Trait mindfulness and the mental and physical health of caregivers for individuals with cancer

BACKGROUND

Mindfulness plays a role in moderating the negative mental and physical health outcomes associated with caregiving. The aims of this study were to examine the relationship between trait mindfulness and the (1) psychological functioning, (2) health behaviors, (3) and physical health of caregivers for individuals diagnosed with cancer.

METHODS

Caregivers completed a battery of questionnaires and examinations assessing sociodemographic characteristics, trait mindfulness, depression, perceived stress, caregiver stress, sleep, diet, physical activity, tobacco use, alcohol use, blood pressure, and BMI. Demographics and cancer diagnostics were collected for the individuals whom caregivers supported. Linear regression, multivariate analyses, and moderator analyses were performed.

RESULTS

Of the 78 caregivers, the mean age was 63.9 (S.D.=13.1); 59% identified as female; 97% identified as White. Regression analyses indicated that caregivers who reported higher levels of trait mindfulness reported significantly less perceived stress (b= -4.38, SE= 0.88, p <.001), lower levels of depression (b= -3.74, SE= 1.10, p = .001), greater caregiver quality of life (b= -9.05, SE=2.12, p < .001), better sleep quality (b= -0.98, SE=0.44, p = 0.03), and lower rates of tobacco use (b= -10.12, SE= 3.43, p =.003). Trait mindfulness was not significantly related to diet, alcohol use, blood pressure, or BMI.

CONCLUSIONS

Higher levels of trait mindfulness are associated with positive mental and physical health measure for caregivers. Future research would benefit from further examining mindfulness-based interventions and their impacts in mitigating the negative toll of caregiving in the context of cancer.

Robotic-assisted pancreaticoduodenctomy at a high-volume pancreas center

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Background: Robotic-assisted pancreatic surgery is gaining momentum due to improved ergonomics, dexterity, and visualization compared to standard laparoscopy. These technical advantages in combination with experience and improved robotic technology may reduce the significant morbidity associated with pancreaticoduodenectomy (PD).

Methods: Retrospective analysis of consecutive robotic-assisted PD performed for all indications. Patients with potentially resectable tumors were selected for robotic PD on the basis of our EUS/CT predictive model. We evaluated perioperative events, final pathology, and complications occurring within the first 30 days on an intention-to-treat basis.

Results: 42 robotic-assisted PD (22 women) were attempted between October 2008 and June 2010. Mean age was 67 years (SD=16, range 27-85), with median BMI 26.5 (IQR=7.8). 52.4% of patients had an ASA score of III. Final pathology included 13 pancreatic ductal adenocarcinoma, 9 peri-ampullary adenocarcinoma, 8 pancreatic neuroendocrine tumors, 5 IPMN, 2 cholangiocarcinoma, 2 pseudo-papillary neoplasm, 1 serous cystadenoma, 1 mucinous cystic neoplasm, and 1 duodenal adenoma. The first 34 patients underwent classic PD, and the final 8 patients had pylorus-preserving PD. Conversion to open was necessary in 8 patients (19%). Mean operative time was 576 min (SD=327, range 327-848 min) with 400mL median estimated blood loss (IQR=475). For malignancies, the R0 resection rate was 88% (4/34) with mean lymph node harvest of 17 (SD=7.3, range 8-37). The pancreatic fistula rate was 21% with ISGPF Grades B and C leaks observed in 9.6%. 10 patients (23.8%) developed minor complications (Clavien grade 1/2), whereas 11 had major complications (26.2%). There was one late death (2.4%). Median length of stay was 10 days (IQR=5). Statistically significant reductions in estimated blood loss (643mL vs. 317mL, p=0.003) and conversion to open (7 vs. 1, p=0.02) were observed in the latter half of the series.

Conclusions: Robotic-assisted PD can be performed safely with postoperative and oncologic outcomes comparable to open surgery. The learning curve continues to evolve after 40 cases.

No significant financial relationships to disclose.

