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Scott AJ, Bisby MA, Heriseanu AI, Salameh Y, Karin E, Fogliati R, Dudeney J, Gandy M, McLellan LF, Wootton B, McDonald S, Correa A, Titov N, Dear BF. Cognitive behavioral therapies for depression and anxiety in people with chronic disease: A systematic review and meta-analysis. Clin Psychol Rev 2023; 106:102353. [PMID: 37865080 DOI: 10.1016/j.cpr.2023.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/12/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Anxiety and depression in chronic disease are common and burdensome co-morbidities. There has been growing interest in cognitive and behavioral therapies (CBTs) for anxiety and depression in chronic disease, however their efficacy has not been well-established. This study examined the efficacy of CBTs for depression and/or anxiety symptoms within chronic disease and explored the moderating role of clinical and methodological characteristics. METHODS Following prospective registration, electronic databases were searched up to 2023 for randomized controlled trials (RCTs) examining CBTs for depression and/or anxiety in any adult chronic disease population. RESULTS We included 56 RCTs. The overall effect of CBTs was g = 0.61 (95% CI, 0.49, 0.72) for depression and g = 0.56 (95% CI, 0.42, 0.70) for anxiety. A range of methodological features significantly moderated the effect sizes obtained, including type of control group and the outcome measure used. Risk of Bias ratings indicated some concerns regarding RCT conduct and reporting. CONCLUSIONS CBTs lead to moderate improvements in both depression and anxiety symptoms among people with chronic disease. However, the efficacy of CBT should be interpreted considering certain study and sample characteristics. It is recommended that future studies make improvements to study methodology and reporting.
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Affiliation(s)
- Amelia J Scott
- School of Psychological Sciences, Macquarie University, Australia.
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Yalda Salameh
- School of Psychological Sciences, Macquarie University, Australia
| | - Eyal Karin
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Joanne Dudeney
- School of Psychological Sciences, Macquarie University, Australia
| | - Milena Gandy
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Bethany Wootton
- Discipline of Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Sarah McDonald
- Discipline of Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Ashleigh Correa
- School of Psychological Sciences, Macquarie University, Australia
| | - Nick Titov
- School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, Macquarie University, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Australia
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Macciò A, Sanna E, Piras R, Lavra F, Vallerino V, Maricosu G, Giglio E, Mura A, Tidore M, Madeddu C. Survival as a clinical outcome and its spiritual significance in a cohort of patients with advanced central pelvic neoplastic disease undergoing total pelvic evisceration: a poorly debated issue. Front Med (Lausanne) 2023; 10:1173687. [PMID: 37359011 PMCID: PMC10288149 DOI: 10.3389/fmed.2023.1173687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background Patients with either treatment-resistant or relapsing advanced central pelvic neoplastic disease present with a condition responsible for debilitating symptoms and consequently poor quality of life (QoL). For these patients, therapeutic strategies are very limited and total pelvic evisceration is the only option for relieving the symptoms and increasing survival. Of note, taking charge of these patients cannot be limited to increasing their lifespan but must also be aimed at improving the clinical, psychological, and spiritual conditions. This study aimed to prospectively evaluate the improvement in survival and QoL, focusing on spiritual wellbeing (SWB), in patients with poor life expectancy who underwent total pelvic evisceration for advanced gynecological cancers at our center. Patients and methods The QoL and SWB were assessed using the European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30), EORTC QLQ-SWB32, and SWB scale, which were repeatedly administered: 30 days before surgery, 7 days after the procedure, 1 and 3 months after surgery, and then every 3 months until death or the last follow-up assessment. Operative outcomes (blood loss, operative time, hospitalization, and incidence of complications) were evaluated as secondary endpoints. The patients and their families were included in a dedicated psycho-oncological and spiritual support protocol, which was managed by specifically trained and specialized personnel who accompanied them during all phases of the study. Results A total of 20 consecutive patients from 2017 to 2022 were included in this study. Of these patients, 7 underwent total pelvic evisceration by laparotomy and 13 underwent laparoscopy. The median survival was 24 months (range: 1-61 months). After a median follow-up of 24 months, 16 (80%) and 10 patients (50%) were alive at 1 year and 2 years after surgery, respectively. The EORTC-QLQ-C30 scores significantly improved yet at 7 days and at 1, 3, 6, and 12 months, as compared with the preoperative values. In particular, an early improvement in pain, overall QoL, and physical and emotional functions was observed. With respect to the SWB, the global SWB item score of the EORTC QLQ-SWB32 questionnaire significantly increased after 1 month and 3 months, as compared with preoperative values (p = 0.0153 and p = 0.0018, respectively), and remained stable thereafter. The mean SWB scale score was 53.3, with a sense of low overall SWB in 10 patients, a sense of moderate SWB in eight patients, and a sense of high SWB in two patients. The SWB scale score significantly increased after 7 days, 1 month, and 3 months, as compared with the preoperative value (p = 0202, p = 0.0171, and p = 0.0255, respectively), and remained stable thereafter. Conclusion Total pelvic evisceration is a valid approach for improving both survival and QoL in selected patients with advanced pelvic neoplasms and poor life expectancy. Our results particularly underline the importance of accompanying the patients and their families during the journey with dedicated psychological and spiritual support protocols.
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Affiliation(s)
- Antonio Macciò
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Elisabetta Sanna
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Roberta Piras
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Fabrizio Lavra
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Valerio Vallerino
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Giovanni Maricosu
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | - Emanuela Giglio
- Unit of Obstetrics and Gynecology, Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy
| | | | | | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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de Vlaming IH, Schellekens MPJ, van der Lee ML. Intensity of mental health treatment of cancer-related psychopathology: the predictive role of Early Maladaptive Schemas. Support Care Cancer 2023; 31:325. [PMID: 37154974 PMCID: PMC10167132 DOI: 10.1007/s00520-023-07764-w] [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: 01/12/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE With the limited availability of mental healthcare, it is of utmost importance to provide care that matches the needs of patients: short if possible, but also more intense when necessary. This study explored whether Early Maladaptive Schemas (EMSs) play a predictive role in the intensity of needed mental health treatment of cancer-related psychopathology. METHODS EMSs were assessed before mental health treatment in 256 patients who sought help at a specialized mental health care centre for those affected by cancer in the Netherlands. Data about treatment indication and intensity of mental health treatment were collected. Univariate and multivariate logistic regression analysis were used to assess the predictive value of the EMSs total score and specific domains on treatment indication and treatment intensity. RESULTS The presence of more severe EMSs predicted an indication for a more intense mental health treatment before start of the treatment, and actual more intense mental health treatment. The domain Impaired Autonomy and Performance appeared to be conceptually close to the domain Disconnection and Rejection, we left the latter out in our multivariate analysis and then found that Impaired Autonomy was the best predictor of intensity of mental health treatment. CONCLUSION Our findings imply that assessing EMSs could help to identify patients who will receive more treatment time.
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Affiliation(s)
- Irene H de Vlaming
- Department of Scientific Research, Helen Dowling Institute, Bilthoven, The Netherlands
- Department of Medical Psychology, Alrijne Hospital, Leiden, The Netherlands
| | - Melanie P J Schellekens
- Department of Scientific Research, Helen Dowling Institute, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Marije L van der Lee
- Department of Scientific Research, Helen Dowling Institute, Bilthoven, The Netherlands.
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
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Javaloyes N, Crespo A, Redal MC, Brugarolas A, Botella L, Escudero-Ortiz V, Sureda M. Psycho-Oncological Intervention Through Counseling in Patients With Differentiated Thyroid Cancer in Treatment With Radioiodine (COUNTHY, NCT05054634): A Non-randomized Controlled Study. Front Psychol 2022; 13:767093. [PMID: 35282223 PMCID: PMC8914112 DOI: 10.3389/fpsyg.2022.767093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDiagnosis and treatment of differentiated thyroid carcinomas (DTC) cause anxiety and depression. Additionally, these patients suffer hormonal alterations that are associated with psychological symptoms (e.g., changes in mood, emotional instability, and memory loss). This study aims to evaluate the effectiveness of a psycho-oncological intervention based on counseling to reduce anxiety and depression related to the treatment in patients with DTC.MethodsA non-randomized controlled study, with two groups [experimental group (EG), n = 37, and control group (CG), n = 38] and baseline and posttreatment measures, was designed. Patients in the EG received a psycho-oncological intervention based on counseling in addition to the standard treatment. The independent variable was the assigned group and the dependent one was the evolution of anxiety and depression, which were analyzed separately, and both were evaluated using the Hospital Anxiety and Depression Scale. Other relevant covariables related to the quality of life (QoL) were also analyzed using Short Form-36 Health Survey and Psychological General Wellbeing Index scales.ResultsThe difference of the posttreatment-baseline variation showed a statistically significant reduction in anxiety and depression in the EG in relation to the CG (p < 0.001). The mean of the Psychological General Wellbeing Index scales score increased significantly in the EG (p < 0.001) and decreased significantly in the CG (p < 0.001). All the baseline and the posttreatment scores of the variables evaluated showed a statistically significant improvement in the EG vs. the CG.ConclusionThis study demonstrates significant benefits of psycho-oncological intervention based on counseling in anxiety, depression, QoL, and wellbeing of the patient with differentiated thyroid carcinomas.
