Exploring the occurrence and the risk factors of the desire for hastened death and depression in people with early-stage dementia in Greece

OBJECTIVES

To assess the factors associated with desire for hastened death and depression in early-stage dementia as well as the association between them. Also, to explore the mediator and moderator role of age in the relationship between depression and desire for hasten death.

METHODS

A prospective cross-sectional study including 100 patients diagnosed with early-stage dementia from a rehabilitation center between December 2018 and July 2019. Measurement tools used were the Mini-Mental State Examination, the Greek Montreal Cognitive Assessment, the Greek Schedule of Attitudes toward Hastened Death, and the Geriatric Depression Scale-15 item. Patients diagnosed with dementia as a result of Stroke history were excluded.

RESULTS

Factors of multifactorial analysis significantly associated with desire for hastened death were as follows: age (p = 0.009), marital status (p = 0.001), and depression (p < 0.001). The factor significantly associated with depression was age (p = 0.001). Also, a mediation/moderation analysis has shown that depression and age are significant predictors of desire for hasten death.

SIGNIFICANCE OF RESULTS

The desire for hastened death and depression in people diagnosed with early-stage dementia includes many components. Younger patients, men, higher educated patients, single, childless, and those with higher depression scores had higher desire for hastened death, while men and older patients had higher scores of desire for depression. Our study provides important information about the desire for hastened death and depression in early-stage dementia, their risk factors, and their association.

Psychometric Properties of the Greek Version of Demoralization Scale-II (DS-II) in Patients with Cancer

Introduction

The concept of demoralization is used to describe situations of existential distress and self-perceived inability to effectively deal with stressors. The Demoralization Scale-II (DS-II) is a short and modified version of the original DS that measures the level of demoralization in patients. The purpose of this study is to evaluate the psychometric properties of the Greek version of the Greek Demoralisation Scale-II (DS-II GR) in the population of patients with cancer.

Methods

The main tool used in this cross-sectional study is the DS-II GR translated and evaluated for its psychometric properties in a sample of 150 Greek patients with cancer. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity, known groups' validity, cut-off points, internal consistency reliability and test-retest reliability were done.

Results

According to the CFA, a two-factor model emerged with a different conceptual content and grouping than the original. The correlation coefficients between DS-II GR and Hospital Anxiety and Depression Scale-Greek (HADS-GR) The internal consistency of DS-II GR for factor 1, factor 2, and total score were measured with Cronbach's alpha and calculated to be 0.906, 0.810, and 0.913.

Conclusion

The Greek version of the demoralization scale is reliable and valid for assessing demoralization in Greek patients with cancer.

Hope and Distress Symptoms of Oncology Patients in a Palliative Care Setting

Background Hope has a positive impact on health, playing a significant role in managing illness and its associated losses. In oncology patients, hope is crucial for effective adaptation to the disease, as well as a strategy for coping with physical and mental distress. It enhances disease management, psychological adaptation, and overall quality of life. However, due to the complexity of the effect of hope on patients, particularly those under palliative care, identifying its relationship with anxiety and depression remains a challenge. Methodology In this study, 130 cancer patients completed the Greek version of the Herth Hope Index (HHI-G) and the Hospital Anxiety and Depression Scale (HADS-GR). Results The HHI-G hope total score was strongly negatively correlated with HADS-anxiety (r = -0.491, p < 0.001) and HADS-depression (r = -0.626, p < 0.001). Patients with performance status, as defined by the Eastern Cooperative Oncology Group (ECOG), of 0-1 without radiotherapy had higher HHI-G hope total scores compared to those with ECOG status 2-3 (p = 0.002) and radiotherapy (p = 0.009). Multivariate regression analysis showed that patients who received radiotherapy had 2.49 points higher HHI-G hope scores compared to those who did not (explaining 3.6% of hope). An increase of 1 point in depression led to a 0.65-point decrease in the HHI-G hope score (explaining 40% of hope). Conclusions A deeper understanding of common psychological concerns and hope in patients with serious illnesses can improve their clinical care. Mental health care should focus on managing depression and anxiety, as well as other psychological symptoms, to enhance and maintain patients' hope.

Sexual Function in Women Survivors of Hematologic Malignancy after Autologous Hematopoietic Stem Cell Transplantation

A multicenter, cross-sectional study was conducted to assess the sexual function of women survivors of hematologic malignancy after autologous hematopoietic stem cell transplantation (AHSCT), and to compare it with that of healthy women controls. Fifty-six sexually active women survivors of hematologic malignancy who underwent AHSCT were recruited through convenience sampling, as well as 60 healthy women. Demographic and clinical data questionnaires and the Female Sexual Function Index (FSFI) were completed. Survivors had a median age of 44 years and a median time since transplant of 3 years, while 48.2% had Hodgkin Lymphoma. Survivors reported an average level of sexual dysfunction, with a total score mean ± SD = 22.51 ± 8.95. The best sexual functioning domain was “pain” and the most affected was “orgasm”. There was a statistically significant association between survivors’ sexual function and age (p < 0.0005) in both the unifactorial and the multifactorial analysis. In addition, there was a statistically significant association between survivors’ sexual function and functional status (p < 0.0005), menopausal status (p < 0.0005), the presence of children (p = 0.002), education (p < 0.0005), and diagnosis (p < 0.0005). Healthy women had statistically significantly higher scores in all FSFI subscales (p < 0.0005). Women survivors of hematologic malignancy, treated by AHSCT, had impaired sexual function, implying the need to implement regular sexual health assessment in survivorship care.

