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Zhao X, Bie F, Luo C, Zhang JE. Distress, illness perception and coping style among thyroid cancer patients after thyroidectomy: A cross-sectional study. Eur J Oncol Nurs 2024; 69:102517. [PMID: 38340645 DOI: 10.1016/j.ejon.2024.102517] [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: 04/08/2023] [Revised: 12/30/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Thyroid cancer generally has a good prognosis, and thyroidectomy is the main treatment given to thyroid cancer patients. Almost every cancer patient experiences varying degrees of distress, which can reduce their quality of life. This study aims to explore the level of distress and its relationship with illness perception and coping style among Chinese thyroid cancer patients after thyroidectomy and to identify the influencing factors on distress. METHODS A cross-sectional study with convenience sampling method was conducted. Totally 184 thyroid cancer patients after thyroidectomy were recruited in a tertiary hospital in Southern China with the response rate being 94.4% . The participants were investigated by a self-designed demographic and disease-related questionnaire, the Distress Management, the Brief Illness Perception Questionnaire, and the Medical Coping Modes Questionnaire. Descriptive statistics, univariate analysis, and multivariate linear regression were applied for data analysis. RESULTS In total, 99 (53.8%) thyroid cancer patients after thyroidectomy scored 4 or higher on the DT. Illness perception, emotional problem, body image loss by surgical scars, and acceptance-resignation were the influencing factors of distress and could explain 67.6% of the variance of distress among thyroid cancer patients after thyroidectomy. CONCLUSIONS Healthcare professionals should not ignore the distress among thyroid cancer patients after thyroidectomy and should take effective measures to alleviate the distress of thyroid cancer patients after thyroidectomy by enhancing their accurate and positive illness perceptions, decreasing their emotional problems, alleviating their body image loss by surgical scars, and avoiding acceptance-resignation coping style.
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Affiliation(s)
- Xinyue Zhao
- Department of Operating Room, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 2nd Zhongshan Road, Guangzhou, 510080, China.
| | - Fenggui Bie
- Department of Operating Room, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 2nd Zhongshan Road, Guangzhou, 510080, China
| | - Caixia Luo
- Department of Operating Room, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 2nd Zhongshan Road, Guangzhou, 510080, China
| | - Jun-E Zhang
- School of Nursing, Sun Yat-sen University, No. 74 2nd Zhongshan Road, Guangzhou, 510080, China.
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2
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Deuning-Smit E, Custers JAE, Kwakkenbos L, Hermens RPMG, Prins JB. Evaluating the capacity of the distress thermometer to detect high fear of cancer recurrence. Psychooncology 2023; 32:266-274. [PMID: 36385563 PMCID: PMC10099705 DOI: 10.1002/pon.6066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Fear of cancer recurrence (FCR) is common and burdensome to patients, but often remains undetected. Oncology professionals report need for tools to improve FCR detection in routine care. Oncology care guidelines recommend the Distress Thermometer (DT) for distress screening, but it has not been validated for FCR. This study evaluated the capacity of the DT and accompanying problem list to detect FCR. METHODS Amalgamated data of two studies with 149 breast cancer and 74 colorectal cancer survivors were used. We evaluated the Dutch DT including the DT score, problem list fears item and emotional domain score using Receiver Operating Characteristic analyses. The Dutch Cancer Worry Scale-6 (CWS-6) was used as reference measure, with validated cut-off scores ≥10 and ≥12 for high FCR. Sensitivity, specificity, negative and positive predictive values were calculated. RESULTS The DT score showed poor performance in discriminating between low and high FCR. The recommended cut-off ≥4 had low sensitivity (65% for CWS-6≥10; 72% for CWS-6 ≥12) and specificity (67% and 58%). No other cut-off had an acceptable combination of sensitivity and specificity. The fears item had low sensitivity (29% and 44.9%) and high specificity (95% and 94%). The emotional domain score had fair performance in discriminating between low and high FCR but there was no cut-off with acceptable sensitivity and specificity. CONCLUSION The DT as currently recommended in oncology care guidelines is not suitable to effectively detect FCR in routine care. To improve patients access to psychosocial care, it should be investigated how FCR-specific measures can be integrated in oncology practice.