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Affiliation(s)
- Nuria Javaloyes
- Plataforma de Oncología, Hospital Quirónsalud Torrevieja, Torrevieja, Spain
| | - Aurora Crespo
- Servicio de Medicina Nuclear, Hospital Universitari Sant Joan, Alicante, Spain
| | - M. Carmen Redal
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Antonio Brugarolas
- Plataforma de Oncología, Hospital Quirónsalud Torrevieja, Torrevieja, Spain
| | - Lara Botella
- Plataforma de Oncología, Hospital Quirónsalud Torrevieja, Torrevieja, Spain
| | - Vanesa Escudero-Ortiz
- Facultad de Ciencias de la Salud, Grupo de Investigación en Farmacia y Nutrición Clínica, Universidad CEU Cardenal, Elche, Spain
| | - Manuel Sureda
- Plataforma de Oncología, Hospital Quirónsalud Torrevieja, Torrevieja, Spain
- *Correspondence: Manuel Sureda,
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Lima MP, Moret-Tatay C, Irigaray TQ. Locus of control, personality and depression symptoms in cancer: Testing a moderated mediation model. Clin Psychol Psychother 2021; 29:489-500. [PMID: 33908672 DOI: 10.1002/cpp.2604] [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] [Received: 02/11/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the mediator role of locus of control on the relationship between the Big Five personality traits and the manifestation of depression symptoms in cancer outpatients. METHOD Participants consisted of 220 cancer outpatients (138 women and 82 men), evaluated individually at the hospital waiting room. The measures applied were as follows: The NEO-Five Factor Inventory (NEO-FFI), Multidimensional Health Locus of Control (MHLC) Scale and Hospital Anxiety and Depression Scale (HADS). RESULTS The factor structure of NEO-FFI was reexamined. A moderated mediation model was found for the powerful others external locus of control (LOC), depression symptoms and extraversion and conscientiousness traits across sex. CONCLUSIONS Extraverted individuals can seek for others' support and use their attachments to find someone to guide them; conscientious patients can rely on their physician and follow every rule and orientation demanded, temporarily delegating to others the responsibility for their lives. All these strategies can help to decrease symptoms of depression. The perception of control can be taught, and it may be specifically relevant for mental health and in the performance of health behaviours.
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Affiliation(s)
- Manuela Polidoro Lima
- Post-Graduate Program in Psychology, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Carmen Moret-Tatay
- MEB Lab, Faculty of Psychology, San Vicente Mártir Catholic University of Valencia, Valencia, Spain.,NESMOS, Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, La Sapienza University of Rome, Rome, Italy
| | - Tatiana Quarti Irigaray
- Post-Graduate Program in Psychology, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Stein B, Müller MM, Meyer LK, Söllner W. Psychiatric and Psychosomatic Consultation-Liaison Services in General Hospitals: A Systematic Review and Meta-Analysis of Effects on Symptoms of Depression and Anxiety. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:6-16. [PMID: 31639791 DOI: 10.1159/000503177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychiatric and psychosomatic consultation-liaison services (CL) are important providers of diagnosis and treatment for hospital patients with mental comorbidities and psychological burdens. OBJECTIVE To perform a systematic review and meta-analysis investigating the effects of CL on depression and anxiety. METHODS Following PRISMA guidelines, a systematic literature search was conducted until 2017. Included were published randomized controlled trials using CL interventions with adults in general hospitals, treatment as usual as control groups, and depression and/or anxiety as outcomes. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Level of integration was assessed using the Standard Framework for Levels of Integrated Healthcare. Meta-analyses were performed using random effects models and meta-regression for moderator effects. RESULTS We included 38 studies (9,994 patients). Risk of bias was high in 17, unclear in 15, and low in 6 studies. Studies were grouped by type of intervention: brief interventions tailored to the patients (8), interventions based on specific treatment manuals (19), and integrated, collaborative care (11). Studies showed small to medium effects on depression and anxiety. Meta-analyses for depression yielded a small effect (d = -0.19, 95% CI: -0.30 to -0.09) in manual studies and a small effect (d = -0.33, 95% CI: -0.53 to -0.13) in integrated, collaborative care studies, the latter using mostly active control groups with the possibility of traditional consultation. CONCLUSIONS CL can provide a helpful first treatment for symptoms of depression and anxiety. Given that especially depressive symptoms in medically ill patients are long-lasting, the results underline the benefit of integrative approaches that respect the complexity of the illness.
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Affiliation(s)
- Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany,
| | - Markus M Müller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Lisa K Meyer
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Wolfgang Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
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Ng JY, Nazir Z, Nault H. Complementary and alternative medicine recommendations for depression: a systematic review and assessment of clinical practice guidelines. BMC Complement Med Ther 2020; 20:299. [PMID: 33028320 PMCID: PMC7541317 DOI: 10.1186/s12906-020-03085-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Up to 50% of individuals diagnosed with depression are known to use complementary and alternative medicine (CAM). The aim of this study was to identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines for the treatment and/or management of depression in adults using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. METHODS A systematic review was conducted to identify depression guidelines. MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Eligible guidelines published by non-profit agencies on treatment of depression for adults were assessed with the AGREE II instrument twice, once for the overall guideline and once for the CAM sections. RESULTS From 931 unique search results, 19 guidelines mentioned CAM, of which 16 made CAM recommendations. Scaled domain percentages from highest to lowest were as follows (overall, CAM section): clarity of presentation (87.0, 66.1%), scope and purpose (80.9, 77.6%), stakeholder involvement (62.0, 44.3%), editorial independence (61.6, 61.6%), rigour of development (58.0, 52.0%), and applicability (42.2, 25.4%). Quality varied within and across guidelines. Only 1 of 16 guidelines was recommended without modifications for both its overall and CAM sections by both appraisers. CONCLUSIONS There are multiple depression guidelines containing CAM recommendations available and there are a comprehensive set of CAM therapy options for depression. The quality of guidelines varied within and across guidelines and the quality of CAM recommendations was generally lower than the overall recommendations in the guidelines for all domains except editorial independence. Generally, characteristics of guidelines, including the year of publication and region of development varied across the guidelines irrespective of quality. Guidelines with higher AGREE II scores can serve as a guide to facilitate communication between patients and medical professionals regarding CAM use for depression, while guidelines with lower scores could be improved in future updates using the AGREE II instrument as a guide.
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Affiliation(s)
- Jeremy Y. Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, MDCL-2112, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Zainib Nazir
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, MDCL-2112, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
| | - Hayley Nault
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, MDCL-2112, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada
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Leterme A, Behal H, Demarty A, Barasino O, Rougegrez L, Labreuche J, Duhamel A, Vaiva G, Servant D. A blended cognitive behavioral intervention for patients with adjustment disorder with anxiety: A randomized controlled trial. Internet Interv 2020; 21:100329. [PMID: 32523873 PMCID: PMC7255181 DOI: 10.1016/j.invent.2020.100329] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/25/2022] Open
Abstract
Adjustment disorder with anxiety (ADA) is a common psychiatric pathology worldwide, but it is often undertreated. Cognitive behavioral therapy (CBT) is the first-line treatment, but very few studies have been carried out for the treatment of ADA. Internet-delivered CBT (iCBT) appears to be an effective treatment option, with the potential to reach a larger proportion of individuals suffering from ADA. Guidance is a beneficial feature of iCBT, provided in most studies by email or telephone (traditional guided iCBT). Blended CBT, which combines an online intervention and therapeutic guidance provided in person (face-to-face), could be a way to benefit from both the advantages of face-to-face CBT regarding human interactional quality and the advantages of internet-based CBT in terms of improved access to treatment. In this randomized controlled trial, the effectiveness of two forms of administration of Seren@ctif, a 5-week CBT program for patients with ADA according the DSM-5, was examined: one delivered through face-to-face sessions (face-to-face CBT) and the other delivered online and guided with face-to-face contact with a nurse (blended CBT); these formats were compared with a wait-list control group (WLC). A total of 120 patients were included and randomized to one of these three conditions. Measures were administered before treatment, after treatment and 6 months after inclusion in the study. Both treatment conditions displayed significant decreases in anxiety, depression, worry and perceived stress at posttreatment when compared to the WLC group. The decrease in symptoms was mostly maintained 6 months after inclusion for the two experimental groups. Blended CBT showed significantly greater reductions in anxiety and depression than did face-to-face CBT on some secondary outcome measures. We conclude that both face-to-face CBT and blended CBT are effective treatments for patients with ADA, and we suggest that blended CBT may be slightly more effective than classical face-to-face CBT. Trial Registration: Clinicaltrials.gov NCT02621775;https://clinicaltrials.gov/ct2/show/NCT02621775(Archived by WebCite at http://www.webcitation.org/6tQrkPs1u).