Factors associated with anxiety and depression in cancer patients: Demographic factors and the role of demoralization and satisfaction with care

OBJECTIVE

Anxiety and depression are common in cancer patients and seem to affect quality of life, treatment compliance and even survival. Defining factors related to anxiety and depression and exploring the role of demoralization and satisfaction with care, could contribute to the improvement of patients' quality of life and quality of health services as well.

METHODS

A convenience sample of 150 cancer inpatients and outpatients from two oncology centers, with various types of solid tumors, participated in a prospective cross-sectional observational study. The psychometric tools used were the Greek versions of the Hospital Anxiety and Depression Scale, FAMCARE-Patient Scale and Oncology Palliative Care (FAMCARESCALE) and Demoralization Scale (DEMORALIZATION SCALE II, DS-II).

RESULTS

Patients mean age was 62 years (20-85 years) and 89 patients (59.3%) were women. Among patients, 33% had breast, 24% gastrointestinal and 15% lung cancer. Eighty-two patients (54.7%) had metastatic disease. Women showed higher rates of anxiety (p = 0.054). Anxiety was inversely related to age (p = 0.043) and positively correlated with time since diagnosis (p = 0.076). Unmarried patients presented with higher rates of depression (p = 0.026). Multiple linear regression showed a statistically significant impact of Demoralization factor 'Meaning and Purpose' on anxiety (p < 0.001, R²  = 36.3%) and depression (p < 0.001, R²  = 49%). Moreover, higher educational level (p = 0.038, R²  = 3.1%) is related to higher levels of anxiety and higher scores of FAMCARESCALE factor-Information/interaction with the health care professionals, is related to lower levels of depression (p = 0.008, R²  = 2.7%).

CONCLUSIONS

The results highlight the significant impact of demoralization on anxiety and depression in cancer patients. Early recognition of demoralization and early referral to mental health professionals will hopefully alleviate the mental burden of cancer patients.

Sexual Function of Male Survivors of Hematological Malignancy Treated by Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Controlled Observational Study

A multicenter, observational, cross-sectional study was conducted to assess the sexual function of male survivors of hematological malignancy treated by autologous hematopoietic stem cell transplantation (AHSCT) and to compare it with that of healthy male controls. By convenience sampling, 71 sexually active male survivors of hematological malignancy who underwent AHSCT were recruited, as well as 74 healthy men. A questionnaire with demographic and clinical data and the International Index of Erectile Function (IIEF) were completed. Survivors had a median age of 47 years, a median time since transplant of 3 years, and 46.5% had Hodgkin lymphoma. Based on the IIEF, they had a high level of sexual function, with best functioning domain "erection" and worst "overall satisfaction". Healthy men had statistically significantly higher scores in all domains of the IIEF, except for "orgasm" (p = 0.205). There was a statistically significant association between sexual function and age (p < 0.0005), years since transplantation (p = 0.006), functional status (p < 0.0005), having children (p < 0.0005), relationship status (p = 0.001), education (p < 0.0005), diagnosis (p < 0.0005) and disease relapse (p = 0.017). Multivariate analysis showed that only age was a strong prognostic factor of sexual function (p < 0.0005). After age was excluded from the model, because of the strong effect it had on the dependent variable, functional status (p = 0.015), education (p = 0.002) and diagnosis (p = 0.001) had a statistically significant association with sexual function. These findings indicate the importance of sexual function for survivors' well-being and the need for implementation of integrated care plans for survivors of hematological malignancy.

A Prospective, Real-World, Multinational Study of Naloxegol for Patients with Cancer Pain Diagnosed with Opioid-Induced Constipation-The NACASY Study

The Naloxegol Cancer Study (NACASY) was a multinational European study aimed to evaluate the 4-week safety and efficacy of naloxegol in a real-world setting in patients with cancer pain diagnosed with opioid-induced constipation. The primary safety endpoint was the incidence of adverse events leading to study discontinuation. We recruited 170 patients who received at least one dose of naloxegol (i.e., safety population). Out of 170 patients, 20 (11.8%, 95%CI 6.9-16.6) discontinued the study due to adverse events, and, of them, 12 (7.1%, 95%CI 3.2-10.9%) were study discontinuations due to naloxegol-related adverse events. From 76 patients subjects who had completed both 4 weeks of treatment and 28 days of the diary, 55 patients (72.4%, 95% CI 62.3-82.4%) were regarded as responders (i.e., showed ≥3 bowel-movements per week and an increase of ≥1 bowel-movement over baseline) to naloxegol treatment. The Patient Assessment of Constipation-Quality of Life Questionnaire total score and all its subscales improved from baseline to 4 weeks of follow up. Our findings support and provide new evidence about the beneficial effect of naloxegol in terms of improvement of constipation and quality-of-life in patients with cancer-related pain and opioid-induced constipation and show a safety profile consistent with previous pivotal and real-world studies.

Herth Hope Index: A Psychometric Evaluation Study within a Sample of Greek Patients with Cancer

Objectives:

This study aims to develop the Greek version of the Herth Hope Index (HHI) and assess its psychometric properties to a palliative care patient sample, using a cross-sectional design.

Materials and Methods:

The HHI was translated into Greek (HHI-Gr) using the ‘forward-backward’ procedure. It was administered to 130 eligible cancer patients, while for the stability of patients’ responses, 40 of these patients completed the HHI-Gr 3 days later. Along with the HHI-Gr, patients also completed the Hospital Anxiety and Depression Scale (HADS) and the Beck Hopelessness Scale (BHS). The HHI-Gr internal consistency reliability (Cronbach’s a), stability (intraclass correlation coefficient [ICC]), factor structure (factor analysis) and convergent validity (correlation with the HADS and the BHS questionnaires) were examined using the Eastern Cooperative Oncology Group (ECOG) performance status.