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Affiliation(s)
- Esther Deuning-Smit
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Kwakkenbos
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Clinical Psychology, Radboud University, Nijmegen, The Netherlands.,Department of Psychiatry, Radboudumc Center for Mindfulness, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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3
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Murphy KM, Chen E, Ip EH, Rosenberg AR, Snyder MA, Salsman JM. Properties of the Shift and Persist Questionnaire in adolescent and young adult cancer patients and survivors: Validity, consistency, and interpretability. Qual Life Res 2023; 32:273-283. [PMID: 35962916 PMCID: PMC9839473 DOI: 10.1007/s11136-022-03219-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE The Shift and Persist model provides an informative framework to understand how adolescent and young adult (AYA) cancer patients and survivors (ages 15-39) may withstand stress and thrive despite adversity. The goal of the present study was to examine the psychometric properties of the Shift and Persist Questionnaire (SPQ) in this population and provide guidelines for interpretation. METHODS AYA cancer patients and survivors were recruited via an online research panel. Participants reported demographics and health history and completed the SPQ and Patient-Reported Outcome Measurement Information System 29-item profile (PROMIS®-29). We evaluated the structural validity, internal consistency, and construct validity of the SPQ. Minimally important differences (MIDs) were estimated to inform SPQ score interpretation. RESULTS 572 eligible individuals completed the survey. On average, participants were aged 24 (SD = 7) at evaluation. Of the participants, 43.5% were female, 77.1% were white, and 17.5% were Hispanic (across races). The two-factor structure of the SPQ demonstrated very good structural validity (CFI > 0.95, SRMR < 0.08), and construct validity with PROMIS-29® domains (convergent Rs = 0.17 to 0.43, divergent Rs = - 0.11 to - 0.51). Internal consistency was adequate (ω = 0.76-0.83). Recommended MIDs were 1 point for the Shift subscale, 1-2 point(s) for the Persist subscale, and 2-3 points for the total SPQ score. CONCLUSION The SPQ is a psychometrically sound measure of skills that contribute to resilience in AYA cancer patients and survivors. MID recommendations enhance the interpretability of the SPQ in this population. Future studies examining shifting and persisting in this population may benefit from administering the SPQ.
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Affiliation(s)
- Karly M Murphy
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
| | - Edith Chen
- Department of Psychology, Weinberg College of Arts & Sciences, Northwestern University, Evanston, IL, USA
| | - Edward H Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Abby R Rosenberg
- Palliative Care and Resilience Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Mallory A Snyder
- Office of Research and National Laboratories, The University of Chicago, Chicago, IL, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
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4
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den Hollander D, Van der Graaf WTA, Fiore M, Kasper B, Singer S, Desar IME, Husson O. Unravelling the heterogeneity of soft tissue and bone sarcoma patients' health-related quality of life: a systematic literature review with focus on tumour location. ESMO Open 2021; 5:e000914. [PMID: 33082266 PMCID: PMC7577059 DOI: 10.1136/esmoopen-2020-000914] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022] Open
Abstract
Patients with sarcoma experience many physical and psychological symptoms, adversely affecting their health-related quality of life (HRQoL). HRQoL assessment is challenging due to the diversity of the disease. This review aims to unravel the heterogeneity of HRQoL of patients with sarcoma with regard to tumour location and to summarise the used measures in research. English-language literature from four databases published between January 2000 and April 2019 was reviewed. Studies that described adult sarcoma HRQoL outcomes were included and classified according to primary sarcoma location. Eighty-seven articles met the inclusion criteria covering sarcoma of the extremities (n=35), pelvis and axial skeleton (n=9), pelvis and extremities (n=5), head and neck (n=4), retroperitoneum (n=2) and multiple sarcoma locations (n=33), respectively. Urogenital and thoracic sarcoma were lacking. Fifty-four different questionnaires were used, most often cancer-generic or generic HRQoL questionnaires. Patients with sarcoma reported lower HRQoL than the general population. Distinctive patterns of HRQoL outcomes according to tumour location regarding symptoms, physical functioning, disability and psychosocial well-being were identified. In metastatic sarcoma, mostly constitutional symptoms were present. To comprehensively assess HRQoL, a sarcoma-specific measurement strategy should be developed and used covering the heterogeneity of sarcoma including location-specific issues to improve personalised HRQoL assessment in future research and clinical practice.
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Affiliation(s)
- Dide den Hollander
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winette T A Van der Graaf
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco Fiore
- Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Bernd Kasper
- Sarcoma Unit, University of Heidelberg, Mannheim University Medical Center, Mannheim, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany
| | - Ingrid M E Desar
- Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga Husson
- Medical Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom.