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Affiliation(s)
- A.C. Leterme
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France,Stress and Anxiety Unit, Department of Psychiatry, Lille University Hospital, Lille, France
| | - H. Behal
- Univ. Lille, CHU Lille, ULR 2694 – METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - A.L. Demarty
- Univ. Lille, Inserm, CHU Lille, CIC1403 – Centre d'Investigation Clinique, F-59000 Lille, France
| | - O. Barasino
- Stress and Anxiety Unit, Department of Psychiatry, Lille University Hospital, Lille, France
| | - L. Rougegrez
- Stress and Anxiety Unit, Department of Psychiatry, Lille University Hospital, Lille, France
| | - J. Labreuche
- Univ. Lille, CHU Lille, ULR 2694 – METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - A. Duhamel
- Univ. Lille, CHU Lille, ULR 2694 – METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - G. Vaiva
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France,Stress and Anxiety Unit, Department of Psychiatry, Lille University Hospital, Lille, France
| | - D. Servant
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France,Stress and Anxiety Unit, Department of Psychiatry, Lille University Hospital, Lille, France,Corresponding author at: Stress and Anxiety Unit, Department of Psychiatry, University Hospital, Hôpital Fontan, rue André Verhaeghe, 59037 Lille Cedex, France.
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Malekzadeh M, Hashemi Mohammadabad N, Kharamin S, Haghighi S. The Effectiveness of Group-based Cognitive Hypnotherapy on the Psychological Well-being of Patients with Multiple Sclerosis: A Randomized Clinical Trial. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2020; 62:364-379. [PMID: 32216621 DOI: 10.1080/00029157.2019.1709149] [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: 10/24/2022]
Abstract
Multiple sclerosis is a chronic, demyelinating disease of the central nervous system mainly affecting young adults. In addition to physical problems, the patients suffer from many psychological problems affecting their psychological well-being. The aim of the present study was to determine the effectiveness of group-based cognitive hypnotherapy on the psychological well-being of patients suffering from multiple sclerosis. This study was designed as a clinical trial with a pretest-posttest control group. From 60 patients diagnosed with multiple sclerosis referred to Beheshti hospital in Yasuj, Iran, 45 patients who met the inclusion criteria were selected by the convenience sampling method. The patients were randomly assigned to intervention (23 individuals) and control (22 individuals) groups through stratified random allocation. After completing the Ryff Scales of Psychological Well-Being, the intervention group attended eight sessions of group-based cognitive hypnotherapy on a weekly basis. The control group did not attend any intervention sessions. At the end of the eight intervention sessions, both groups completed the Ryff's Scale of Psychological Well-being again. The collected data were analyzed using the SPSS software (Version 23). Analysis of Covariance (ANCOVA) and two-way Analysis of variance (ANOVA) tests were used in order to compare the groups. The results indicated that cognitive hypnotherapy had a significant effect on the total score of psychological well-being (F (45, 1) = 6.07, p = .018, η2 = 0.12) and the dimension of environmental mastery (p < .05). Therefore, it is recommended to use hypnotherapy to promote the psychological well-being of patients suffering from multiple sclerosis.
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Affiliation(s)
- Mohammad Malekzadeh
- Yasuj University of Medical Sciences, Social Determinants of Health Research Center, Yasuj, Iran
| | | | - Shirali Kharamin
- Yasuj University of Medical Sciences, Social Determinants of Health Research Center, Yasuj, Iran
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10
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Patterson JM. Psychological Interventions for the Head and Neck Cancer Population Who Are Experiencing Dysphagia. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2019_pers-sig13-2019-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Joanne M. Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Speech and Language Therapy, Sunderland Royal Hospital, United Kingdom
- School of Health Sciences, University of Liverpool, United Kingdom
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11
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Sanjida S, McPhail SM, Shaw J, Couper J, Kissane D, Price MA, Janda M. Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta-analyses. Psychooncology 2018; 27:2063-2076. [DOI: 10.1002/pon.4794] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/31/2018] [Accepted: 06/03/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Saira Sanjida
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
| | - Steven M. McPhail
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
- Centre for Functioning and Health Research; Metro South Health; Brisbane Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology; The University of Sydney; Sydney Australia
| | - Jeremy Couper
- Mental Health, Justice Health, Alcohol and Drug Services; Canberra Australia
- Academic Unit of Psychiatry & Addiction Medicine; Australian National University Medical School, The Canberra Hospital; Canberra Australia
| | - David Kissane
- Department of Psychiatry; Monash University; Melbourne Australia
| | - Melanie A. Price
- Psycho-oncology Co-operative Research Group, School of Psychology; The University of Sydney; Sydney Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
- Centre for Health Services Research; The University of Queensland; Brisbane Australia
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Fulton JJ, Newins AR, Porter LS, Ramos K. Psychotherapy Targeting Depression and Anxiety for Use in Palliative Care: A Meta-Analysis. J Palliat Med 2018; 21:1024-1037. [DOI: 10.1089/jpm.2017.0576] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica J. Fulton
- Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Amie R. Newins
- Department of Psychology, University of Central Florida, Orlando, Florida
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Katherine Ramos
- Durham Veterans Affairs Health Care System, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
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O'Donnell ML, Metcalf O, Watson L, Phelps A, Varker T. A Systematic Review of Psychological and Pharmacological Treatments for Adjustment Disorder in Adults. J Trauma Stress 2018; 31:321-331. [PMID: 29958336 DOI: 10.1002/jts.22295] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 11/10/2022]
Abstract
Adjustment disorder is a common psychiatric disorder, yet knowledge of the efficacious treatments for adjustment disorder is limited. In this systematic review, we aimed to examine psychological and pharmacological interventions that target adjustment disorder in adults to determine which interventions have the best evidence for improving adjustment disorder symptoms. We performed database searches for literature published between January 1980 and September 2016 and identified studies that included both a sample majority of individuals diagnosed with adjustment disorder and findings on adjustment disorder symptom outcomes. There were 29 studies that met the inclusion criteria for qualitative synthesis; the majority of studies (59%) investigated psychological therapies rather than pharmacological treatments (35%). The range of psychological therapies tested was diverse, with the majority containing cognitive behavioral therapy (CBT) components (53%), followed by three studies that were psychodynamic-related, three studies that were behavioral therapy-based, and two studies that involved relaxation techniques. We rated individual studies using a modified National Health and Medical Research Council quality and bias checklist and then used the Grading of Recommendations Assessment, Development and Evaluation (GRADE; Grade Working Group, 2004) system to rate the overall quality of the evidence. Despite several randomized controlled trials, the quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder was ranked as low to very low. Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events.
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Affiliation(s)
- Meaghan L O'Donnell
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Olivia Metcalf
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Loretta Watson
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Andrea Phelps
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Tracey Varker
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Abstract
A person who faces the diagnosis of cancer is subjected to changes within his body, but also with regard to his view of himself and his social relationships. Cancer related psychological distress occurs frequently and has a different prevalence according to-among other factors-cancer type and stage of disease. The main psychiatric disturbances observed in patients with cancer are adjustment disorders and affective disorders (anxiety and depression), which in the majority of patients are due to stressors related to the occurrence and threat of the disease and pre-existing psychological vulnerabilities; however, they might also be a direct consequence of biological causes either resulting from bodily modifications induced by the cancer or from treatment side effects. This chapter provides theoretical and practical information on the main psychotherapeutic approaches for cancer patients, complemented by some reflections on their clinical and scientific evidence.