Results:

The HHI-Gr yielded a one-factor model and a Cronbach alpha (0.860) with excellent internal consistency reliability and stability ICC (>0.90). Satisfactory convergent validity was supported by the correlation analysis between the HHI-Gr and BHS (r = 0.718, P < 0.001). Overall test-retest reliability was satisfactory with a range between 0.77 and 0.96 (P < 0.001).

Conclusion:

These results demonstrate that the HHI-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the measurement of the levels of hope among Greek oncology patients.

The Experience of Living With Breast Cancer and the Assessment of Needs and Expectations

Living with a chronic disease constitutes a biographical reversal characterized by change and loss. The aims of this study are to conceptualize the meaning of breast cancer, of its burden, to explore the patient's needs and expectations while being admitted to a palliative care unit, and to evaluate the fulfillment of those expectations. Two semistructured interviews were conducted, audio taped, transcribed verbatim, and subjected to the qualitative method of Interpretative Phenomenological Analysis. The first interview was conducted at the first visit of the patient to the palliative care unit, and the second after 2 weeks of receiving palliative care services. Qualitative findings indicated that the meaning of cancer can be interpreted as a transition of fading away. The transition began with redefining cancer from "my difficult moment" to "fortunately to its final destination"; struggling with the paradox of "the will to see the development of yourself and your child" and "wishing to die" while being able to "adapt" to "a balanced" day to day leaving and preparing for death. The need for interdisciplinarity is expressed.

Complementary Therapies for Patients with Cancer: Reflexology and Relaxation in Integrative Palliative Care. A Randomized Controlled Comparative Study

Objectives: Comparison of the effects of reflexology and relaxation on pain, anxiety, and depression, and quality of life (QoL) of patients with cancer. Design: A stratified random sample was selected, using an experimental design. Location: An outpatient Palliative Care Unit in Attica, Greece. Subjects: 88 patients suffering with cancer. Interventions: The sample was randomly divided into two equal groups, a reflexology and a relaxation group. The number of interventions for both groups was six 30-min weekly sessions. Outcome measures: The Greek Brief Pain Inventory (G-BPI) was used to measure pain, the Greek Hospital Anxiety and Depression Scale for screening anxiety and depression, and finally the Short Form Health Survey was used to measure QoL. Measurements of the above tools were taken three times in both groups as follows: preintervention, at fourth and at sixth week of intervention. Results: Anxiety and depression for both groups exhibited a statistically significant decrease during the observation period (p < 0.001, η² > 0.25) but at the sixth week, there was a more significant decrease in the reflexology group compared with the relaxation group (p = 0.062, η² = 0.044 vs. p = 0.005, η² = 0.096 for anxiety), (p = 0.006, η² = 0.094 vs. p = 0.001, η² = 0.138 for depression). QoL physical and mental component measurements were significantly greater for the reflexology group (p < 0.001, η² = 0.168 and p = 0.017, η² = 0.071, respectively). The baseline-to-sixth week G-BPI measurements were markedly decreased for the reflexology group (p = 0.207, η² = 0.020). Conclusions: Both interventions, relaxation and reflexology, seemed to be effective in decreasing anxiety and depression in patients with cancer. However, reflexology was found to be more effective in improving QoL (physical component) and to have a greater effect on pain management than relaxation.

Sexuality and quality of life of patients with hematologic malignancy and hematopoietic stem cell transplantation: a critical review

PURPOSE

This systematic review aims to investigate the relationship between sexuality and quality of life (QoL) of patients with hematological malignancies that underwent hematopoietic stem cell transplantation (HSCT).

METHODS

A bibliographic search was carried out through PubMed database with the following terms for the years 2008 to 2019: sexuality, sexual function, quality of life, hematopoietic stem cell transplantation.

RESULTS

Fourteen studies were included in the review. They present heterogeneity regarding measurement tools, time of measurement and type of HSCT. The common theme that emerged from most studies is that sexual dysfunction is reported after years of HSCT and it negatively impacts QoL. Women and allogenic HSCT with its consequences (graft versus host disease) were risk factors for sexual dysfunction. Sexual activity of HSCT patients was decreased at first but resumed after the first year. The most common sexual problems reported were erectile dysfunction for men and lack of desire for women. In the majority of studies the amelioration of physical, psychological symptoms and sexual function lead to improvement in QoL over time.

CONCLUSIONS

Sexuality and QoL of patients are affected by HSCT in varying degrees, and seems to be a significant and positive correlation between sexuality and QoL. However, with weaknesses and shortcomings in the revised studies' methodology (sample sizes, type of HSCT, attrition rates etc.), results are difficult to generalize.

Quality of Life, Anxiety, and Depression in the Head-and-Neck Cancer Patients, Undergoing Intensity-Modulated Radiotherapy Treatment

Aims:

The aim of this study is to investigate and compare distress and quality-of-life parameters among head-and-neck cancer patients who underwent intensity-modulated radiotherapy (IMRT).

Subjects and Methods:

The patients' sample consists of 55 individuals under IMRT treatment. Three questionnaires (Quality of Life Questionnaire [QLQ]-C30 and QLQ-H and N35) of the European Organization for the Research and Treatment of Cancer and the Greek Hospital Anxiety and Depression Scales were used.

Results:

Functioning and symptoms scales measured a week before the scheduled treatment worsen significantly until the end of the treatment and at the 3-month follow-up, tend to revert to their pretreatment values.

Conclusions:

Our results showed that all parameters (functioning scales, symptoms scales, and G-HAD subscales) worsen from the start to the end treatment and tend to revert to their pretreatment values after a 3-month period.

The effect of cancer patients' attachment orientations on their satisfaction of medical care

PURPOSE

To assess the effect of cancer patients' attachment patterns on their satisfaction of medical care.