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5
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Park CHK, Kim H, Kim Y, Joo YH. Characteristics of Patients Presenting to a Psycho-Oncology Outpatient Clinic. Psychiatry Investig 2021; 18:743-754. [PMID: 34333898 PMCID: PMC8390942 DOI: 10.30773/pi.2021.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to determine the overall profile of patients in a psycho-oncology clinic and the differences in their characteristics according to the cancer site. METHODS The charts of 740 patients aged under 81 years were reviewed. The data from 586 completed questionnaires were subjected to multiple comparison analyses using one-way analysis of variance to examine the demographic and clinical differences according to the cancer site. RESULTS Most (n=532, 71.9%) patients were referred. Most new patients (n=426, 96.6%) received a psychiatric diagnosis; the most common diagnosis was depressive disorder (n=234, 31.6%). Likewise, depressive disorder accounted for the majority of diagnoses in all groups except for the digestive system cancer group in which sleep-wake disorder was the most prevalent. The female genital cancer group showed a higher level of anxiety symptoms than other groups, except for breast and haematolymphoid cancer groups, and psychological distress than all other groups. CONCLUSION There appear to be delays in the referral of cancer patients seeking psychiatric help to a psycho-oncology clinic. Along with tailoring approaches by cancer site, thorough evaluation and appropriate management of sleep-wake and anxiety symptoms are important for digestive system and female genital cancer patients, respectively.
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Affiliation(s)
- C Hyung Keun Park
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yangsik Kim
- Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Yeon Ho Joo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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6
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Harbeck E, Chambers S, Porter-Steele J, Anderson D, Sanmugarajah J, Hughes F, Nehill C, Seib C. Screening for distress in women with gynaecological cancer: Adaptation of the distress thermometer for gynaecological oncology patients. Eur J Cancer Care (Engl) 2021; 30:e13486. [PMID: 34258811 DOI: 10.1111/ecc.13486] [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: 09/09/2019] [Revised: 04/07/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Generic distress screening tools may not recognise the unique concerns reported in some cancer populations. The face and content validity of a screening tool derived from the National Cancer Comprehensive Network distress thermometer and problem list and adapted specifically for women with gynaecological cancer is presented. METHODS Building on existing work, panels of clinicians and researchers, and focus groups with women treated for gynaecological cancer, developed a nuanced distress screening tool. RESULTS The clinical reference group used an iterative process to reduce 54 items to 22 across four domains (practical/family/psychological/physical). These items were included in the draft tool, which was reviewed by two focus groups of long-term cancer survivors. Participants unanimously thought the tool was necessary though several changes were recommended. The final draft tool contained a global distress score and 25 items across the four domains. CONCLUSIONS This measure provides a structured screening tool tailored to the concerns of women with gynaecological cancer, enhancing communication between clinicians and their patients about potentially identified and unrecognised sources of distress. Future research will focus on establishing sensitivity and specificity of this tool and further assessing its utility in clinical settings for all gynaecological cancers (including rare cancers like vulvar cancer).
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Affiliation(s)
- Emma Harbeck
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Suzanne Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Janine Porter-Steele
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Choices Cancer Support Program, Wesley Hospital, Brisbane, Queensland, Australia
| | - Debra Anderson
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jasotha Sanmugarajah
- Director for Medical Oncology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | | | | | - Charrlotte Seib
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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7
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Kim H, Park CHK, Kim Y, Joo Y. Correlates of Psychological Distress in Patients With Cancer at a Psycho-oncology Clinic. J Acad Consult Liaison Psychiatry 2021; 62:595-605. [PMID: 34245944 DOI: 10.1016/j.jaclp.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/04/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with cancer experience significant psychological distress. Most studies investigated individual risk factors for distress in their respective treatment setting, which limit generalizability of results or comparison of relative importance. OBJECTIVE To investigate the relation between psychological distress in patients referred to a psycho-oncology clinic and its correlates in a comprehensive manner. METHOD Medical charts of patients who visited the psycho-oncology clinic at a tertiary hospital from May 2019 to May 2020 were reviewed. Demographic, cancer-related, and psychiatric factors; health-related quality of life; and somatic pain were investigated. The Hospital Anxiety and Depression Scale, item 9 on the Patient Health Questionnaire-9, Functional Assessment of Cancer Therapy-General, Present Pain Intensity, and Distress Thermometer were measured at the index visit. Simple and multiple linear regression analyses were performed with the Distress Thermometer score as a dependent variable. RESULTS A total of 454 patients were included. The univariate analyses showed age and physical, emotional, and functional well-being scores on the Functional Assessment of Cancer Therapy-General were negatively associated with the Distress Thermometer scores, while female genital cancer, advanced disease, recent radiotherapy, the Hospital Anxiety and Depression Scale score, and the Present Pain Intensity score showed a positive relation. After adjusting for all other variables, female genital cancer (P = 0.027), anxiety subscale of the Hospital Anxiety and Depression Scale (P < 0.001), the Present Pain Intensity (P = 0.002), and physical (P < 0.001) and functional (P = 0.019) well-being subscales of the Functional Assessment of Cancer Therapy-General remained significant. CONCLUSIONS Patients with cancer who visited a psycho-oncology clinic experienced more distress if they had female genital cancer, low health-related quality of life score, severe anxiety, or somatic pain.