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Affiliation(s)
- Mirjam de Vries
- Service de Psychiatrie de Liaision, Département de Psychiatrie, Centre hospitalier universitaire vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Friedrich Stiefel
- Service de Psychiatrie de Liaision, Département de Psychiatrie, Centre hospitalier universitaire vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland
- Faculté de Biologie et Médecine, Université de Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland
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Lloyd-Williams M. Depression–-the Hidden Symptom in Advanced Cancer. J R Soc Med 2017; 96:577-81. [PMID: 14645605 PMCID: PMC539654 DOI: 10.1177/014107680309601202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mari Lloyd-Williams
- University of Liverpool Medical School, Department of Primary Care, Harrison Hughes Building, Brownlow Hill, Liverpool L69 3GB, UK.
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16
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Arnaboldi P, Oliveri S, Vadilonga V, Santoro L, Maggioni A, Pravettoni G. Perceived utility of an integrated psychological intervention for gynaecological cancer patients admitted for surgery: preliminary data. Ecancermedicalscience 2017; 11:722. [PMID: 28275391 PMCID: PMC5336389 DOI: 10.3332/ecancer.2017.722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate patients' satisfaction and perceived utility for psychological consultations delivered by clinical psychologists in a sample of gynaecological cancer patients hospitalised for surgery. METHODS A total of 51 gynaecological cancer patients who scored higher than four on the distress thermometer (DT) were proposed and received a psychological consultation during hospitalisation for surgery. After six months from discharge, patients were asked, during a telephone interview, to rate their level of distress post-treatment, their perceived satisfaction, and usefulness of the psychological intervention received. RESULTS At the time of the telephone interview, the distress levels stated by patients tended to be lower than those at hospital admission, and around 61% of the patients expressed maximum satisfaction with psychological intervention. Among these, 60.8% rated the psychological consultation useful for dealing with the hospitalisation itself, 45.1% useful for dealing with personal issues and 58.8% for dealing with issues related to returning home. People who were at their first diagnosis and those who had no other reason to be distressed beyond their cancer found psychological support significantly more useful for facing up to personal issues. CONCLUSIONS Patients are highly satisfied with integrative psychological interventions delivered by clinical psychologists in a medical setting such as that of gynaecological cancer surgery and from the six-month follow-up, it emerged that such interventions help in promoting patients' adjustment to the phase of hospitalisation and post-hospital discharge.
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Affiliation(s)
- Paola Arnaboldi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Via Ripamonti, Milan, Italy
| | - Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Via Ripamonti, Milan, Italy
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Festa del Perdono, Milan, Italy
| | - Valeria Vadilonga
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Via Ripamonti, Milan, Italy
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology (IEO), Via Ripamonti, Milan, Italy
| | - Angelo Maggioni
- Gynecology Oncology Division, European Institute of Oncology (IEO), Via Ripamonti, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Via Ripamonti, Milan, Italy
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Festa del Perdono, Milan, Italy
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Abstract
Objective Psychotherapy is a common non-pharmacological approach to help cancer patients in their psychological distress. The benefit of psychotherapies was documented, but the types of psychotherapies proposed are varied. Given that the previous literature review was a decade ago and no quantitative analysis was done on this topic, we again critically and systematically reviewed all published trials on psychotherapy in cancer patients. Method We identified 17 clinical trials on six types of psychotherapy for cancer patients by searching PubMed and EMBASE. Result There were four trials involved adjunct psychological therapy which were included in quantitative analysis. Each trial demonstrated that psychotherapy improved the quality of life and coping in cancer patients. There was also a reduction in distress, anxiety, and depression after a psychological intervention. However, the number and quality of clinical trials for each type of psychotherapy were poor. The meta-analysis of the four trials involved adjunct psychological therapy showed no significant change in depression, with only significant short-term improvement in anxiety but not up to a year-the standardized mean differences were -0.37 (95% confidence interval (CI) = -0.57, -0.16) at 2 months, -0.21 (95% CI = -0.42, -0.01) at 4 months, and 0.03 (95 % CI = -0.19, 0.24) at 12 months. Conclusion The evidence on the efficacy of psychotherapy in cancer patients is unsatisfactory. There is a need for more rigorous and well-designed clinical trials on this topic.
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Affiliation(s)
- Ng Chong Guan
- 1 Department of Psychological Medicine, University Malaya Medical Centre, Malaysia
| | - Salina Mohamed
- 2 Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Malaysia
| | - Lai Kian Tiah
- 3 Department of Psychology, HELP University, Malaysia
| | - Teoh Kar Mun
- 4 Faculty of Arts and Social Science, Universiti Tunku Abdul Rahman, Malaysia
| | - Ahmad Hatim Sulaiman
- 1 Department of Psychological Medicine, University Malaya Medical Centre, Malaysia
| | - Nor Zuraida Zainal
- 1 Department of Psychological Medicine, University Malaya Medical Centre, Malaysia
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Testoni I. Psicologia del lutto e del morire: dal lavoro clinico alla death education. PSICOTERAPIA E SCIENZE UMANE 2016. [DOI: 10.3280/pu2016-002004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Faretta E, Borsato T, Civilotti C, Fernandez I, Pagani M. EMDR and CBT: A Comparative Clinical Study With Oncological Patients. JOURNAL OF EMDR PRACTICE AND RESEARCH 2016. [DOI: 10.1891/1933-3196.10.3.215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research in clinical psycho-oncology is becoming an area of key importance in investigating the effects of the interventions of support and/or psychotherapy with patients. This study was conducted with the aim of evaluating the effectiveness of the eye movement desensitization and reprocessing (EMDR) approach compared to a non–trauma-focused cognitive behavioral therapy (CBT) intervention. There were 11 male and 46 female participants, with mixed cancer diagnoses. Thirty-one subjects received EMDR therapy, and 26 received CBT for 12 sessions of 60 minutes each. The Symptom Checklist-90-R (SCL-90-R), COPE inventory, and Davidson Trauma Scale (DTS) were administered at three different times (T0, before intervention; T1, after the sixth session; and T2, after the 12th session); the Karnofsky Performance Status was administered at T0 only. In the EMDR group, a significant improvement was reported for the following 11 of the 17 dependent variables: COPE subscales, Avoidance Strategies and Positive Attitude; all three DTS subscales, Intrusion, Avoidance, and Hyperarousal; and 6 SCL-90-R subscales. In the CBT group, a significant improvement was reported for the following 4 of the 17 dependent variables: COPE subscales Positive Attitude and Transcendent Orientation; two DTS subscales, Intrusion, and Avoidance, with no improvement on any of the SCL-90-R subscales. This innovative study shows the value of trauma-focused treatment for patients with cancer and allows important preliminary suggestions on the usefulness of applying EMDR therapy in an oncological setting, although further research in this context is still needed.
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20
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Deckx L, van Abbema DL, van den Akker M, van den Broeke C, van Driel M, Bulens P, Tjan-Heijnen VCG, Kenis C, de Jonge ET, Houben B, Buntinx F. A cohort study on the evolution of psychosocial problems in older patients with breast or colorectal cancer: comparison with younger cancer patients and older primary care patients without cancer. BMC Geriatr 2015; 15:79. [PMID: 26156892 PMCID: PMC4496825 DOI: 10.1186/s12877-015-0071-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 06/10/2015] [Indexed: 12/27/2022] Open
Abstract
Background Although older cancer survivors commonly report psychosocial problems, the impact of both cancer and ageing on the occurrence of these problems remains largely unknown. The evolution of depression, cognitive functioning, and fatigue was evaluated in a group of older cancer patients in comparison with a group of younger cancer patients and older persons without cancer. Methods Older (≥70 years) and younger cancer patients (50 – 69 years) with breast or colorectal cancer stage I - III, and older persons without cancer (≥70 years) were included. Data were collected at baseline and one year follow-up and were available for 536 persons. Depression was evaluated with the 15-item Geriatric Depression Scale. Cognitive functioning was measured with the cognitive functioning subscale of the European Organization for Research and Treatment of Cancer. Fatigue was measured with a Visual Analogue Scale. Risk factors for depression, cognitive functioning, and fatigue were analysed using multivariate logistic regression analyses. Risk factors included cancer- and ageing-related factors such as functional status, cancer treatment, and comorbidities. Results The evolution of psychosocial problems was similar for the group of older (N = 125) and younger cancer patients (N = 196): an increase in depression (p < 0.01), slight worsening in cognitive functioning (p = 0.01), and no clear change in fatigue. Also, compared to the group of people without cancer (N = 215), the differences were small and after one year of follow-up only depression was more frequent in older cancer patients compared to older persons without cancer (18 % versus 9 %, p = 0.04). In multivariate analyses the main risk factors for psychosocial problems after one year follow-up were changes in functional status and presence of baseline depression, fatigue, or cognitive impairment. Conclusion Over the course of one year after a diagnosis of cancer, cancer patients face increasing levels of depression and increasing difficulties in cognitive functioning. The main risk factor for psychosocial problems was presence of the problem at baseline. This calls for regular screening for psychosocial problems and exchange of information on psychosocial functioning between different health care providers and settings during the treatment and follow-up trajectory of cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0071-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Deckx
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium.
| | - Doris L van Abbema
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands.
| | - Marjan van den Akker
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. .,Department of Family Medicine, CAPHRI - School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Carine van den Broeke
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium.
| | - Mieke van Driel
- Discipline of General Practice, School of Medicine, The University of Queensland, Building 16/910, Royal Brisbane and Women's Hospital, Brisbane, 4029, QLD, Australia.
| | - Paul Bulens
- Limburgs Oncologisch Centrum, Stadsomvaart 11, 3500, Hasselt, Belgium.
