzies Health Institute Queensland Griffith University Southport Queensland Australia
- Australian and New Zealand Urogenital and Prostate Cancer (ANZUP) Trials Group Sydney New South Wales Australia
- Exercise Medicine Research Institute Edith Cowan University Perth Western Australia Australia
- Institute for Resilient Regions University of Southern Queensland Toowoomba Queensland Australia
| | - Joanne F. Aitken
- Menzies Health Institute Queensland Griffith University Southport Queensland Australia
- Institute for Resilient Regions University of Southern Queensland Toowoomba Queensland Australia
- Cancer Council Queensland Brisbane Queensland Australia
- School of Public Health University of Queensland Brisbane Queensland Australia
- School of Research–Public Health Queensland University of Technology Brisbane Queensland Australia
| | - Matthew Foote
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Mark B. Pinkham
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Louisa G. Gordon
- School of Public Health University of Queensland Brisbane Queensland Australia
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
- School of Nursing Queensland University of Technology Brisbane Queensland Australia
| | - Gemma Lock
- Cancer Council Queensland Brisbane Queensland Australia
| | - Brigid Hanley
- Cancer Council Queensland Brisbane Queensland Australia
| | | | - Stephanie Jones
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - Julia Robertson
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
| | - David Shum
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
- Department of Rehabilitation Sciences Hong Kong Polytechnic University Hong Kong China
| | - Elizabeth Conlon
- School of Applied Psychology, Menzies Health Institute Queensland Griffith University Brisbane Queensland Australia
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26
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IJzerman-Korevaar M, Snijders TJ, de Graeff A, Teunissen SCCM, de Vos FYF. Prevalence of symptoms in glioma patients throughout the disease trajectory: a systematic review. J Neurooncol 2018; 140:485-496. [PMID: 30377935 PMCID: PMC6267240 DOI: 10.1007/s11060-018-03015-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/09/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Glioma patients suffer from a wide range of symptoms which influence quality of life negatively. The aim of this review is to give an overview of symptoms most prevalent in glioma patients throughout the total disease trajectory, to be used as a basis for the development of a specific glioma Patient Reported Outcome Measure (PROM) for early assessment and monitoring of symptoms in glioma patients. METHODS A systematic review focused on symptom prevalence in glioma patients in different phases of disease and treatment was performed in MEDLINE, CINAHL and EMBASE according to PRISMA recommendations. We calculated weighted means for prevalence rates per symptom. RESULTS The search identified 2.074 unique papers, of which 32 were included in this review. In total 25 symptoms were identified. The ten most prevalent symptoms were: seizures (37%), cognitive deficits (36%), drowsiness (35%), dysphagia (30%), headache (27%), confusion (27%), aphasia (24%), motor deficits (21%), fatigue (20%) and dyspnea (20%). CONCLUSIONS Eight out of ten of the most prevalent symptoms in glioma patients are related to the central nervous system and therefore specific for glioma. Our findings emphasize the importance of tailored symptom care for glioma patients and may aid in the development of specific PROMs for glioma patients in different phases of the disease.
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Affiliation(s)
- Margriet IJzerman-Korevaar
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Tom J Snijders
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Filip Y F de Vos
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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27
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Hyde MK, Zajdlewicz L, Lazenby M, Dunn J, Laurie K, Lowe A, Chambers SK. The validity of the Distress Thermometer in female partners of men with prostate cancer. Eur J Cancer Care (Engl) 2018; 28:e12924. [PMID: 30252180 DOI: 10.1111/ecc.12924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 04/04/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023]
Abstract
Female partners of prostate cancer (PCa) survivors experience heightened psychological distress that may be greater than that expressed by PCa patients. However, optimal approaches to detect distressed, or at risk of distress, partners are unclear. This study applied receiver operating characteristics analysis to evaluate diagnostic accuracy, sensitivity and specificity of the Distress Thermometer (DT) compared to widely used measures of general (Hospital Anxiety and Depression Scale) and cancer-specific (Impact of Events Scale-Revised) distress. Participants were partners of men with localised PCa (recruited around diagnosis) about to undergo or had received surgical treatment (N = 189), and partners of men diagnosed with PCa who were 2-4 years post-treatment (N = 460). In both studies, diagnostic utility of the DT overall was not optimal. Although area under the curve scores were acceptable (ranges: 0.71-0.92 and 0.83-0.94 for general and cancer-specific distress, respectively), sensitivity, specificity and optimal DT cut-offs for partner distress varied for general (range: ≥2 to ≥5) and cancer-specific (range: ≥3 to ≥5) distress both across time and between cohorts. Thus, it is difficult to draw firm conclusions about the diagnostic capabilities of the DT for partners or recommend its use in this population. More comprehensive screening measures may be needed to detect partners needing psychological intervention.