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Affiliation(s)
- Harin Kim
- Department of Psychiatry, Asan Medical Center, Seoul, Korea; College of Medicine, University of Ulsan, Seoul, Korea
| | | | - Yangsik Kim
- Department of neuropsychiatry, National Center for Mental Health, Seoul, Korea
| | - Yeonho Joo
- Department of Psychiatry, Asan Medical Center, Seoul, Korea; College of Medicine, University of Ulsan, Seoul, Korea.
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8
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Portigliatti Pomeri A, La Salvia A, Carletto S, Oliva F, Ostacoli L. EMDR in Cancer Patients: A Systematic Review. Front Psychol 2021; 11:590204. [PMID: 33536968 PMCID: PMC7847844 DOI: 10.3389/fpsyg.2020.590204] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Psychological distress is common among patients with cancer, with severe consequences on their quality of life. Anxiety and depression are the most common clinical presentation of psychological distress in cancer patients, but in some cases cancer may represent a traumatic event resulting in posttraumatic stress disorder (PTSD). Currently, Eye Movement Desensitization and Reprocessing (EMDR) therapy is considered an evidence-based treatment for PTSD, but recent studies also showed its effectiveness for anxiety and depression. The aim of the present systematic review is to summarize the current literature on the effect of EMDR on cancer-related psychological distress. Methods: A literature search was conducted for peer-reviewed articles about "EMDR" and "cancer patients" in the following electronic databases: PubMed, MEDLINE, Science Direct, Google Scholar, and Cochrane library. Results: Our search identified 7 studies in which EMDR was used with a total of 140 cancer patients. The psychiatric diagnosis was PTSD in 3 studies. Otherwise, the diagnosis concerned the anxious and depressive disorder spectrum. Overall, EMDR treatment schedules used were highly heterogeneous, with a different number of sessions (from 2 to 12) and a different duration of therapy (up to 4 months). However, across all studies analyzed EMDR therapy was judged to be adequate in reducing symptoms of psychological distress in this population. Conclusions: According to the results of our analysis, the level of evidence regarding EMDR efficacy in cancer patients is limited by the scarcity of studies and their low methodological quality. Although better quality research is needed, available data suggest that EMDR could be a promising treatment for psychological distress in patients with cancer.
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Affiliation(s)
| | - Anna La Salvia
- Department of Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Sara Carletto
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- Clinical Psychology Unit, University Hospital City of Science and Health, Torino, Italy
| | - Francesco Oliva
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Italy
| | - Luca Ostacoli
- Clinical Psychology Unit, University Hospital City of Science and Health, Torino, Italy
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Italy
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9
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Arch JJ, Genung SR, Ferris MC, Kirk A, Slivjak ET, Fishbein JN, Schneider RL, Stanton AL. Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors. Support Care Cancer 2020; 28:4425-4433. [PMID: 31925530 PMCID: PMC7347435 DOI: 10.1007/s00520-020-05297-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Despite cancer survivors' frequent endorsement of anxiety symptoms, assessing the full range of anxiety disorders (AD), their timing of onset relative to cancer diagnosis, co-morbidity with mood disorder, and predictors of post-cancer onset, is rare or absent to date. This study provides a step toward addressing these gaps. METHODS Cancer survivors at re-entry after primary treatment completion who screened positively for anxiety symptoms (N = 133) and sought care through an intervention trial completed standardized diagnostic interviews, dimensional assessment of disorder severity, and timing of disorder onset relative to cancer diagnosis. We evaluated sociodemographic and medical predictors of developing a first AD after cancer diagnosis. RESULTS Most ADs began after cancer diagnosis (58%); for 68% of affected patients, this represented their first AD episode. The most common was generalized anxiety disorder (GAD; 41%), where "cancer-focused GAD" was distinguished from "typical GAD"; the next most common were specific phobia (14%) and social anxiety disorder (13%). A minority (31%) of ADs were comorbid with major depression. Relative to having no AD, experiencing more lingering treatment side effects predicted developing a first AD after cancer diagnosis. Relative to having an AD that began before cancer diagnosis, reporting a higher cancer stage predicted developing a first AD after diagnosis. CONCLUSIONS Cancer survivors at re-entry seeking care for anxiety symptoms manifested a broad range of ADs which most commonly developed after cancer diagnosis and were prompted by the experience of cancer. Such disorders represent an unusually late-life, cancer-linked etiology that warrants further investigation and clinical attention.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA.