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands.
| | - Cindy Kenis
- Department of General Medical Oncology, University Hospitals Leuven, UZ Herestraat 49 - box 815, 3000, Leuven, Belgium.
| | - Eric T de Jonge
- Department of Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Bert Houben
- Department of Abdominal and Oncological Surgery, Jessa Hospital - Campus Salvator, Salvatorstraat 20, 3500, Hasselt, Belgium.
| | - Frank Buntinx
- Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. .,Department of Family Medicine, CAPHRI - School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
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21
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Aarts JWF, Deckx L, van Abbema DL, Tjan-Heijnen VCG, van den Akker M, Buntinx F. The relation between depression, coping and health locus of control: differences between older and younger patients, with and without cancer. Psychooncology 2015; 24:950-7. [PMID: 25644618 DOI: 10.1002/pon.3748] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 12/11/2014] [Accepted: 12/16/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Depression is an important health issue in cancer patients. People use different coping strategies and health locus of control to manage stressful situations, which relate to different risks of depression. Coping strategies and health locus of control can be changed by cognitive behavioral interventions. METHODS In a cohort study, we investigated differences in coping strategy and health locus of control in older (≥70 years) and middle-aged (50-69 years) cancer patients, and older patients without cancer (≥70 years), and their association with presence of depression. We also investigated how these factors interact. We used the short version of the Utrecht Coping List, the Multidimensional Health Locus of Control scale, and the 15-item Geriatric Depression Scale. RESULTS Data were available from 1317 participants. Overall prevalence of depression was 12%. Older cancer patients tended to use an avoiding coping strategy more frequently than middle-aged cancer patients. This was associated with higher risk of depression. Older cancer patients less often used an active coping strategy, in comparison with middle-aged cancer patients, which was associated with a lower risk of depression. Especially in women using a seeking social support strategy, there was a lower risk of depression. Overall, the internal health locus of control was associated with higher and the external 'powerful others' locus with lower risk of depression. CONCLUSIONS Older cancer patients strongly differ from middle-aged cancer patients, in particular with respect to coping. Interventions to prevent or alleviate depression should incorporate these differences.
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Affiliation(s)
- Jurian W F Aarts
- Department of Family Medicine, Maastricht University CAPHRI - School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Laura Deckx
- Department of General Practice, KU Leuven, Leuven, Belgium
| | - Doris L van Abbema
- Department of Medical Oncology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, Maastricht University CAPHRI - School for Public Health and Primary Care, Maastricht, The Netherlands.,Department of General Practice, KU Leuven, Leuven, Belgium
| | - Frank Buntinx
- Department of Family Medicine, Maastricht University CAPHRI - School for Public Health and Primary Care, Maastricht, The Netherlands.,Department of General Practice, KU Leuven, Leuven, Belgium
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Rankin NM, Butow PN, Thein T, Robinson T, Shaw JM, Price MA, Clover K, Shaw T, Grimison P. Everybody wants it done but nobody wants to do it: an exploration of the barrier and enablers of critical components towards creating a clinical pathway for anxiety and depression in cancer. BMC Health Serv Res 2015; 15:28. [PMID: 25608947 PMCID: PMC4307637 DOI: 10.1186/s12913-015-0691-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/09/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This study aimed to explore barriers to and enablers for future implementation of a draft clinical pathway for anxiety and depression in cancer patients in the Australian context. METHODS Health professionals reviewed a draft clinical pathway and participated in qualitative interviews about the delivery of psychosocial care in their setting, individual components of the draft pathway, and barriers and enablers for its future implementation. RESULTS Five interrelated themes were identified: ownership; resources and responsibility; education and training; patient reluctance; and integration with health services beyond oncology. CONCLUSIONS The five themes were perceived as both barriers and enablers and provide a basis for an implementation plan that includes strategies to overcome barriers. The next steps are to design and deliver the clinical pathway with specific implementation strategies that address team ownership, endorsement by leaders, education and training modules designed for health professionals and patients and identify ways to integrate the pathway into existing cancer services.
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Affiliation(s)
- Nicole M Rankin
- Translational Research Fellow, Sydney Catalyst, The University of Sydney, Chris O'Brien Lifehouse, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Phyllis N Butow
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.
| | - Thida Thein
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.
| | - Tracy Robinson
- Workforce Education and Development Group, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Joanne M Shaw
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.
| | - Melanie A Price
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.
| | - Kerrie Clover
- Calvary Mater Newcastle Hospital, Newcastle, Australia.
| | - Tim Shaw
- Workforce Education and Development Group, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Peter Grimison
- Chris O'Brien Lifehouse, Missenden Road, Camperdown, NSW, Australia.
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Taneja MK. Life style management in head and neck cancer patients. Indian J Otolaryngol Head Neck Surg 2013; 65:289-92. [PMID: 24427584 DOI: 10.1007/s12070-013-0682-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022] Open
Abstract
Head and neck (HN) cancers involve highly visible body parts, structurally complex, and crucial to survival. A diagnosis of HN cancer, like any cancer diagnosis, is often accompanied by much fear and uncertainty. In addition, patients treated for HN cancer face difficulties in eating, chewing, drinking, breathing, speaking, as well as changes in appearance. Simultaneously, the burden of HN cancer is often manifested in psychosocial dysfunction, which can have a negative impact on quality of life (QL). Psychosocial interventions such as education along with cognitive-behavioral therapy generally provide an overall positive effect. With the growing impetus to investigate factors associated with these dysfunctions and disfigurement caused by the treatment, and considerable advancement in the development and validation of many global and disease-specific measures, there is an opportunity for further research to develop an appropriate clinical intervention program for such patients so that these patients can live a near normal life. Life style changes including dietary habits make gross changes in QL.
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Omylinska-Thurston J, Cooper M. Helpful processes in psychological therapy for patients with primary cancers: A qualitative interview study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2013. [DOI: 10.1080/14733145.2013.813952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Faller H, Schuler M, Richard M, Heckl U, Weis J, Küffner R. Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients With Cancer: Systematic Review and Meta-Analysis. J Clin Oncol 2013; 31:782-93. [PMID: 23319686 DOI: 10.1200/jco.2011.40.8922] [Citation(s) in RCA: 480] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose This study aimed to evaluate the effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer. Methods Literature databases were searched to identify randomized controlled trials that compared a psycho-oncologic intervention delivered face-to face with a control condition. The main outcome measures were emotional distress, anxiety, depression, and quality of life. Outcomes were evaluated for three time periods: post-treatment, ≤ 6 months, and more than 6 months. We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies. Sensitivity analyses and meta-regression were used to explore reasons for heterogeneity. Results We retrieved 198 studies (covering 22,238 patients) that report 218 treatment-control comparisons. Significant small-to-medium effects were observed for individual and group psychotherapy and psychoeducation. These effects were sustained, in part, in the medium term (≤ 6 months) and long term (> 6 months). Short-term effects were evident for relaxation training. Studies that preselected participants according to increased distress produced large effects at post-treatment. A moderator effect was found for the moderator variable “duration of the intervention,” with longer interventions producing more sustained effects. Indicators of study quality were often not reported. Small-sample bias indicative of possible publication bias was found for some effects, particularly with individual psychotherapy and relaxation training. Conclusion Various types of psycho-oncologic interventions are associated with significant, small-to-medium effects on emotional distress and quality of life. These results should be interpreted with caution, however, because of the low quality of reporting in many of the trials.