METHODS

This was a cross-sectional design study performed in an outpatient palliative care clinic. The sample consisted of 100 cancer patients. Participants completed the Greek versions of patients' satisfaction, and attachment orientation to close others (Family, Close Friends, Medical Care Providers).

RESULTS

"Information/interaction with health-care professionals" subscale positively correlated with "disease duration". "Availability of care" subscale was negatively correlated with "discomfort with closeness", "anxiety", and "avoidance". "Information/interaction with health-care professionals" positively correlated with "metastasis", "chemotherapy", and "hormonotherapy", while "availability of care" had positive correlations with "education", "chemotherapy", and "hormonotherapy". Multiple regression model showed that "discomfort with closeness" was associated with "information/interaction with health-care professionals". Similarly, "chemotherapy" and "surgery" were positively associated with "information/interaction with health-care professionals". Disease duration was associated with increased satisfaction with "information/interaction with health-care professionals". Predictors of "availability of care" were "discomfort with closeness", "education", and "avoidance".

CONCLUSIONS

"Chemotherapy", "surgery" and "discomfort with closeness" predicted low satisfaction with "information/interaction with health-care professionals", while "discomfort with closeness" and "avoidance" predicted low satisfaction with "availability of care" and at the same time a high level of "education" predicted patients' satisfaction with "availability of care".

A Systematic Review of Sexuality and Depression of Cervical Cancer Patients

Objectives: The goal of this article is to investigate the correlation between sexuality and depression of cervical cancer (CC) patients. Methods: A bibliographical search was carried out in the databases CINAHL, PubMed, and Cochrane Library with the following terms in English for the years 2006 to 2017: sexuality, sexual function, sexual dysfunction, sexual problems, mood, depression, emotional distress, cervical cancer. Results: Fourteen studies were included. They present heterogeneity in the stage of the disease, the selected treatments, and their sample. From the studies, only 7 are evaluated as good methodologically. Sexual dysfunction and depression of CC patients persist for many years after treatments. The younger women, those who underwent radiotherapy, and those who had chronic fatigue, as an aftereffect of treatments, had increased depression. Women that underwent surgery and adjuvant therapy experienced the highest rates of depressive symptoms. There is a positive relationship between sexuality and depression in patients with CC. Conclusions: Sexuality and depression οf women with CC are affected by their therapies to a significant extent. There is a positive correlation between the two variables. The existing methodologically good studies are scarce, and for this reason the results cannot be generalized in all CC patients.

Depression as a Mediator or Moderator Between Preparatory Grief and Sense of Dignity in Patients With Advanced Cancer

The objectives of the study were to evaluate the relationship between depression, preparatory grief, and loss of dignity in patients with advanced cancer and whether depression has a mediator and/or a mediator role between preparatory grief and dignity. The participants were 120 patients with advanced cancer who completed the Greek version of the Patient Dignity Inventory, the Greek Hospital Anxiety and Depression Scale, and the Preparatory Grief in Advanced Cancer Patients questionnaire. Depression was highly correlated with preparatory grief and loss of dignity. Additionally, strong relationship was found between preparatory grief and loss of dignity. Mediation analyses revealed that preparatory grief influenced loss of dignity as well as indirectly by its effect on depression. However, there was not any affect of depression as moderator. The effect of depression on preparatory grief in patients with advanced cancer and dignity emphasizing the need for further research to confirm the current relationship as well as the need for treatment of depression.

Psychometric Properties of the Multidimensional Scale of Perceived Social Support in Greek Nurses

BACKGROUND

Psychosocial well-being in the workplace may increase retention of oncology nurses, while a lack of social support has been a predictor of occupational stress in nurses.

PURPOSE

To further explore this phenomenon by examining the psychometric properties of the Multidimensional Scale of Perceived Social Support in Greek nurses working in oncology and mental health settings.

METHODS

A cross-sectional design was used. The sample consisted of 150 nurses (70 oncology nurses and 80 mental health nurses) from the area of greater Athens who joined the study. The scale was translated to Greek using the "forward-backward" procedure. The Multidimensional Scale of Perceived Social Support's internal consistency reliability (Cronbach's α), stability (intraclass correlation coefficient), factor structure (factor analysis), and convergent validity (correlation with Ways of Coping Questionnaire) were examined.

RESULTS

A three-factor (significant others, family, and friends) model was confirmed. The subscales representing the three factors demonstrated excellent internal consistency reliability (Cronbach's αs > .90) and stability intraclass correlation coefficient (>.90).

CONCLUSIONS

The measure is reliable and valid, and it can be used to assess nurses' social support; the results of such an assessment could be helpful when selecting strategies for assisting nurses.

Factors Affecting Opioid Treatment in Cancer Patients

Purpose: Pain is prevalent in cancer patients, appearing to be moderate to severe in more than one third of them. Despite the fact that fentanyl is widely used with effective analgesic results, some patients do not correspond to treatment, resulting in opioid change. Methods: This is a cohort study, performed in Greek patients with cancer. Its scope was to identify potential reasons responsible for opioid change, due to transdermal-fentanyl intolerance, resulting from inadequate analgesia (pain relief<33% in 1week) and/or unacceptable adverse-events (grade≥3 at Common Terminology Criteria-v4.0). The final sample included 289 participants. To investigate responsible reasons for transdermal-fentanyl intolerance we studied its relation with patients’ history, haematology, biochemistry, body-mass-index, demographic and disease related characteristics. The Eastern Cooperative Oncology Group performance status scale, the Mini Mental State Examination questionnaire, the M.D.Anderson Symptom Inventory and the Greek Brief Pain Inventory were also used to measure performance status and quality-of-life for the same reason. Results: Almost one third of the patients had to change to an alternative opioid oral-morphine in order to achieve adequate analgesia or/and avoid adverse-events. The most common adverse-events observed were nausea/vomiting and sleepiness. Statistical analysis demonstrated that younger age (OR=0.976) and obesity (OR=0.29 against underweight, OR=0.39 against normal, OR=0.48 against pre-obese) had a higher possibility to contribute to modification of the analgesic treatment. Furthermore, a higher impact of symptoms in patient’s life (OR=1.184) and chemotherapy (OR=2.109) could also contribute to the need of change of the opioid analgesic medication. Conclusion: This study found significant variables for transdermal-fentanyl intolerance. This knowledge may help person-center care in moderate to severe cancer pain. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Personalized Symptom Goals and Patient Global Impression on Clinical Changes in Advanced Cancer Patients

