Care of Cancer Survivors: Distress and Mental Health

In 2022, it was estimated that 18.1 million US adults were cancer survivors. By 2032, this number is projected to increase to 22.5 million. All patients with cancer experience some degree of psychological distress associated with the diagnosis. This can include mental health conditions, most commonly anxiety and depression. Management of such conditions in cancer survivors begins with detection via screening. Commonly used screening tools include the National Comprehensive Cancer Network (NCCN) Distress Thermometer, the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Patient Health Questionnaire-9 (PHQ-9). Initial management involves patient education and psychotherapy. If needed, pharmacotherapy is similar to that for patients in the general population. Of note, several commonly prescribed antidepressants have been shown to decrease the effects of tamoxifen, which breast cancer survivors may be taking as adjuvant endocrine therapy. Integrative medicine therapies, such as music interventions, yoga, mindfulness meditation, and exercise, have shown benefit. Patients undergoing treatment should have outcomes assessed. Thoughts of self-harm or suicidal ideation are common among cancer survivors with mental health conditions. Clinicians should regularly ask patients about suicidal ideation. If present, this indicates the need for more intensive or altered treatment.

Patient-centered home cancer screening attitudes during SARS-CoV-2 pandemic

COVID-19 has caused disruptions in health care, in particular cancer screenings. The primary aim of our work was to evaluate the degree to which populations were accepting of home-based screenings for colorectal cancer (CRC) and cervical cancer (primary HPV testing). Three groups of adults having distinct health burdens which may affect acceptance of home-based cancer screening were identified through outpatient electronic medical records as follows as either having survived a COVID hospitalization, having been positive for non-COVID respiratory illness or having type 2 diabetes. 132 respondents (58% female) completed an online survey with hypothetical cases about their acceptance of home-based CRC or cervical cancer screening. Among females, urine and vaginal screening for primary HPV testing was acceptable to 64% and 59%, respectively. Among both males and females, CRC home screening with fecal immunochemical test (FIT) or Cologuard was acceptable to 60% of the respondents. When adjusting for education, women with a positive attitude toward home-based urine /vaginal screening were 49 times and 23 times more likely to have a positive attitude toward CRC screening (aOR=48.7 (95% CI: 7.1, 337) and aOR=23.2 (95% CI: 3.8, 142), respectively). This report indicates that home-based cancer screens for CRC and primary HPV testing are acceptable to men and women and may allow for greater compliance with screening in the future.

Patient-Centered Home Cancer Screening Attitudes During COVID-19 Pandemic

The COVID-19 pandemic disrupted health care delivery of cancer screenings. The primary aim of our work was to evaluate the degree to which populations were accepting of home-based screenings for colorectal cancer (CRC) and cervical cancer (ie, primary human papillomavirus [HPV] testing). Three groups of adults having distinct health burdens that may affect acceptance of home-based cancer screening were identified through outpatient electronic medical records: those having survived a COVID-19 hospitalization; those having been positive for a non-COVID-19 respiratory illness; or those having type 2 diabetes. A total of 132 respondents (58% female) completed an online survey with hypothetical cases about their acceptance of home-based CRC or cervical cancer screening. Among women respondents, urine and vaginal screening for primary HPV testing was acceptable to 64% and 59%, respectively. Among both men and women, at-home CRC screening with fecal immunochemical test or Cologuard^® was acceptable to 60% of the respondents. When adjusting for education, women with a positive attitude toward home-based urine and vaginal screening were 49 times and 23 times more likely, respectively, to have a positive attitude toward CRC screening. These findings indicate that home-based cancer screens for CRC and primary HPV testing are acceptable to men and women and may allow for greater compliance with screening in the future.