Expressed emotion, depression, and survival in patients diagnosed with hepatobiliary carcinoma

e20597

Background: The aims of the present study were to (1) investigate the association between expressed emotion, health related quality of life, and depression, and (2) explore the association between expressed emotion and survival in patients diagnosed with hepatobiliary carcinoma. Methods: The study was prospective in design. Ninety-six patients diagnosed with hepatobiliary carcinoma were administered a battery of questionnaires that measured depression, health-related quality of life, and expressed emotion. Medical chart review was used to gather disease specific information. Mann Whitney U and Kruskal Wallis tests were performed to test differences between groups and Cox regression analyses were performed to test predictors of survival. Results: At diagnosis, 54% of the patients reported a CES-D score ≥ 16 (clinical range). Patients who reported CES-D scores in the clinical range were found to have significantly lower overall health related quality of life (Mann Whitney U= 506, p = 0.003) and in particular lower emotional (Mann Whitney U=551, = 0.009) and functional well being (Mann Whitney U=507.5, p = 0.003). Patients who reported CES-D scores in the clinical range also reported a higher frequency of cancer-related symptoms (Mann Whitney U=503.5, p= 0.002) at diagnosis using the FACT-Hepatobiliary module. Patients who reported lower levels of emotional expression were found to have higher levels of depression (Mann Whitney U-6.6, p=0.04) and lower social and family well-being (Mann Whitney U=6.4, p=0.04). Using Cox regression, sociodemographic and disease-specific characteristics, depression, and expressed emotion were entered into a model. Significant predictors of survival included greater number of lesions (p=0.04), larger size of tumor (p=0.02), and lower levels of emotional expression (p=0.03). Conclusions: Preliminary findings suggest that patients with low levels of emotional expression reported higher rates of depression, poorer quality of life, and shorter survival. Interventions should be developed to treat symptoms of depression to improve quality of life. Expression of both positive and negative emotions should be encouraged by health care professionals.

No significant financial relationships to disclose.

Effects of lipodystrophy on quality of life and depression in HIV-infected men on HAART

The aim of the study was a prospective assessment of the possible consequences of a diagnosis of lipodystrophy on health-related quality of life (HRQL) and depressive symptomatology in HIV-seropositive men who have sex with men. A standardized physical assessment for lipodystrophy was introduced within a prospective study in April 1999. Over a 2-year follow- up, 37 HIV-seropositive men who met the criteria for lipodystrophy were longitudinally compared to 92 HIV-seropositive men without lipodystrophy and 88 HIV-seronegative men on measures of HRQL and depression. A series of questionnaires, which included the Medical Outcomes Study Short-Form 36 (SF-36) and the Center for Epidemiological Studies-Depression (CES-D), were administered to assess HRQL and depression, respectively. SF-36 scores were summarized using the mental and physical components; CES-D results were reported as both dichotomous (with or with clinical depression) and continuous scores. Neither the mental nor physical components of the SF-36 showed any significant differences between patients with lipodystrophy versus HIV-seropositive patients without lipodystrophy. Similarly, lipodystrophy status was not significantly associated with either continuous depression scores or presence of clinical depression. However, consistent with previous results, HIV-seropositive men without lipodystrophy (compared to HIV-seronegative men) reported higher scores on both components of the SF-36 scales and both categorizations of the CES-D. The results of this study suggest that lipodystrophy does not negatively affect HRQL or depression, above and beyond, the diagnosis of HIV infection, although the impact of the severity of lipodystrophy on these conditions will require further study.

Depression, immunity, and survival in patients diagnosed with hepatobiliary carcinoma

18525

Background: Depression has been found to be associated with increased morbidity and mortality in healthy adults. The prevalence of depression in patients diagnosed with cancer, and in particular hepatobiliary carcinoma (HBC), is significantly higher than the general population. The aims of the present study were to: (1) examine the prevalence of depressive symptoms in patients with HBC, (2) test the relationship between depressive symptoms and survival, and (3) begin to explore underlying mechanisms that explain the relationship between depression and survival in patients with HBC. Methods: 101 patients diagnosed with HBC were administered a battery of questionnaires which included the Center for Epidemiological Studies-Depression (CES-D) questionnaire. Disease-specific data was gathered from medical charts and survival was measured from the date of diagnosis to death. Immune markers (NK cell, IL-4 and 5, TNF, and IFN) were collected in 24 patients. Results: At diagnosis, 39% of the sample reported a score of 16 or greater (clinical range). Using Cox Regression, demographic (age, gender, ethnicity) and disease specific variables (diagnosis, treatment, hepatitis, cirrhosis, tumor location, tumor number, tumor size, vascularity of lesion, and portal vein invasion) variables, as well as CES-D score at diagnosis were analyzed. CES-D scores >16 [Wald = 4.0, p = 0.05] and portal vein invasion (PVI) [Wald = 9.0, p = 0.003] significantly predicted survival. Using Kaplan Meier Survival analysis (Breslow test) and stratifying for PVI, a trend was found [Chi-Square = 3.1, p = 0.08] in which patients with PVI and CES-D scores >16, survived 7.4 months whereas patients with CES-D scores <16 survival 13 months. Patients without PVI and CES-D scores >16 survived 18.2 months whereas those with CES-D scores <16 survived 24.7 months. In a sample of 24 patients, those who reported CES-D scores >16 had significantly lower Natural Killer cell numbers than patients with CES-D scores <16 while covarying age, gender, stress, social support, and coping style [F(1,21) = 9.39, p = 0.003]. Conclusions: Depression may be an important prognostic factor for patients diagnosed with HBC.