BACKGROUND

The aim of this study was to assess the patients' global impression (PGI) after symptom management, as well as the achievement of personalized symptom goals (PSG). The secondary outcome was to assess related factors.

SUBJECTS, MATERIALS, AND METHODS

Advanced cancer patients admitted to palliative care units rated symptom intensity by using the Edmonton Symptom Assessment Score (ESAS) at admission and then after 1 week. For each symptom, patient-reported PGI and PSG, as well as the rate of PSG response, were evaluated.

RESULTS

Eight hundred seventy-six patients were taken into consideration for this study. A mean of 1.71-2.16 points was necessary to perceive a bit better improvement of symptom intensity. Most patients had a PSG of ≤3. A statistically significant number of patients achieved their PSG after starting palliative care. Patients with high intensity of ESAS items at admission achieved a more favorable PGI response. In the multivariate analysis, symptom intensity and PSG were the most frequent factors independently associated to a best PGI, whereas high levels of Karnofsky had a lower odd ratio.

CONCLUSION

PSG and PGI seem to be relevant for patients' assessment and decision-making process, translating in terms of therapeutic intervention. Some factors may be implicated in determining the individual target and clinical response.

IMPLICATIONS FOR PRACTICE

Personalized symptom goals and global impression of change are relevant for patients' assessment and decision-making process, translating in terms of therapeutic intervention. Some factors may be implicated in determining the individual target and clinical response.

Advanced Cancer Patients’ Perceptions of Dignity

Purpose:

The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics.

Methods:

The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory–Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS).

Results:

Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity.

Conclusions:

Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

Psychometric Properties of the Greek Version of the Patient Dignity Inventory in Advanced Cancer Patients

CONTEXT

The patient dignity inventory (PDI) is an instrument to measure dignity distressing aspects at the end of life.

OBJECTIVES

The aims of the present study were the translation of the PDI in Greek language as well as to measure its psychometric aspects in a palliative care unit.

METHODS

A back-translation method was obtained at the Greek version. One hundred twenty advanced cancer patients completed the Greek version of the PDI, the Greek hospital anxiety and depression scale, the Greek schedule of attitudes toward hastened death (SAHD-Gr), and the Greek 12-item short form health survey.

RESULTS

Confirmatory factor analysis failed to fit to the original instrument's structure and exploratory factor analysis was conducted revealing five factors ("Psychological Distress," "Body Image and Role Identity," "Self-Esteem," "Physical Distress and Dependency," and "Social Support"). The psychometric analysis of the PDI-Gr demonstrated a good concurrent validity, and the instrument discriminated well between subgroups of patients regarding age differences. Cronbach α were between 0.71 and 0.9 showing a good internal consistency.

CONCLUSION

The Greek version of the PDI showed good psychometric properties in advanced cancer patients, supported the usefulness of the instrument assessing the sense of dignity distressing aspects of the terminally ill cancer patients.

Assessing Spirituality and Religiousness in Advanced Cancer Patients

The aim of this study was to translate the Spiritual Involvement and Beliefs Scale into the Greek language and validate its psychometric properties in a sample of advanced cancer patients treated in a palliative care unit. The scale was translated into Greek with the “forward-backward” procedure. It was administered twice, with a 3-day interval, to 82 patients with advanced cancer. Patients completed the Spiritual Involvement and Beliefs Scale and the Greek Hospital Anxiety and Depression Scale. The scale had an overall Cronbach α of 0.89. Overall test-retest reliability was satisfactory at P < .0005. Satisfactory construct validity was supported between the Spiritual Involvement and Beliefs Scale subscales and Hospital Anxiety and Depression subscales. Interscale and interitem correlations were found satisfactory at P < .0005. These results support that the Spiritual Involvement and Beliefs Scale is an instrument with satisfactory psychometric properties and is a valid research tool for spirituality in advanced cancer patients.

A prospective randomized controlled clinical trial of zoledronic acid for bone metastases

In this study, we assessed the safety, tolerability, and effectiveness of two therapeutic regimens relating to the frequency of zoledronic acid (ZOL) infusion. Sixty adult patients with bone metastases were randomly assigned to two study groups. The first group (group A) received 4 mg ZOL every two weeks, and the second group (group B) received 4 mg ZOL every four weeks. Assessment measures included C-telopeptide (CTX) rate, the Greek Brief Pain Inventory (GBPI), the linear analogue scale assessment (LASA) of quality of life, and biochemical markers. Assessments were made at weeks 12, 24, 36, and 48. Clinical endpoints included effective decrease in bone resorption markers, pain relief, and improvement of mobility status. The follow-up period was 48 weeks. No statistically significant differences between groups A and B were found in overall profile of biochemical markers, Eastern Cooperative Oncology Group (ECOG) performance status, and GBPI score at the end of the follow-up period. Assessment of bone metastases revealed a slight difference between the two groups, however this difference was not statistically significant. These findings indicate that administering zoledronic acid at four rather that two weeks has no significant impact on overall outcome.