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Affiliation(s)
- Melissa K Hyde
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | | | - Mark Lazenby
- School of Nursing, Yale University, New Haven, Connecticut
| | - Jeff Dunn
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia.,School of Social Science, The University of Queensland, St Lucia, Queensland, Australia
| | - Kirstyn Laurie
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Anthony Lowe
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Suzanne K Chambers
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia.,Faculty of Health, University of Technology Sydney, New South Wales, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
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28
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Renovanz M, Maurer D, Lahr H, Weimann E, Deininger M, Wirtz CR, Ringel F, Singer S, Coburger J. Supportive Care Needs in Glioma Patients and Their Caregivers in Clinical Practice: Results of a Multicenter Cross-Sectional Study. Front Neurol 2018; 9:763. [PMID: 30254605 PMCID: PMC6141995 DOI: 10.3389/fneur.2018.00763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/22/2018] [Indexed: 12/21/2022] Open
Abstract
Objective: Supportive care needs in glioma patients often remain unrecognized, and optimization in assessment is required. First, we aimed at assessing the support needed using a simple structured questionnaire. Second, we investigated the psychosocial burden and support requested from caregivers. Methods: Patients were assessed at three centers during their outpatient visits. They completed the Distress Thermometer (DT; score ≥ 6 indicated significant burden in brain tumor patients), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30+BN20, and the Patients' Perspective Questionnaire (PPQ) that assessed psychosocial distress as well as support requested and received by patients for specific domains (e.g., family, doctor, and mobile care). In each subgroup, patients' caregivers were assessed simultaneously by a questionnaire developed for the study. Multivariate backward logistic regressions were performed for investigating predictors of patients' request for support. Results: Assessments were conducted for 232 patients. Most patients (82%) had a high-grade glioma and a mean age of 52 years (range 20-87). The male to female ratio was 1.25:1. According to the PPQ results, 38% (87) of the patients felt depressed; 44% (103), anxious; and 39% (91), tense/nervous. Desired support was highest from doctors (59%) and psychologists (19%). A general request for support was associated with lower global health status (p = 0.03, odds ratio (OR) = 0.96, 95% CI: 0.92-0.99) according to EORTC QLQ-C30. Most of the assessed caregivers (n = 96) were life partners (64%; n = 61) who experienced higher distress than the corresponding patients (caregivers: 6.5 ± 2.5 vs. patients: 5.3 ± 2.4). When patients were on chemotherapy, caregivers indicated DT ≥ 6 significantly more frequently than patients themselves (p = 0.02). Conclusion: Our data showed that glioma patients and their caregivers were both highly burdened. The PPQ allowed us to evaluate the psychosocial support requested and perceived by patients, detect supportive care needs, and provide information at a glance. Patients in poorer clinical condition are at risk of having unmet needs. The caregivers' burden and unmet needs are not congruent with the patients' need for support. In particular, caregivers of patients on chemotherapy were more highly burdened than patients themselves.