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, 80045, USA.
| | - Sarah R Genung
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Michelle C Ferris
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Alex Kirk
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Elizabeth T Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Joel N Fishbein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Rebecca L Schneider
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, 90095, USA
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10
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Powell-Chandler A, Boyce K, James O, Scourfield L, Torkington J, Bisson J, Cornish JA. Psychological sequelae of colonic resections. Colorectal Dis 2020; 22:945-951. [PMID: 31981271 DOI: 10.1111/codi.14986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/15/2020] [Indexed: 02/08/2023]
Abstract
AIM The prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) in the general population has been estimated to be 5.9%, 3.3% and 4.4% respectively. The aim of this study was to determine whether psychological problems are more prevalent following colorectal surgery. METHOD Patients who had undergone colorectal resection in a 2-year period across four centres were asked to complete validated screening questionnaires for anxiety, depression and PTSD (GAD-7, PHQ-9, PCL-5) 12-48 months after surgery. Risk factors were identified using multiple linear regression analysis. RESULTS After excluding those who had died or received palliative diagnoses, questionnaires were sent to 1150 patients. 371 responded (32.3% response rate); median age 67 (20-99) years; 51% were men. 58% of patients underwent surgery for cancer; 23% had emergency surgery. 28% of patients screened positive for at least one psychological condition, with 20% screening positive for anxiety, 22% for depression and 14% for PTSD. Patients who were younger, women, had surgery as an emergency, for benign conditions, had stomas and had critical care stay were more likely to have poorer psychological outcomes. Multiple linear regression found that only younger age (P = 0.000) and female gender (P = 0.048) were significant risk factors. CONCLUSION The prevalence of anxiety, depression and PTSD appears to be high in patients who have undergone colorectal surgery. Younger patients and women are particularly at risk. Further work is needed to determine how best to prevent, detect and treat people with adverse psychological outcomes following colorectal surgery.
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Affiliation(s)
| | - K Boyce
- Health Education and Improvement Wales, Cardiff, UK
| | - O James
- Health Education and Improvement Wales, Cardiff, UK
| | | | - J Torkington
- Cardiff University, Cardiff, UK.,University Hospital of Wales, Cardiff, UK
| | | | - J A Cornish
- Cardiff University, Cardiff, UK.,University Hospital of Wales, Cardiff, UK.,Royal Glamorgan Hospital, Llantrisant, UK
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11
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van Nuenen FM, Donofrio SM, Tuinman MA, van de Wiel HBM, Hoekstra-Weebers JEHM. Effects on patient-reported outcomes of "Screening of Distress and Referral Need" implemented in Dutch oncology practice. Support Care Cancer 2020; 28:3391-3398. [PMID: 31781949 PMCID: PMC7256091 DOI: 10.1007/s00520-019-05140-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/17/2019] [Indexed: 11/12/2022]
Abstract
PURPOSE This study investigated the effect of the "Screening for Distress and Referral Need" (SDRN) process (completing a screening instrument; patient-caregiver discussion about the patient's responses, regardless of distress level, and possible referral to specialized care), implemented in Dutch oncology practice on patient-reported outcomes (PROs). METHODS A non-randomized time-sequential study was conducted to compare two cohorts. Cohort 1 respondents (C1) were recruited before and cohort 2 respondents (C2) after SDRN implementation in nine Dutch hospitals. Participants completed the EORTC-QLQ-C30, HADS, Patient Satisfaction Questionnaire-III, and the Distress Thermometer and Problem List (DT&PL). Descriptive analyses and univariate tests were conducted. RESULTS C2 respondents (N = 422, response = 54%) had significantly lower mean scores on the practical (t = 2.3; p = 0.02), social (t = 2.3; p = 0.03), and emotional PL domains (t = 2.9; p = 0.004) compared with C1 (N = 518, response = 53%). No significant differences were found on quality of life, anxiety, depression, satisfaction with care, distress level, the spiritual and physical PL domains, or on referral wish. CONCLUSIONS After implementation of SDRN, patients report significantly fewer psychosocial (practical, social, and emotional) problems on the DT/PL but responses on the other patient-reported outcomes were comparable. These results add to the mixed evidence on the beneficial effect of distress screening. More and better focused research is needed.