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Affiliation(s)
- Hermann Faller
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Michael Schuler
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Matthias Richard
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Ulrike Heckl
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Joachim Weis
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Roland Küffner
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
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A review of cognitive therapy in acute medical settings. Part I: Therapy model and assessment. Palliat Support Care 2012; 11:141-53. [DOI: 10.1017/s147895151200082x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Although cognitive therapy (CT) has established outpatient utility, there is no integrative framework for using CT in acute medical settings where most psychosomatic medicine (P-M) clinicians practice. Biopsychosocial complexity challenges P-M clinicians who want to use CT as the a priori psychotherapeutic modality. For example, how should clinicians modify the data gathering and formulation process to support CT in acute settings?Method:Narrative review methodology is used to describe the framework for a CT informed interview, formulation, and assessment in acute medical settings. Because this review is aimed largely at P-M trainees and educators, exemplary dialogues model the approach (specific CT strategies for common P-M scenarios appear in the companion article.)Results:Structured data gathering needs to be tailored by focusing on cognitive processes informed by the cognitive hypothesis. Agenda setting, Socratic questioning, and adaptations to the mental state examination are necessary. Specific attention is paid to the CT formulation, Folkman's Cognitive Coping Model, self-report measures, data-driven evaluations, and collaboration (e.g., sharing the formulation with the patient.) Integrative CT-psychopharmacological approaches and the importance of empathy are emphasized.Significance of results:The value of implementing psychotherapy in parallel with data gathering because of time urgency is advocated, but this is a significant departure from usual outpatient approaches in which psychotherapy follows evaluation. This conceptual approach offers a novel integrative framework for using CT in acute medical settings, but future challenges include demonstrating clinical outcomes and training P-M clinicians so as to demonstrate fidelity.
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Hart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM, Craft LL, Steel JL, Cuijpers P, Mohr DC, Berendsen M, Spring B, Stanton AL. Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. J Natl Cancer Inst 2012; 104:990-1004. [PMID: 22767203 DOI: 10.1093/jnci/djs256] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients. METHODS Efficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges' g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided. RESULTS Ten randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges' g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07). CONCLUSIONS Our findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.
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Affiliation(s)
- Stacey L Hart
- Department of Psychology, University of California Los Angeles, CA 90095-1563, USA
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Edelman S, Kidman AD. Application of Cognitive Behaviour Therapy to Patients Who Have Advanced Cancer. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.17.2.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPatients who are diagnosed with advanced cancer frequently experience high levels of anxiety and depression. Few of the studies that evaluated psychological interventions with this cohort have demonstrated improvements in psychological measures in the period following therapy. However, a recent study that evaluated the efficacy of a group cognitive behaviour therapy (CBT) intervention with patients who had advanced breast cancer found improved outcomes on measures of mood and self-esteem following the intervention. This paper describes some of the CBT techniques used in the intervention, which might also be useful in the treatment of patients with other types of terminal illness.
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Stagg EK, Lazenby M. Best Practices for the Nonpharmacological Treatment of Depression at the End of Life. Am J Hosp Palliat Care 2011; 29:183-94. [DOI: 10.1177/1049909111413889] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Mark Lazenby
- Yale School of Nursing, South New Haven, CT, USA
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DuHamel KN, Mosher CE, Winkel G, Labay LE, Rini C, Meschian YM, Austin J, Greene PB, Lawsin CR, Rusiewicz A, Grosskreutz CL, Isola L, Moskowitz CH, Papadopoulos EB, Rowley S, Scigliano E, Burkhalter JE, Hurley KE, Bollinger AR, Redd WH. Randomized clinical trial of telephone-administered cognitive-behavioral therapy to reduce post-traumatic stress disorder and distress symptoms after hematopoietic stem-cell transplantation. J Clin Oncol 2010; 28:3754-61. [PMID: 20625129 DOI: 10.1200/jco.2009.26.8722] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE A significant number of survivors of hematopoietic stem-cell transplantation (HSCT) report enduring adverse effects of treatment, including illness-related post-traumatic stress disorder (PTSD) symptoms and general distress. We report results of a randomized clinical trial that tested the effects of a 10-session, telephone-administered cognitive-behavioral therapy (CBT) intervention on PTSD, depression, and distress symptoms. METHODS Survivors who had undergone HSCT 1 to 3 years earlier (N = 408) were assessed for study eligibility. Those who met study eligibility criteria (n = 89) completed a baseline assessment that included a clinical interview and self-report measures of PTSD symptoms (the primary outcome) and depression and general distress (the secondary outcomes). Next, they were randomly assigned to CBT or an assessment-only condition. Survivors in the CBT group completed 10 individual telephone-based CBT sessions (T-CBT) that included strategies to reduce PTSD symptoms, depression, and general distress. Follow-up assessments occurred at 6, 9, and 12 months after the baseline assessment. RESULTS Linear mixed-model analyses revealed that, compared with HSCT survivors in the assessment-only condition, survivors who completed T-CBT reported fewer illness-related PTSD symptoms, including less avoidance (P < .001) and fewer intrusive thoughts (P < .05) as well as less general distress and fewer depressive symptoms (P < .05) even after controlling for potential demographic and medical covariates. These results were consistent across the three follow-up assessments. CONCLUSION A brief, telephone-administered CBT intervention developed for HSCT survivors is an efficacious treatment for reducing illness-related PTSD symptoms and general distress.
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Weinberger T, Forrester A, Markov D, Chism K, Kunkel EJS. Women at a dangerous intersection: diagnosis and treatment of depression and related disorders in patients with breast cancer. Psychiatr Clin North Am 2010; 33:409-22. [PMID: 20385344 DOI: 10.1016/j.psc.2010.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Breast cancer is a relatively common diagnosis for American women and depressive symptoms occur in many women with breast cancer. Identification of women with breast cancer and concomitant depressive symptoms and mood disorders requires particular attention by heath care providers, and may be aided by the administration of a variety of diagnostic and/or screening tools. Insomnia is also a significant problem for women with breast cancer at various stages of diagnosis and treatment, including after remission. Although many studies on the treatment of depression in women with breast cancer have been done, and the data do point to the efficacy of several antidepressants in this population, there are no data to support the widely held hypothesis that treatment of depression in patients with breast cancer may positively affect morbidity and mortality. Breast cancer treatments may give rise to depressive symptoms and this should be considered in the approach to pharmacotherapy. Several psychotherapeutic modalities offer relief of the symptoms and syndromes of depression in breast cancer. Future research can answer the question of which approach is most appropriate for which patients, and whether therapy can improve a variety of health outcomes and survival for women with breast cancer.
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Affiliation(s)
- Tal Weinberger
- Consultation-Liaison Psychiatry, Thomas Jefferson University, 1020 Sansom Street, Suite 1652, PA 19107, USA
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Schneider S, Moyer A, Knapp-Oliver S, Sohl S, Cannella D, Targhetta V. Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis. J Behav Med 2010; 33:1-14. [PMID: 19784868 PMCID: PMC2813921 DOI: 10.1007/s10865-009-9227-2] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 09/14/2009] [Indexed: 11/26/2022]
Abstract
This meta-analysis examined whether effects of psychosocial interventions on psychological distress in cancer patients are conditional upon pre-intervention distress levels. Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait Anxiety Inventory (STAI). Multilevel mixed-effects modeling was used to meta-analyze effect-sizes separately for the HADS (27 trials, 2,424 patients) and STAI (34 trials, 2,029 patients). Pre-intervention distress significantly moderated intervention effects, explaining up to 50% of the between-study effect-size variance: effects on anxiety and depression were generally negligible when pre-intervention distress was low and pronounced when it was high. These results could not be explained by differences in intervention type, setting, dose, and whether intervention was targeted at distressed patients. Psychosocial interventions may be most beneficial for cancer patients with elevated distress. Future research should identify which treatment components are most effective for these patients to facilitate optimal treatment tailoring and cost-effective health care.
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Affiliation(s)
- Stefan Schneider
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA.
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Cohen M. A model of group cognitive behavioral intervention combined with bio-feedback in oncology settings. SOCIAL WORK IN HEALTH CARE 2010; 49:149-164. [PMID: 20175020 DOI: 10.1080/00981380903158128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article's goal is to present a model for social work with cancer patients and their relatives aimed at teaching ways of coping with cancer and its implications. The article presents a model of six meetings, emphasizing learning processes and acquisition of skills enabling participants to recognize and change distressing thoughts, combined with learning relaxation methods and guided imagery. An additional unique property of this model is the bio-feedback, which assists in creating awareness of physiological alertness states and in learning and implementing the different methods for decreasing pressure and stress.