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Affiliation(s)
- Mirjam Renovanz
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dorothea Maurer
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heike Lahr
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elke Weimann
- Department of Neurology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Monika Deininger
- Department of Neurosurgery, University Medical Center Ulm, Günzburg, Germany
| | | | - Florian Ringel
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jan Coburger
- Department of Neurosurgery, University Medical Center Ulm, Günzburg, Germany
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Rapp M, Schipmann S, Hoffmann K, Wiewrodt R, Steiger HJ, Kamp M, Stummer W, Wiewrodt D, Sabel M. Impact of distress screening algorithm for psycho-oncological needs in neurosurgical patients. Oncotarget 2018; 9:31650-31663. [PMID: 30167085 PMCID: PMC6114967 DOI: 10.18632/oncotarget.25833] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/09/2018] [Indexed: 11/25/2022] Open
Abstract
Background Cerebral tumors are associated with high rates of anxiety, depression and reduced health related quality of life. Nevertheless psychooncological screening instruments are neither implemented nor well defined in the daily routine of neurosurgical departments. Therefore, we tried (1) to identify a suitable screening algorithm for neurosurgical patients, (2) to define clinical risk factors for increased distress and (3) to analyze the optimal screening time point. Results Between October 2013 and January 2015 472 elective neurosurgical in-patients (median age 55.85 years) of the neurosurgical departments of the University Hospitals Duesseldorf and Muenster were prospectively included into this study. Regarding their diagnosis 244 (51.7%) patients were identified with malignant lesions and 228 (48.3%) patients with benign lesions. Increased distress was diagnosed in 63.1% of all patients via DT, in 13.6% via HADS and 27.8% via PO-Bado. Combining the cut-off criteria with the problem list increased sensitivity (90%) and specificity (70%) of the DT assessment. Regarding risk factors pre-existing psychiatric disorders, ataractic medication and a decreased clinical performance status were associated with increased distress. Patients and methods Patients with diagnosis of an intracranial lesion with elective surgical indication were screened for psychological distress via three assessment-instruments the Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer (DT), and the Basic Documentation for Psycho-Oncology (PO-Bado). Screening results were correlated with clinical and demographic data. Conclusion Postoperative distress screening for neurosurgical patients is important independent from the neurosurgical diagnosis. The DT represents a suitable, non time-consuming instrument for daily routine in a neurosurgical department.
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Affiliation(s)
- Marion Rapp
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | | | - Kira Hoffmann
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - Rainer Wiewrodt
- Pulmonary Division, Dpt. of Medicine A, University Hospital Muenster, Muenster, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - Marcel Kamp
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Michael Sabel
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
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30
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Giammalva GR, Iacopino DG, Azzarello G, Gaggiotti C, Graziano F, Gulì C, Pino MA, Maugeri R. End-of-Life Care in High-Grade Glioma Patients. The Palliative and Supportive Perspective. Brain Sci 2018; 8:brainsci8070125. [PMID: 29966347 PMCID: PMC6071221 DOI: 10.3390/brainsci8070125] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 11/16/2022] Open
Abstract
High-grade gliomas (HGGs) are the most frequently diagnosed primary brain tumors. Even though it has been demonstrated that combined surgical therapy, chemotherapy, and radiotherapy improve survival, HGGs still harbor a very poor prognosis and limited overall survival. Differently from other types of primary neoplasm, HGG manifests also as a neurological disease. According to this, palliative care of HGG patients represents a peculiar challenge for healthcare providers and caregivers since it has to be directed to both general and neurological cancer symptoms. In this way, the end-of-life (EOL) phase of HGG patients appears to be like a journey through medical issues, progressive neurological deterioration, and psychological, social, and affective concerns. EOL is intended as the time prior to death when symptoms increase and antitumoral therapy is no longer effective. In this phase, palliative care is intended as an integrated support aimed to reduce the symptoms burden and improve the Quality Of Life (QOL). Palliative care is represented by medical, physical, psychological, spiritual, and social interventions which are primarily aimed to sustain patients’ functions during the disease time, while maintaining an acceptable quality of life and ensuring a dignified death. Since HGGs represent also a family concern, due to the profound emotional and relational issues that the progression of the disease poses, palliative care may also relieve the distress of the caregivers and increase the satisfaction of patients’ relatives. We present the results of a literature review addressed to enlighten and classify the best medical, psychological, rehabilitative, and social interventions that are addressed both to patients and to their caregivers, which are currently adopted as palliative care during the EOL phase of HGG patients in order to orientate the best medical practice in HGG management.