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Affiliation(s)
- Floor M van Nuenen
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stacey M Donofrio
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Marrit A Tuinman
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry B M van de Wiel
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
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12
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Admiraal JM, Hoekstra-Weebers JEHM, Schröder CP, Tuinier W, Hospers GAP, Reyners AKL. Distress, problems, referral wish, and supportive health care use in breast cancer survivors beyond the first year after chemotherapy completion. Support Care Cancer 2020; 28:3023-3032. [PMID: 31511981 PMCID: PMC7256025 DOI: 10.1007/s00520-019-05030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/06/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE We examined distress levels, problems, referral wish, and supportive health care use in a cross-sectional group of breast cancer survivors at two-time points with a 1-year time interval. Also, factors related to continuing elevated distress were explored. METHODS Breast cancer survivors, 1-5 years after chemotherapy completion, filled in the Dutch Distress Thermometer/Problem List (DT/PL) and questions on background characteristics at study inclusion (T1). DT/PL responses and health care use were discussed during semi-structured interviews. One year later, re-assessment took place (T2). The data were analyzed by descriptive and univariate analyses. Continuing elevated distress was defined as a DT score ≥ 5 at T1 and T2. RESULTS Seventy-three survivors completed all questionnaires (response = 84.6%). Eighteen (25%) experienced continuing elevated distress. Fatigue (T1 N = 48 (66%); T2 N = 41 (56%)) and lack of physical fitness (T1 N = 44 (60%); T2 N = 36 (49%)) were most often reported. Time since diagnosis, health care use, and practical, social, emotional and physical problems were significantly associated with continuing elevated distress. Between diagnosis and T1, N = 49(67%) used supportive healthcare services, mostly a psychologist and/or a physical/lymphedema therapist, and between T1 and T2, 39 (53%) did. At T1, 8 (11%) expressed a referral wish and at T2, 11 (16%) did. CONCLUSIONS Screening and management of distress, problems, and referral wish are important, even years after chemotherapy completion as a substantial proportion of breast cancer survivors continue to report elevated distress and problems. Special attention should be paid to survivors reporting physical problems, especially fatigue and lack of physical fitness, since these problems are most strongly related to continuing elevated distress.
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Affiliation(s)
- J M Admiraal
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, The Netherlands
| | - C P Schröder
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - W Tuinier
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - G A P Hospers
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - Anna K L Reyners
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands.
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13
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Langford DJ, Cooper B, Paul S, Humphreys J, Hammer MJ, Levine J, Conley YP, Wright F, Dunn LB, Miaskowski C. Distinct Stress Profiles Among Oncology Patients Undergoing Chemotherapy. J Pain Symptom Manage 2020; 59:646-657. [PMID: 31711968 DOI: 10.1016/j.jpainsymman.2019.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Cancer and its treatment are inherently stressful and stress impacts important patient outcomes. Patients vary considerably in their response to stress. Understanding this variability requires a patient-centered multidimensional approach. OBJECTIVES The objectives of this study were to identify and characterize patient subgroups with distinct multidimensional stress profiles (stress appraisal, exposure, and adaptation) during cancer treatment. METHODS Among 957 patients undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer, latent profile analysis was performed to identify patient subgroups using concurrent evaluations of global (Perceived Stress Scale) and cancer-specific (Impact of Events Scale-Revised) stress, lifetime stress exposure (Life Stressor Checklist-Revised), and resilience (Connor-Davidson Resilience Scale-10). RESULTS Three latent classes were identified: "Normative" (54.3%; intermediate global stress and resilience, lower cancer-related stress, lowest life stress); "Stressed" (39.9%; highest global and cancer-specific stress scores, lowest resilience, most life stress); and "Resilient" (5.7%; lowest global stress, cancer-specific stress comparable to Normative class, highest resilience, intermediate life stress). Characteristics that distinguished the Stressed from the Normative class included the following: younger age, female gender, lower socioeconomic status, unmarried/partnered, living alone, poorer functional status, and higher comorbidity burden. Compared to Stressed patients, Resilient patients were more likely to be partnered, to not live alone, and had a higher functional status. No demographic or clinical characteristics differentiated Normative from Resilient patients. Exposure to specific life stressors differed significantly among the classes. CONCLUSION A subset of patients warrants intensive psychosocial intervention to reduce stress and improve adaptation to cancer. Intervention efforts may be informed by further study of Resilient patients.