The Attitudes of Greek Physicians and Lay People on Euthanasia and Physician-Assisted Suicide in Terminally Ill Cancer Patients

The purpose of this article is to explore the attitudes of lay people and physicians regarding euthanasia and physician-assisted suicide in terminally ill cancer patients in Greece. The sample consisted of 141 physicians and 173 lay people. A survey questionnaire was used concerning issues such as euthanasia, physician-assisted suicide, and so forth. Many physicians (42.6%) and lay people (25.4%, P = .002) reported that in the case of a cardiac and/or respiratory arrest, there would not be an effort to revive a terminally ill cancer patient. Only 8.1% of lay people and 2.1% of physicians agreed on physician-assisted suicide ( P = .023). Many of the respondents, especially physicians, supported sedation but not euthanasia or physician-assisted suicide. However, many of the respondents would prefer the legalization of a terminally ill patient's hastened death.

Bone Density as a Marker of Response to Radiotherapy in Bone Metastatic Lesions: A Review of the Published Data

Metastases to the bone are presenting in a great percentage of patients with cancer, causing a variety of symptoms, affecting the quality of life and survival of patients. A multidisciplinary approach from different health providers is required for treatment, including radiation oncologists, medical oncologists and surgeons. The role of radiotherapy in the management of bone metastases has long been established through multiple randomized trials. The estimation of response to the therapy is subjective and is based on the palliation of the symptoms that the patients report. However, a quantification of the tumor burden and response to the treatment with the use of an objective method to measure those parameters is a clinical expectation in oncology. The change in bone density in affected areas (mainly lytic) after local radiotherapy, representing the cellular changes that have occurred, is a promising marker of response to treatment.

Death and Grief in the Greek Culture

None would disagree that death is the great separator. Death has many meanings, and they change with culture and society. In the Greek mythology, the dead journeyed to the Afterlife, ruled by Hades. Death was not perceived as an end in and by itself, but rather as another “world” to belong to. By Classical times there was a rise to burial rituals and commemorative practices, carried out throughout the centuries. Christian religion attempted to change the way the dead were mourned, and preached the immortality of the soul and resurrection of the dead. Nevertheless, the way people grieved and buried their dead has not changed much. The only change is a difficulty in the receptiveness of burial procedures, observed in large cities and in younger population. Today in Greece, the perceptions and practices on grief and death derive both on the ancient and the Christian Orthodox traditions.

Attachment orientations of Greek cancer patients in palliative care. A validation study of the Experiences in Close Relationships scale (ECR-M16)

PURPOSE

Health-care professionals may serve as attachment figures, nevertheless little research has been made in the palliative context. The psychometric properties of the brief ECR-M16 in Greek cancer patients were explored.

METHODS

The ECR-M16 was translated into Greek (G-ECR-M16), and was administered to 100 patients before starting palliative care and 7 days later to test its stability. Patients (N=35) also completed the EORTC QLQ-C30 scales.

RESULTS

Cronbach's alphas for the discomfort for closeness, anxiety and avoidance scales were 0.871, 0.762, and 0.761, respectively. Test-retest reliability was very satisfactory (p< 0.0005). Factor analysis yielded three factors (58.75% of the variance). Known-groups validity showed that discomfort with closeness had a statistically significant correlation with advanced disease stage (p=0.022).

CONCLUSIONS

The G-ECR-M16 is a valid research tool for the attachment patterns' impact in Greek cancer patients.

Psychometric Properties of the Patients' Satisfaction Instrument FAMCARE-P13 in a Palliative Care Unit

PURPOSE

To investigate the psychometric properties of the Greek 13-item measure of patients' satisfaction (FAMCARE-P13) in palliative care setting.

METHODS

A hundred patients completed the FAMCARE-P13. Exploratory factor analysis and confirmatory factor analysis (CFA) have been conducted. Two factors' solution was revealed from CFA. The questionnaire was administered to an initial validation sample and then for test-retest in a sample of 40 patients 3 days later. The Rosenberg Self-Esteem Scale measuring global self-esteem has been also used as a gold standard for construct validity. Subscale and known groups validity have also been tested for FAMCARE-P13s' validity.

RESULTS

A reduced 13-item version of our measure (FAMCARE-P13) possessed 2-factor structure with high reliability. Patient satisfaction was correlated with physical distress, communication and relationship with health-care providers, and caregiver satisfaction.

CONCLUSIONS

We recommend the use of the Greek FAMCARE-P13 to assess care satisfaction of patients with advanced-stage cancer.

Hypothesis: Is heroin a 'barrier' against cancer? A retrospective analysis of heroin-addicted individuals untreated for opioid dependence between 2001-2010

PURPOSE

The findings of previous studies attracted our interest in searching and defining the percentage of deaths from cancer in 'heroin regular addicts' i.e. those who had never stopped taking the drug since they started.

METHODS

The archives of the Greek Reitox Focal Point of the years 2001 to 2010 were retrospectively searched, focusing on the number of deaths from cancer of the regular heroin addicts.

RESULTS

The records from 2,321 regular heroin addicts showed that none of them died from cancer. It seems that heroin might act as a "barrier" against cancer.

CONCLUSION

Further studies are needed to confirm our results and to explore the potential cause for this surprising finding.

Splenic irradiation as palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis: a multi-institutional experience

PURPOSE

To evaluate the impact of splenic irradiation as a palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis.