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Affiliation(s)
- Giuseppe Roberto Giammalva
- Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy.
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy.
| | - Giorgio Azzarello
- Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy.
| | - Claudia Gaggiotti
- Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy.
| | - Francesca Graziano
- Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy.
| | - Carlo Gulì
- Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy.
| | - Maria Angela Pino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, 90127 Palermo, Italy.
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, 90133 Palermo, Italy.
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31
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Jansson MRN, von Heymann-Horan A, Rasmussen BK, Albieri V, Frederiksen K, Suppli N, Dalton SO, Johansen C, Bidstrup PE. Risk for use of antidepressants, anxiolytics, and hypnotics in partners of glioma patients-A nationwide study covering 19 years of prescriptions. Psychooncology 2018; 27:1930-1936. [PMID: 29683227 DOI: 10.1002/pon.4744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/28/2018] [Accepted: 04/12/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Suffering from malignant brain tumor is a stressful condition, for patients and their partners. In a retrospective cohort study using nationwide registries, we examined partners' risk for first use of antidepressants, anxiolytics, or hypnotics. METHODS We followed all 4373 partners of adults with glioma, diagnosed in 1998 to 2013 in Denmark and a cohort of 43 808 partners of glioma-free persons matched 1:10. In Cox proportional hazard models, we estimated hazard ratios (HRs) for a first prescription of psychotropic medications (antidepressants, anxiolytics, or hypnotics) according to the partner's glioma status. Among partners of glioma patients, we further estimated HRs for a first prescription of psychotropic medication according to disease characteristics, sociodemographic factors, and bereavement. RESULTS Two years after diagnosis, 29% of female and 21% of male partners of glioma patients had had a first prescription of psychotropic medication compared with 10% in female and 8% in male partners of glioma-free persons. Partners of glioma patients had a significantly increased, 4-fold higher risk for a first prescription of psychotropic medications in the first year after diagnosis than partners of glioma-free persons (HR 4.10, 95% CI, 3.80:4.43). Among partners of glioma patients, the risk was significantly reduced in bereaved compared with non-bereaved partners. CONCLUSIONS We have documented, for the first time, that the psychological impact of a diagnosis of glioma is such a severe stress exposure that it increases the risk for having medication prescribed to treat symptoms of anxiety, sleep problems, and depression.
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Affiliation(s)
| | | | - Birthe K Rasmussen
- Department of Neurology, Nordsjaellands Hospital, University of Copenhagen, Denmark.,Danish Neuro-Oncology, Denmark
| | - Vanna Albieri
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Nis Suppli
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Oncology, University Hospital Rigshospitalet, Copenhagen, Denmark
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Heckel L, Fennell KM, Orellana L, Boltong A, Byrnes M, Livingston PM. A telephone outcall program to support caregivers of people diagnosed with cancer: utility, changes in levels of distress, and unmet needs. Support Care Cancer 2018; 26:3789-3799. [PMID: 29766259 DOI: 10.1007/s00520-018-4246-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/06/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the utility of a telephone outcall program for cancer caregivers and to examine longitudinal changes in their distress levels and supportive care needs. METHODS As part of the PROTECT trial, caregivers assigned to the intervention arm (N = 108) received three telephone outcalls from a Cancer Council 13 11 20 nurse at three time points (7-10 days post-randomization, 1 and 4 months later). During each call, caregivers were screened for distress using the Distress Thermometer (range: 0-10) then six supportive care issues were raised for discussion. Participants completed a utility survey 1 month post-intervention. RESULTS The outcall program was highly acceptable and perceived as beneficial by caregivers. Overall, 95% reported it was worth their time to take part in the outcall program and 82% stated that the program was very relevant to them. Level of distress and impact of distress decreased over time (p = 0.0031, p < 0.0001, respectively). Average call duration decreased over time (p < 0.0001) and was longer for female than male caregivers (p = 0.0009). The frequency of caregivers discussing issues related to psychological distress (p = 0.0003), health literacy (p < 0.0001), financial (p = 0.0014), and practical concerns (p = 0.0121) decreased over time. Psychological distress was more often discussed by female than male caregivers (p = 0.0153), and family issues more often by younger (< 55 years) than older caregivers (p = 0.0071). CONCLUSIONS Utility of this outcall program was high. Caregivers' level of distress and unmet needs decreased over time. Gender and age differences emerged, which warrants the need for tailored support. Further research is necessary to identify the best method of improving access to 13 11 20 services for caregivers.