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Affiliation(s)
- Dale J Langford
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | | | | | - Jon Levine
- School of Nursing, University of California, San Francisco, San Francisco, California, USA; School of Dentistry, University of California, San Francisco, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA.
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
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14
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Ousseine YM, Butow PN, Fenaux P, Dring R, Festy P, Restivo L, Vey N, Mancini J. Association between health literacy, communication and psychological distress among myelodysplastic syndromes patients. Leuk Res 2018; 73:44-50. [PMID: 30216938 DOI: 10.1016/j.leukres.2018.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/24/2018] [Accepted: 08/12/2018] [Indexed: 12/20/2022]
Abstract
MDS is a complex and potentially severe disease which can trigger psychological distress. A lack of information received and understood about MDS may also arouse feelings of distress. Low health literacy (HL) might play a role particularly among older patients. Our aim was to assess MDS-related distress and to study the factors associated with it, including medical and non-medical factors such as HL. A self-administered questionnaire was mailed to all members of French and Australian patients' national MDS associations. Data of 280 patients were analysed. A majority of patient (59.5%) reported low functional HL and 50% reported regular difficulties in asking physicians questions. Distress was not modified by gender, awareness of increased risk of developing leukaemia or MDS characteristics. French patients had a higher mean IES score (adjusted β = 5.9, p = 0.004) compared to Australian patients. Poor satisfaction with information provided about MDS, lower functional HL and difficulties in asking physician's questions were also independently associated with distress. MDS-related distress seems more related to HL and communication with physicians than to MDS characteristics. More efforts are needed to improve health literacy, tailor information for MDS patients and support them psychologically in order to improve their emotional well-being.
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Affiliation(s)
- Youssoufa M Ousseine
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" Group, Marseille, France
| | - Phyllis N Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making (CeMPED), and Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia
| | - Pierre Fenaux
- AP-HP, Hôpital Saint-Louis, Service d'Hématologie Clinique, Groupe Francophone des Myélodysplasies (GFM), Paris, France; Paris 7 University, Paris, France
| | - Rebecca Dring
- Leukaemia Foundation of Australia, Melbourne, Australia
| | - Patrick Festy
- Connaître et Combattre les Myélodysplasies, Paris, France
| | - Léa Restivo
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" Group, Marseille, France
| | - Norbert Vey
- Institut Paoli-Calmettes, Marseille, F-13273 France; Aix-Marseille Univ, Inserm, CNRS, UM105, CRCM, Marseille, France
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" Group, Hop Timone, BIOSTIC, Marseille, France.