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Affiliation(s)
- Miri Cohen
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Cort E, Moorey S, Hotopf M, Kapari M, Monroe B, Hansford P. Palliative care nurses' experiences of training in cognitive behaviour therapy and taking part in a randomized controlled trial. Int J Palliat Nurs 2009; 15:290-8. [PMID: 19568216 DOI: 10.12968/ijpn.2009.15.6.42988] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This article describes the experiences of clinical nurse specialists in a palliative homecare team who took part in a cluster randomized controlled study. The study aimed to determine whether palliative care nurses given basic training in cognitive behavioural therapy (CBT) were able to use core components of this training when treating advanced cancer patients with anxiety or depression. METHOD Fifteen nurses were randomly allocated to either receive training in cognitive behavioural techniques or to continue their practice as usual. Nurses were interviewed following the CBT training and after the research study. RESULTS The CBT group reported a positive change in their approach to patients. Nurses felt empowered, more skilled and effective not only to assess and support patients with symptoms of anxiety and depression but also to facilitate change. In addition, nurses placed considerable value on being given a psychological model and set of interventions. CONCLUSIONS Nurses found taking part in the study demanding in terms of time and commitment; however, the authors conclude that research in the community palliative care setting is feasible.
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Affiliation(s)
- E Cort
- St Christopher's Hospice, London.
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Dolbeault S, Cayrou S, Brédart A, Viala AL, Desclaux B, Saltel P, Gauvain-Piquard A, Hardy P, Dickes P. The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. Psychooncology 2009; 18:647-56. [PMID: 19039808 DOI: 10.1002/pon.1440] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Many women with breast cancer need psychological help to cope more effectively after treatment. Cognitive and behavioural techniques are not yet well established in France. A multi-site randomized study was conducted to evaluate the effects of a psycho-educational group intervention in this population. METHODS Two hundred and three patients, recruited after primary treatment, were randomly assigned either to a treatment group (psycho-educational intervention) or to a waiting-list control group. The 8-week programme of 2 h sessions comprised of thematic discussions, information and training in stress management techniques. Evaluation at baseline, after 8 sessions, and 1 month after programme completion, included evaluations using the STAI, POMS, MAC, EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales. RESULTS We observed a significant reduction in anxiety (STAI, POMS) among group participants, a reduction in anger, depression and fatigue (POMS), a significant improvement in vigor and interpersonal relationships (POMS), in emotional and role functioning, in health status and fatigue level (EORTC QLQ-C30). In contrast, coping strategies (MAC) were not significantly different between groups. No group-related negative effects were observed and the global satisfaction levels were very high. CONCLUSION This study demonstrates the feasibility and effectiveness of a psycho-educational intervention, which can accelerate the reduction of those negative affects which are present at the end of treatment. It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support, widely proposed in France, and should now be tested in groups with other types of cancer and at other disease phases.
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Affiliation(s)
- S Dolbeault
- Psycho-Oncology Unit, Curie Institute Paris, France.
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Abstract
Problem-solving therapy (PST) has emerged as a promising treatment for major depressive disorder (MDD). The treatment, which is brief and easily accessible to a variety of health practitioners, has often been implemented within primary care settings. Building on this research, this case study highlights utilization of problem-solving therapy with a breast cancer patient diagnosed with recurrent major depression, applied within the context of a medical center oncology clinic. Following an 8-session PST protocol, the patient demonstrated notable decreases in self-reported depression and anxiety symptoms and an overall increase in quality of life and medical functioning. Consistent with an accumulating literature, these data support PST as an effective and parsimonious intervention for individuals with depression and concurrent medical problems such as breast cancer.
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Moorey S, Cort E, Kapari M, Monroe B, Hansford P, Mannix K, Henderson M, Fisher L, Hotopf M. A cluster randomized controlled trial of cognitive behaviour therapy for common mental disorders in patients with advanced cancer. Psychol Med 2009; 39:713-723. [PMID: 18761755 DOI: 10.1017/s0033291708004169] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT) has been shown to reduce psychological morbidity in people with cancer, but no randomized controlled trial (RCT) exists in palliative care. We aimed to determine whether home care nurses could be taught to deliver basic cognitive behavioural techniques and so reduce symptoms of anxiety and depression. METHOD Clinical nurse specialists (CNSs) at St Christopher's Hospice were randomly allocated to receive training in CBT or continue their usual practice. At the end of the trial, nurses were rated on the Cognitive Therapy First Aid Rating Scale (CTFARS) for CBT competence. Home care patients who scored as possible cases on the Hospital Anxiety and Depression Scale (HADS) entered the trial. Participants received home care nursing visits. Assessments were carried out at baseline, 6, 10 and 16 weeks. RESULTS Eight nurses received CBT training and seven continued practice as usual. The mean CTFARS scores were 35.9 for the CBT nurses and 19.0 for the controls (p=0.02). A total of 328 patients (54%) were possible cases and 80 entered the trial; most of those excluded were too ill to participate. There was an interaction between group and time: individuals receiving CBT had lower anxiety scores over time [coefficient -0.20, 95% confidence interval (CI) -0.35 to -0.05, p=0.01]. No effect of the training was found for depression. CONCLUSIONS It is possible to conduct a randomized trial of psychological interventions in palliative care but there is considerable attrition from physical morbidity and mortality. Nurses can learn to integrate basic CBT methods into their clinical practice. This training may be associated with better outcomes for symptoms of anxiety.
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Affiliation(s)
- S Moorey
- South London and Maudsley NHS Foundation Trust, UK.
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Pitceathly C, Maguire P, Fletcher I, Parle M, Tomenson B, Creed F. Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Ann Oncol 2009; 20:928-34. [DOI: 10.1093/annonc/mdn708] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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MANOS D, SEBASTIÁN J, MATEOS N, BUENO M. Results of a multi-componential psychosocial intervention programme for women with early-stage breast cancer in Spain: quality of life and mental adjustment. Eur J Cancer Care (Engl) 2009; 18:295-305. [DOI: 10.1111/j.1365-2354.2008.00978.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Armento MEA, Hopko DR. Behavioral Activation of a Breast Cancer Patient With Coexistent Major Depression and Generalized Anxiety Disorder. Clin Case Stud 2009. [DOI: 10.1177/1534650108327474] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Recently developed behavioral activation interventions have shown promise in effectively treating depression through increasing value-based activity levels that elicit response-contingent reinforcement. This case study highlights the implementation of behavioral activation to a breast cancer patient with major depression and generalized anxiety disorder, applied within the context of a medical center oncology clinic. Following an eight-session behavioral activation protocol, the patient demonstrated notable decreases in self-reported depressive and anxious symptoms and an overall increase in quality of life and medical functioning. These treatment gains were maintained through 6-month follow-up. Consistent with an accumulating literature, these data support behavioral activation as an effective and parsimonious intervention for individuals with depression and concurrent medical problems such as breast cancer.
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Anderson T, Watson M, Davidson R. The use of cognitive behavioural therapy techniques for anxiety and depression in hospice patients: a feasibility study. Palliat Med 2008; 22:814-21. [PMID: 18755828 DOI: 10.1177/0269216308095157] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anxiety and depression are common in palliative care patients. Cognitive behavioural therapy (CBT) has been recommended as one possible treatment, and it has been suggested that non-mental health professionals may be able to treat milder disorders with CBT. The aim of this study was to assess whether the use of CBT techniques in hospice patients is an acceptable intervention, and whether a palliative care professional with short CBT training can usefully apply such techniques. A feasibility study of a brief CBT intervention following training was conducted. Qualitative analysis was carried out on patient feedback from semi-structured interviews. Hospital Anxiety and Depression Scale scores pre-and post-intervention were analysed statistically. Eleven patients completed a short course using CBT techniques. The intervention was acceptable for 10 patients. One patient found it unacceptable due to advanced disease, lethargy and severe depression. Anxiety or depression symptoms were helped in eight patients. This study showed that a palliative care professional with short training in CBT was usefully able to apply CBT techniques to hospice patients with mild-to-moderate anxiety or depression.
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Affiliation(s)
- T Anderson
- Belfast City Hospital, Belfast, Northern Ireland, UK.
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Hopko DR, Bell JL, Armento M, Robertson S, Mullane C, Wolf N, Lejuez CW. Cognitive-behavior therapy for depressed cancer patients in a medical care setting. Behav Ther 2008; 39:126-36. [PMID: 18502246 DOI: 10.1016/j.beth.2007.05.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 04/17/2007] [Accepted: 05/24/2007] [Indexed: 01/17/2023]
Abstract
Major depression is the most common psychiatric disorder among cancer patients and is associated with decreased quality of life, significant deterioration in recreational and physical activities, relationship difficulties, sleep problems, more rapidly progressing cancer symptoms, and more metastasis and pain relative to nondepressed cancer patients. Although some research has explored the utility of psychological interventions with cancer patients, only one study to date has explored the potential benefits of cognitive-behavior therapy among cancer patients with well-diagnosed depression. Addressing this gap in the literature, this study represents an open clinical trial to assess the effectiveness of a brief Cognitive-Behavioral Treatment for Depression (CBTD) among depressed cancer patients in a medical care setting. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally maintained at 3-month follow-up. Behavioral activation interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment that may improve psychological outcomes and quality of life among cancer patients. Study limitations and future research directions are discussed.