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Affiliation(s)
- Leila Heckel
- Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia.
| | - Kate M Fennell
- Cancer Council SA, 202 Greenhill Road, Eastwood, South Australia, 5063, Australia.,Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Sturt Road, Bedford Park, South Australia, 5042, Australia.,Sansom Institute for Health Research, University of South Australia, City East Campus, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Liliana Orellana
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, VIC, 3220, Australia
| | - Anna Boltong
- Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Monica Byrnes
- Cancer Council SA, 202 Greenhill Road, Eastwood, South Australia, 5063, Australia
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Liu F, Huang J, Zhang L, Fan F, Chen J, Xia K, Liu Z. Screening for distress in patients with primary brain tumor using distress thermometer: a systematic review and meta-analysis. BMC Cancer 2018; 18:124. [PMID: 29394923 PMCID: PMC5797347 DOI: 10.1186/s12885-018-3990-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/16/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with primary brain tumors are reported to have an elevated level of distress prevalence, due to the functional sequelae and the unfavorable prognosis, but the estimated prevalence of this disorder varies among studies. The Distress Thermometer (DT) is widely used distress screening tools to identify patients suffering from elevated psychosocial distress. The objective of this meta-analysis is to get a summarized estimate of distress prevalence in adult primary brain tumor patients screened by the DT instrument to identify distress in brain tumor patients. METHOD We searched studies published in PubMed, PsycINFO, and Cochrane library through August 2017 and checked related reviews and meta-analyses for eligible studies. Studies were eligible if they were published in the peer-reviewed literature and evaluated distress level by Distress Thermometer. The prevalence of distress symptoms in patients with the intracranial tumor was estimated by study-level characteristics using stratified meta-analysis. The prevalence of distress level or symptoms during the follow-up examination at different time points was detected by secondary analysis of the longitudinal studies included. RESULTS Twelve studies including a total of 2145 brain tumor patients were included in this analysis. Eight used a cross-sectional design and four were longitudinal. The pooled prevalence of distress was 38.2% (95% confidence interval (CI) 28.7%-47.7%) for the overall sample. The pooled prevalence of distress DT ≥4 was 41.1% (642/1686, 95% CI 28.6%-53.5%) and the pooled prevalence of distress by DT ≥6 was 29.7% (137/459, 95% CI 19.5%-39.9%). The distress symptom did not decrease in follow-up studies (Relative Increase Ratio:1.02, 95% CI, (0.78, 1.35)). A huge heterogeneity in different studies was detected, and different screening scales were not compared. CONCLUSION The high prevalence of distress becomes an enormous challenge for primary brain tumor patients. Routine screening and evaluation of distress in brain tumor patients may assist medical workers to develop proper interventions, which may lead to better quality of life and oncology management.