No significant financial relationships to disclose.

Clinically meaningful changes in health-related quality of life in patients diagnosed with hepatobiliary carcinoma

BACKGROUND

To test the reliability, sensitivity to change in biomarkers associated with disease progression and response to treatment, and clinical meaningfulness of the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) in patients with hepatobiliary carcinoma.

PATIENTS AND METHODS

One hundred and fifty-eight patients diagnosed with hepatobiliary carcinoma were prospectively studied. Health-related quality of life (HRQL) was assessed at baseline (prior to treatment), 3-month follow-up (n=55) and 6-month follow-up (n=27).

RESULTS

The internal consistency of all the scales of the FACT-Hep were adequate at all time points (>0.75). The FACT-Hep was found to be sensitive to changes in clinical indicators (alkaline phosphate, alpha-fetoprotein, hemoglobin and survival) that reflect disease progression and response to treatment. Combined results from distribution-based and cross-sectional anchor-based analyses provide the following minimally important difference (MID) estimates: FACT-General (FACT-G) subscales=2-3; FACT-G=6-7; Hepatobiliary Cancer Subscale=5-6; FACT-Hep=8-9; Trial Outcome Index=7-8; and FACT-Hepatobiliary Symptom Index=2-3 points.

CONCLUSIONS

The FACT-Hep is a reliable instrument that is responsive to clinical indicators of disease progression and response to treatment. The MID estimates can aid interpretation of HRQL data and facilitate sample size calculation in clinical trials.

Highly active antiretroviral therapy (HAART). Awareness and beliefs about infectivity and the influence on sexual behaviour in the general population of Sweden

The purpose of the present study was to assess the relationship between the awareness of HAART, beliefs regarding transmission of HIV of persons taking HAART, norms associated with sexual risk behaviour, fear of HIV/AIDS, optimism of finding a cure or vaccine, and sexual behaviour in the general population of Sweden. A mail survey was sent to 4,000 randomly selected individuals aged 16-44 years. The study shows that the general public of Sweden is aware of HAART. Only 15% of the population had never heard of HAART. Eight percent believed that those taking HAART were 'no longer' or 'less' infective. Those not aware of HAART reported greater fear of HIV infected persons, less volunteer testing for HIV, and more sexual partners. Those who believed that persons taking HAART were less infective reported greater fear, more optimism concerning the possibilities to find a cure or vaccine, and had more discussions regarding HIV. We conclude that a group that may be at increased risk of HIV infection may be persons who are not aware of HAART or believe that persons are no longer infective when taking HAART. These persons may be an additional target group for HIV prevention.

A decade of HIV/AIDS prevention in Sweden: changes in attitudes associated with HIV and sexual risk behaviour from 1987 to 1997

OBJECTIVE

The objective of the present study was to monitor the changes in determinants of HIV-related attitudes and behaviour over a 10 year period.

DESIGN/METHODS

In the past decade, over 11,000 individuals in Sweden participated in this repeated cross-sectional study to assess the changes in attitudes and behaviour associated with HIV. Changes in the fear of persons who are HIV seropositive, optimism that scientists will find a cure or vaccine for HIV/AIDS, engagement in discussions concerning HIV/AIDS as well as condom use, the number of sexual partners, and frequency of unprotected casual sex were assessed during four study years, 1987, 1989, 1994, and 1997.

RESULTS

The findings of this study suggest that changes in attitudes regarding HIV were more robust whereas only modest changes in sexual behaviour were observed. The fear of HIV-seropositive persons, optimism that a cure or vaccine would be developed, and engagement in discussions concerning HIV all decreased over the 10 year period. A trend in increased condom use was observed, particularly in younger participants, but little change in sex with multiple partners and unprotected casual sex was observed between 1987 and 1997.

CONCLUSION

Changes in attitudes regarding HIV are usually more often observed than changes in sexual behaviour. However, increased condom use in younger participants may be reflective of secular changes in sexual behaviour that may facilitate the prevention of HIV in Sweden.