METHODS

Seventeen patients with chronic myelogenous leukemia and 3 with idiopathic polycythaemia presented with splenomegaly, splenic pain and anemia. Due to symptomatic splenomegaly, despite first-line treatment, the patients underwent splenic irradiation. Two patients received two different schedules of external radiotherapy (580 cGy in 5 fractions and 600 cGy in 6 fractions). Eight patients received 980 cGy in 14 fractions. Ten patients received two courses of 360 cGy in 6 fractions, 3 months apart. Median follow-up was 12 months post irradiation.

RESULTS

The patients showed excellent response to treatment one month post-radiotherapy, while treatment was well tolerated without severe toxicity. The dimensions of the spleen decreased significantly. Pain-related Visual Analogue Score (VAS) regressed after completion of irradiation. During 12-month follow-up all patients maintained the benefit of radiotherapy.

CONCLUSION

This study indicates that splenic irradiation could be a safe and effective palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis.

The impact of radiotherapy on symptoms, anxiety and QoL in patients with cancer

AIM

To evaluate prospectively disease- and treatment-related symptoms, anxiety and quality of life (QoL), in patients with different types of cancer undergoing external-beam radiotherapy (RT) and examine the relationship among them, at baseline and at the end of the treatment.

PATIENTS AND METHODS

This study included 90 patients with cancer. Patients' QoL was evaluated using the Linear Analog Scale Assessment (LASAs) questionnaire, anxiety was measured with the Spielberger state and trait inventory (STAI), while symptoms were assessed using the MD Anderson Symptom Inventory (MDASI). The assessments were carried-out at baseline and at the end of RT.

RESULTS

At baseline, the QoL scores were reduced (7.5±6.5) and MDASI elevated (2.35±1.7). Patients' QoL was correlated with symptoms (r=-0.684, p=0.0005). A correlation was found between STAI-trait with MDASI scores (r=0.214, p=0.046). At the second assessment, there were significant correlations between MDASI and QoL (r=-0.68, p=0.0005). The STAI-trait had a moderate correlation with MDASI score (r=0.43, p=0.0005) and with QoL (r=-0.253, p=0.0017).

CONCLUSION

The present study showed a significant impact of symptoms and high levels of anxiety following RT, which correlated with a compromised QoL. The worsening in patients' perception of their QoL did not seem to lead to a significant reduction in daily activities or treatment tolerance.

Samarium-153Sm-EDTMP as an equivalent variant to pharmaceutical analgesic treatment

PURPOSE

Cancer pain is the most serious symptom for patients, especially during their terminal phase, when palliative medicine is needed. Our study tried to verify the usefulness of single-shot intravenous administration of Samarium (Sm)-153EDTMP in patients with bone metastases (group-A, N=53, males=25, females=28, age range: 30-69 years), as well as to compare a series of variables, using as a control group (group-B, N=37, males=17, females=20, age range: 30-69 years) with patients who were under drug treatment given from a physician specialized in palliative medicine.

METHODS

Both groups answered the following questionnaires: Greek Brief Pain Inventory (GBPI), Brief Multidimensional Life Satisfaction Scale (BMLSS), Hospital Anxiety Depression Scale (HADS) and ECOG performance status.

RESULTS

Pain severity and pain interference improvement p=0.0005 for both groups. HADS-anxiety: Samarium group, p= 0.397, drugs group p= 0.031. HADS-depression improvement for both groups p=0.031 and p=0.003, respectively. BMLSS improvement p=0.029 and p=0.265, while EGOG PS improvement was p=0.005 and p=0.014, respectively (numeric values).

CONCLUSION

Intravenous administration of Sm-153EDTMP was equivalent to drug treatment against cancer pain for patients with multiple bone metastasis, an option for those patients who are intolerant or resistant to drug treatment. Samarium-treated patients needed less or not at all pain killers, having a better cost-effective result.

The influence of sense of control and cognitive functioning in older cancer patients' depression

OBJECTIVE

This study aimed to evaluate the associations between depression, sense of control, and cognitive functioning, as well as the predictive power of sense of control and cognitive functioning in older cancer patients' depression.

METHODS

Eighty-six cancer patients were referred to a palliative care unit. They completed the 15-item Geriatric Depression Scale, the Cancer Locus of Control, and the Mini Mental State Examination questionnaires.

RESULTS

Higher perceived control over the 'course of illness' was associated with higher levels of depressive symptoms (p < 0.0005), whereas lower perceived control over the 'cause of illness' was associated with higher depressive symptoms. The same results were found for 'cause of illness' between non-depressed and depressed patients (p = 0.001). Multivariate analysis revealed that whereas an external orientation in 'course of illness' increased the likelihood of depression (p = 0.002), an external orientation in 'cause of illness' decreased the likelihood of depression (p = 0.05).

CONCLUSIONS

Older cancer patients' sense of control orientation over the course of illness and the cause of illness predicted the levels of depressive symptomatology.

Locus of control and distressing symptoms in young cancer patients when assessing depression

PURPOSE

The aim of the current study was to evaluate the correlation between depression, sense of control (internal and external) and cancer-related distressing symptoms in younger patients (<65 years) with locally advanced or metastatic cancer, and to investigate their potential predictive role when screening for depression.

METHODS

70 patients completed the Beck Depression Inventory (BDI), the Cancer Locus of Control Scale, the Linear Analogue System Assessment (LASA) (for Quality of Life/ QoL) and the M.D. Anderson Symptom Inventory (MDASI). Distressing symptoms, QoL, and locus of control (LOC) were correlated with the presence of depression.

RESULTS

The total BDI score was suggestive of depression. In univariate analysis significant correlations were found between the presence of depression and poor QoL, low Eastern Cooperative Oncology Group performance status and 'sense of control over the course of cancer' (p<0.0005). Depression was significantly correlated with pain, distress and poor general activity, overall enjoyment of life and relationships (p=0.004), as well as anxiety, fatigue, anorexia, dyspnoea and sleep disturbances (p=0.001). Multivariate analysis demonstrated that poor QoL and 'sense of control over the course of cancer', as well as anxiety, fatigue, anorexia, dyspnoea and sleep disturbances were significantly correlated with depression (p<0.0005).