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Affiliation(s)
- Fangkun Liu
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Jing Huang
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.,Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (xiangya), Changsha, Hunan, 410011, China
| | - Liyang Zhang
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Fan Fan
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Jindong Chen
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.,Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (xiangya), Changsha, Hunan, 410011, China
| | - Kun Xia
- The State Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China.
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Do carer’s levels of unmet needs change over time when caring for patients diagnosed with high-grade glioma and how are these needs correlated with distress? Support Care Cancer 2017; 26:275-286. [DOI: 10.1007/s00520-017-3846-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/24/2017] [Indexed: 12/27/2022]
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35
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Kuchinad KE, Strowd R, Evans A, Riley WA, Smith TJ. End of life care for glioblastoma patients at a large academic cancer center. J Neurooncol 2017; 134:75-81. [PMID: 28528421 DOI: 10.1007/s11060-017-2487-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
Glioblastoma (GBM) is a universally fatal disease, complicated by significant cognitive and physical disabilities, inherent to the disease course. The purpose of this study was to retrospectively analyze end-of-life care for GBM patients at an academic center and compare utilization of these services to national quality of care guidelines, with the goal of identifying opportunities to improve end-of-life care. Single center retrospective cohort study of GBM patients at Johns Hopkins Hospital (JHH) between 2009 and 2014, using electronic medical records and hospice records. Comprehensive medical record review of 100 randomly selected patients with GBM, who were actively treated at JHH. Secondary analysis of all JHH GBM patients (n = 45) who received hospice care at Gilchrist Services, our largest provider, during this time period. Of 100 patients, 76 were referred to hospice. Despite the poor survival and changes in mental capacity associated with this disease, only 40% of individuals had documentation of code status and only 17% had any documentation of advance directives (ADs). None had documentation by a health care provider of a formal symptom, psychosocial, or spiritual assessment at greater than 50% of clinic visits. Only 17% used chemotherapy in their last month of life. 37% were hospitalized in the last month of life for an average of 9 days. Of the Gilchrist Services patients, the median length of stay in hospice was 21 days and 64% of these patients died in their residence with hospice services. Documentation of palliative care and end-of-life measures could improve quality of care for GBM patients, especially in the use of ADs, symptom, spiritual, and psychosocial assessments, with earlier use of hospice to prevent end-of-life hospitalizations.
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Affiliation(s)
| | - Roy Strowd
- Brain Tumor Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | | - Thomas J Smith
- Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Harry J. Duffey Family Professor of Palliative Medicine, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Blalock 369, Baltimore, MD, 21287-0005, USA.
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36
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Boele FW, Grant R, Sherwood P. Challenges and support for family caregivers of glioma patients. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjnn.2017.13.1.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Robin Grant
- Consultant neurologist, Edinburgh Centre for Neuro-Oncology
| | - Paula Sherwood
- Professor, University of Pittsburgh (Acute and Tertiary Care, School of Nursing)
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37
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Halkett GKB, Lobb EA, Shaw T, Sinclair MM, Miller L, Hovey E, Nowak AK. Distress and psychological morbidity do not reduce over time in carers of patients with high-grade glioma. Support Care Cancer 2016; 25:887-893. [DOI: 10.1007/s00520-016-3478-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
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38
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Coping with the Unthinkable: Psychosocial Advances in the Management of Primary Brain Tumour. BRAIN IMPAIR 2016. [DOI: 10.1017/brimp.2016.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Brain cancer is a complex and distressing illness with a typically poor prospect for survival. Worldwide, approximately 256,000 people (1800 in Australia) are diagnosed each year (Ferlay, Soerjomataram & Ervik, 2013). Cancer of the brain poses a double threat – to one's survival and sense of self. Most people with primary brain tumour develop serious neuro-cognitive symptoms (e.g., seizures, memory loss) and experience poor mental health and quality of life, which places enormous burden on family care givers. Not surprisingly, high rates of psychological distress have been reported by people with brain tumour and their family care givers. Psychological distress can persist beyond primary treatment, and often increases in the long-term phase of illness due to the perceived threat and experience of recurrence and functional decline. Over the last decade, there have been many advances in the psychosocial management of people with brain tumour. This paper provides an overview of the functional, psychological and social consequences of brain tumour, summarises some leading developments in psychological assessment and management, and outlines future directions in intervention research.