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Affiliation(s)
- Derek R Hopko
- University of Tennessee, Knoxville, Department of Psychology, Knoxville, TN 37996-0900, USA.
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Edelman S. Group therapy with metastatic cancer patients. CLIN PSYCHOL-UK 2008. [DOI: 10.1080/13284209908521042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah Edelman
- Psycho-Oncology Unit, University Of Technology , Sydney
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Arving C, Sjödén PO, Bergh J, Hellbom M, Johansson B, Glimelius B, Brandberg Y. Individual psychosocial support for breast cancer patients: a randomized study of nurse versus psychologist interventions and standard care. Cancer Nurs 2007; 30:E10-9. [PMID: 17510577 DOI: 10.1097/01.ncc.0000270709.64790.05] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In a prospective, randomized study, an individual psychosocial support intervention performed by specially trained oncology nurses, or psychologists, were compared with standard care. Consecutive primary breast cancer patients about to start adjuvant therapy (n = 179) were included. Data were supplied by the questionnaires European Organisation for Research and Treatment of Cancer Quality of Life Study Group Core Quality of life questionnaire with 30 questions (EORTC QLQ-C30) and Breast Cancer Module with 23 questions (BR23), the Hospital Anxiety and Depression Scale, Spielberger's State-Trait Anxiety Inventory, and the Impact of Event Scale before randomization and 1, 3, and 6 months later. Patient files provided data on utilization of psychosocial support offered in routine care. Global quality of life/health status, nausea and vomiting, and systemic therapy side effects were the subscales showing significant Group by Time interactions, favoring the interventions. Intervention groups improved statistically significantly more than the standard care group regarding insomnia, dyspnea, and financial difficulties. Nurse patients experienced less intrusion compared with the standard care group. All groups showed statistically and clinically significant improvements with time on several subscales. The intervention groups, however, improved to a greater extent. Fewer patients in the intervention groups used psychosocial hospital support compared with the standard care group. In conclusion, psychosocial support by specially trained nurses using techniques derived from cognitive behavioral therapy is beneficial for breast cancer patients and may be a realistic alternative in routine cancer care.
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Affiliation(s)
- Cecilia Arving
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
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Ramsay K, Ramsay J, Main D. Both group peer counselling and individual counselling reduce anxiety and depression, and increase self-esteem and overall life satisfaction in palliative cancer care. COUNSELLING PSYCHOLOGY QUARTERLY 2007. [DOI: 10.1080/09515070701240071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The detrimental effect of a helpless coping response on the quality of life of cancer patients is well documented. Helplessness is significantly related to emotional distress. There is also evidence that this coping response is an independent prognostic factor associated with a significantly increased risk of disease recurrence and death. These findings highlight the need to develop specific strategies to enable patients to overcome helplessness. Recent research in patients with advanced cancer indicates that emotional distress appears to be caused by low levels of positive effect. Consequently, attention should be paid to the much neglected study of positive psychological states such as fighting spirit and resilience. In the meantime, some suggestions-based on clinical experience-of inducing and fostering positive effect in our patients are outlined.
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Affiliation(s)
- Steven Greer
- St Raphael's Hospice, London Road, North Cheam, Surrey SM3 9DX, UK.
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Abstract
Presence of support has repeatedly been linked to good long-term health outcomes based on demonstrations of better immune function, lower blood pressures, and reduced mortality (among others). Despite a massive literature on the benefits of support, there is surprisingly little hard evidence about how, and how well, social support interventions work. Using a computerized search strategy, 100 studies that evaluated the efficacy of such interventions were located. The presenting problems ranged from cancer, loneliness, weight loss, and substance abuse to lack in parenting skills, surgery, and birth preparation. For the purpose of review and evaluation, studies were subdivided into (1) group vs. individual interventions, (2) professionally led vs. peer-provided treatment, and (3) interventions where an increase of network size or perceived support was the primary target vs. those where building social skills (to facilitate support creation) was the focus. On the whole, this review provided some support for the overall usefulness of social support interventions. However, because of the large variety of existing different treatment protocols and areas of application, there is still not enough evidence to conclude which interventions work best for what problems. Specific methodological and conceptual difficulties that plague this area of research and directions for future research are discussed.
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Affiliation(s)
- Brenda E Hogan
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4
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Khochikar MV. Treatment algorithm in hormone-resistant prostate cancer: Practical guidelines. Indian J Urol 2007; 23:67-9. [PMID: 19675767 PMCID: PMC2721501 DOI: 10.4103/0970-1591.30271] [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] [Indexed: 11/29/2022] Open
Abstract
Treatment of hormone-resistant prostate cancer can be a challenging situation. The first important step in treating this condition is to assess if one has achieved the castrate level or not. If the castrate levels are not achieved, attempt should be made to achieve so. If the castrate level is achieved, then androgen withdrawals may be of help. Supportive care, care of the clinical problems forms an integral part of the treatment. Cancer-specific chemotherapy is certainly an option in progressive disease.
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Affiliation(s)
- Makarand V Khochikar
- Department of Uro-oncology, Siddhi Vinayak Ganapati Cancer Hospital, Miraj, India
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Savard J, Simard S, Giguère I, Ivers H, Morin CM, Maunsell E, Gagnon P, Robert J, Marceau D. Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: Psychological and immunological effects. Palliat Support Care 2006; 4:219-37. [PMID: 17066964 DOI: 10.1017/s1478951506060305] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective:Depression is particularly prevalent in patients with advanced cancer. Cognitive therapy (CT) is an empirically supported treatment for depression in the general population. However, efficacy remains to be demonstrated in patients with advanced cancer. A prior controlled trial of CT in a group format showed improvements in depression, mood disturbance, and self-esteem; however, these effects were not maintained over time. Studies examining the efficacy of individual format CT interventions that may ensure more long-term maintenance of benefits are necessary. This study assessed the efficacy of CT for depression administered individually in women with metastatic breast cancer and its effect on immune function.Method: Forty-five women were randomly assigned to either individual CT or to a waiting-list control (WLC) condition. CT was composed of eight weekly sessions of CT and three booster sessions administered at 3-week intervals following the end of treatment.Results: Patients treated with CT had significantly lower scores on the Hamilton Depression Rating Scale at posttreatment compared to untreated patients. Pooled data from both groups indicated significant reductions of depressive symptoms from pre- to posttreatment, as well as reduction of associated symptoms including anxiety, fatigue, and insomnia symptoms. These effects were well sustained at the 3- and 6-month follow-up evaluations. CT for depression did not appear to have a significant impact on immune functioning.Significance of results: Findings of this study support the efficacy of CT for depression in this population and suggest that the administration of individual and booster sessions after treatment termination may be instrumental in sustaining the treatment effects over time.
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Affiliation(s)
- Josée Savard
- Laval University Cancer Research Center, Université Laval, Québec, Québec, Canada.
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Sikorskii A, Given C, Given B, Jeon S, McCorkle R. Testing the effects of treatment complications on a cognitive-behavioral intervention for reducing symptom severity. J Pain Symptom Manage 2006; 32:129-39. [PMID: 16877180 DOI: 10.1016/j.jpainsymman.2006.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2006] [Indexed: 11/27/2022]
Abstract
Patients (n = 231) diagnosed with solid tumors and undergoing chemotherapy were randomly assigned to the experimental arm (n = 114) or to conventional care (n = 117). A symptom severity index based on summed severity scores across 15 symptoms was the primary outcome. Building on previously published work, an analysis was undertaken to determine the effects of patient characteristics and treatment complications on reductions in symptom severity achieved by a trial of a cognitive-behavioral intervention (CBI). The impact of the intervention on symptom severity differed by the occurrence of neutropenic events, chemotherapy dose delays or dose reductions, and number of comorbid conditions. Patients with more comorbid conditions, as well as those who did not experience neutropenia or dose delay/reduction, who received the intervention reported lower severity at 20 weeks compared to those who received conventional care. This research begins to specify the clinical conditions under which CBIs are effective in lowering symptom severity.
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Affiliation(s)
- Alla Sikorskii
- College of Nursing, Michigan State University, East Lansing, Michigan 48824, USA
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