CONCLUSIONS

We suggest that younger cancer patients' poor QoL, 'sense of control over the course of cancer', as well as anxiety, fatigue, anorexia, dyspnoea and sleep disturbances are significantly correlated with the presence of depression and can eventually represent potential screening predictors.

Irradiation Toxicity and Inflammatory Bowel Diseases (IBD): Review

BACKGROUND/AIM

The evaluation of radiotherapy toxicity in oncologic IBD patients. Defining the optimal patient and treatment factors that would be able to reduce the risk to organs.

MATERIALS AND METHODS

A review of all published radiotherapy trials was performed to identify the clinical and treatment factors of inflammatory bowel disease's patients treated for different solid tumors.

RESULTS

Overall, acute (Grade ≥ 3) gastrointestinal complications attributable to RT ranged between 20-21% of the treated patients. A late Grade ≥ 3 gastrointestinal toxicity was developed in a range between 8-29%.

CONCLUSION

A special attention should be given to the description of IBD location, activity status, concurrent chemotherapy, irradiation dose and technique, in order to minimize post-irradiation morbidity. It is not easy to distinguish late morbidity attributable to radiotherapy due to the IBD itself.

The key role of bisphosphonates in the supportive care of cancer patients

The present review aims at providing an assessment of the clinical significance of Biphosphonates (BPs) in the treatment of patients with cancer.

MATERIALS AND METHODS

A systematic literature review was performed based on database search in PubMed/Medline and included articles up to August 2013.

RESULTS

BPs can reduce, delay, and prevent complications related to bone metastases. They improve mobility, functionality, pain, and quality of life. They limit survival of any inactive cancer cells in the microenvironment of the bone marrow, contributing to their death from anti-neoplastic treatments. Moreover, they limit and delay bone morbidity due to osteoporosis related to hormonotherapy in breast and prostate cancer. Finally, benefits can be derived from the combination of BPs with radiotherapy in bone density, recalcification, opioid use, and patient's quality of life and performance status.

CONCLUSION

The contribution of BPs in the course of certain neoplasms is preventive and synergistic to other treatments.

Measurement of blood phosphorus: a quick and inexpensive method for detection of the existence of cancer in the body. Too good to be true, or forgotten knowledge of the past?

The possible elevation of phosphorous (P) in cancer patients blood serum has been reported in the past. This however seems to have passed unnoticed. One hundred individuals, divided into two groups of fifty each, i.e. cancer patients (group A) and healthy individuals (group B), were included in this retrospective study. The incidence of cancer by site in group A was 24% head and neck, 50% non-small cell lung cancer (SCLC) and 26% cervical cancer. In all cancer patients in group A the serum P was over the normal values, in contrast with the normal values of P measured in group B. The mean value of serum P in group A and B were 7.80 (± 2.24) and 3.38 (± 0.58), respectively (P<0.001, Mann Whitney test). Increased amount of phosphorus in the blood, when other causes justifying the increase were excluded, should be considered as indicative for the existence of unidentified cancerous lesions.

Breakthrough cancer pain: an observational study of 1000 European oncology patients

CONTEXT

Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients.

OBJECTIVES

The aim of this study was to characterize breakthrough pain in a diverse population of cancer patients.

METHODS

The study involved 1000 cancer patients from 13 European countries. Patients were screened for breakthrough pain using a recommended diagnostic algorithm and then questioned about the characteristics and management of their pain.

RESULTS

Of the 1000 patients, 44% reported incident pain, 41.5% spontaneous pain, and 14.5% a combination. The median number of episodes was three a day. The median time to peak intensity was 10 minutes, with the median for patients with incident pain being five minutes (P < 0.001). The median duration of untreated episodes was 60 minutes, with the median for patients with incident pain being 45 minutes (P = 0.001). Eight hundred six patients stated that pain stopped them doing something, 66 that it sometimes stopped them doing something, and only 107 that it did not interfere with their activities. Patients with incident pain reported more interference with walking ability and normal work, whereas patients with spontaneous pain reported more interference with mood and sleep. As well, 65.5% of patients could identify an intervention that improved their pain (29.5%, pharmacological; 23%, nonpharmacological; 12%, combination). Regarding medications, 980 patients were receiving an opioid to treat their pain, although only 191 patients were receiving a transmucosal fentanyl product licensed for the treatment of breakthrough pain.

CONCLUSION

Breakthrough cancer pain is an extremely heterogeneous condition.

The influence of distressing symptoms to levels of depression in cancer patients

PURPOSE

Our objectives were to identify the depression and the distressing symptoms in younger and elderly advanced cancer patients.

METHODS

: The instruments that have been used were the Beck Depression Inventory (BDI) for younger patients, the Geriatric Depression Scale (GDS) for geriatric patients and the M. D. Anderson Symptom Inventory (MDASI) for the severity and impact of cancer-related symptoms.

RESULTS

A trend for significant correlation was found between the GDS and MDASI symptoms for nausea (p=0.058), while a significant correlation was observed for increased sadness (p=0.011), increased constipation (p=0.021), interference of symptoms in mood (p=0.012) and in relations with people (p=0.007); interference of symptoms in mood was the most important risk factor. For younger patients, many statistically significant associations were found between distressing symptoms and depression; however, interference of symptoms in mood (p=0.045) was the only important risk factor.

CONCLUSION

Health-care professionals should take into consideration the risk factors for depressive symptoms suggesting a holistic care in advanced cancer patients.