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Boele FW, Given CW, Given BA, Donovan HS, Schulz R, Weimer JM, Drappatz J, Lieberman FS, Sherwood PR. Family caregivers' level of mastery predicts survival of patients with glioblastoma: A preliminary report. Cancer 2016; 123:832-840. [PMID: 27787881 DOI: 10.1002/cncr.30428] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/24/2016] [Accepted: 10/10/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is associated with a poor prognosis, and patients rely heavily on family caregivers for physical and emotional support. The capability and mental health of family caregivers may influence their ability to provide care and affect patient outcomes. The objective of the current study was to investigate whether caregivers' anxiety, depressive symptoms, burden, and mastery influenced survival in a sample of patients newly diagnosed with GBM. METHODS Baseline data from caregiver-patient dyads participating in a longitudinal study funded by the National Institutes of Health were used. Cox regression analyses were performed to determine whether caregiver anxiety (Profile of Mood States-Anxiety), depressive symptoms (Center for Epidemiologic Studies-Depression Scale), burden (Caregiver Reaction Assessment), and feelings of mastery (Mastery Scale) predicted the survival time of patients with GBM after controlling for known covariates (patient age, Karnofsky performance status, type of surgery, and postsurgical treatment). RESULTS A total of 88 caregiver-patient dyads were included. The median overall survival for the sample was 14.5 months (range, 0-88 months). After controlling for covariates, caregiver mastery was found to be predictive of patient survival. With each unit increase in mastery, there was a 16.1% risk reduction in patient death (95% confidence interval, 0.771-0.913; P<.001). CONCLUSIONS To the authors' knowledge, the results of the current study are among the first to explore the impact of family caregiving on the outcomes of patients with GBM. If these results are supported in other studies, providing neuro-oncology caregivers with more structured support and guidance in clinical practice has the potential to improve caregivers' feelings of mastery, thereby influencing patients' well-being for the better. Cancer 2017;123:832-40. © 2016 American Cancer Society.
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Affiliation(s)
- Florien W Boele
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charles W Given
- Department of Family Medicine, Michigan State University, East Lansing, Michigan
| | - Barbara A Given
- College of Nursing, Michigan State University, East Lansing, Michigan
| | - Heidi S Donovan
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richard Schulz
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jason M Weimer
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jan Drappatz
- Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Frank S Lieberman
- Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paula R Sherwood
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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40
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Randazzo D, Peters KB. Psychosocial distress and its effects on the health-related quality of life of primary brain tumor patients. CNS Oncol 2016; 5:241-9. [PMID: 27397796 PMCID: PMC6040083 DOI: 10.2217/cns-2016-0010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/05/2016] [Indexed: 11/21/2022] Open
Abstract
All cancer patients experience distress from the diagnosis, the effects of the disease or the treatment. Clinically significant distress decreases overall quality of life and the recognition of distress with prompt intervention is essential. The National Comprehensive Cancer Network distress thermometer (NCCN-DT) is a validated measuring tool that has been utilized in the primary brain tumor population to detect psychologic distress thereby provoking a referral process to the appropriate support system. Brain tumor patients commonly reported emotional and physical distress encompassing: fatigue, fears, memory and concentration and worry. More research is needed to identify the stressors of all primary brain tumor patients and their caretakers and integrate appropriate interventions to improve health-related quality of life in both groups.
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Affiliation(s)
- Dina Randazzo
- Department of Neurology, Duke University Medical Center, The Preston Robert Tisch Brain Tumor Center, Durham, NC 27710, USA
| | - Katherine B Peters
- Department of Neurology, Duke University Medical Center, The Preston Robert Tisch Brain Tumor Center, Durham, NC 27710, USA
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