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15
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Leermakers L, Döking S, Thewes B, Braamse AMJ, Gielissen MFM, de Wilt JHW, Collette EH, Dekker J, Prins JB. Study protocol of the CORRECT multicenter trial: the efficacy of blended cognitive behavioral therapy for reducing psychological distress in colorectal cancer survivors. BMC Cancer 2018; 18:748. [PMID: 30021555 PMCID: PMC6052704 DOI: 10.1186/s12885-018-4645-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 06/28/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Approximately one third of the colorectal cancer survivors (CRCS) experience high levels of psychological distress. Common concerns experienced by CRCS include distress related to physical problems, anxiety, fear of cancer recurrence (FCR) and depressive symptoms. However, psychological interventions for distressed CRCS are scarce. Therefore, a blended therapy was developed, combining face-to-face cognitive behavioral therapy (CBT) with online self-management activities and telephone consultations. The aim of the study is to evaluate the efficacy and cost-effectiveness of this blended therapy in reducing psychological distress in CRCS. METHODS/DESIGN The CORRECT study is a two-arm multicenter randomized controlled trial (RCT). A sample of 160 highly distressed CRCS (a score on the Distress Thermometer of 5 or higher) will be recruited from several hospitals in the Netherlands. CRCS will be randomized to either the intervention condition (blended CBT) or the control condition (care as usual). The blended therapy covers approximately 14 weeks and combines five face-to-face sessions and three telephone consultations with a psychologist, with access to an interactive self-management website. It includes three modules which are individually-tailored to patient concerns and aimed at decreasing: 1) distress caused by physical consequences of CRC, 2) anxiety and FCR, 3) depressive symptoms. Patients can choose between the optional modules. The primary outcome is general distress (Brief Symptom Inventory-18). Secondary outcomes are quality of life and general psychological wellbeing. Assessments will take place at baseline prior to randomization, after 4 and 7 months. DISCUSSION Blended CBT is an innovative and promising approach for providing tailored supportive care to reduce high distress in CRCS. If the intervention proves to be effective, an evidence-based intervention will become available for implementation in clinical practice. TRIAL REGISTRATION This trial is registered in the Netherlands Trial Register ( NTR6025 ) on August 3, 2016.
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Affiliation(s)
- L. Leermakers
- Radboud Institute for Health Sciences, Department of Medical Psychology Radboud University Medical Center, (840), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - S. Döking
- Radboud Institute for Health Sciences, Department of Medical Psychology Radboud University Medical Center, (840), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - B. Thewes
- Radboud Institute for Health Sciences, Department of Medical Psychology Radboud University Medical Center, (840), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A. M. J. Braamse
- Department of Medical Psychology, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - M. F. M. Gielissen
- Radboud Institute for Health Sciences, Department of primary and community care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Siza (disability service) Arnhem, P.O. Box 532, 6800 AM Arnhem, The Netherlands
| | - J. H. W. de Wilt
- Radboud Institute for Health Sciences, Department of Surgery, Radboud university medical center, (725), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - E. H. Collette
- Department of Medical Psychology, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - J. Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - J. B. Prins
- Radboud Institute for Health Sciences, Department of Medical Psychology Radboud University Medical Center, (840), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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16
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Haynes-Lewis H, Clayton MF, Viswanathan S, Moadel-Robblee A, Clark L, Caserta M. Distress and Supportive Care Needs of Ethnically Diverse Older Adults With Advanced or Recurrent Cancer. Oncol Nurs Forum 2018; 45:496-507. [PMID: 29947356 DOI: 10.1188/18.onf.496-507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the prevalence of supportive care needs (SCNs) and distress and to describe relationships among these and patient characteristics for ethnically diverse older adults with advanced or recurrent cancer. SAMPLE & SETTING Cross-sectional survey in five outpatient oncology clinics in an urban academic medical center involving 100 participants receiving cancer care in an economically challenged community. METHODS & VARIABLES The supportive care framework for cancer care guided this study, and participants completed the SCN Survey Short Form 34 and the Distress Thermometer. Study variables are cancer diagnosis, gender, helping to raise children, number of comorbid diseases, race or ethnicity, treatment status, and zip code. RESULTS Clinically meaningful distress was found in about a third of patients. Distress was not affected by race or ethnicity. Many ethnically diverse older patients with advanced or recurrent cancer report distress and SCNs; those with high distress are more likely to report multiple SCNs. IMPLICATIONS FOR NURSING Nursing assessment of patient SCNs and distress is integral to establishing individualized patient-centered care plans and to delivering optimal care.
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17
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Cancer patients' experiences with and opinions on the process 'Screening of Distress and Referral Need' (SDRN) in clinical practice: A quantitative observational clinical study. PLoS One 2018; 13:e0198722. [PMID: 29902202 PMCID: PMC6002053 DOI: 10.1371/journal.pone.0198722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/24/2018] [Indexed: 11/20/2022] Open
Abstract
Objective This observational clinical study investigated patients’ experiences with and opinions on the Dutch ‘Screening of Distress and Referral Need’ (SDRN) process implemented in oncology practice. Insight into these can guide improvement of the SDRN process. Methods Patients from hospitals that had implemented SDRN for at least a year completed questions on experiences with essential SDRN process steps (1: completion of the Distress Thermometer and Problem List as screening instrument (DT&PL), 2: information on SDRN+DT&PL, 3: information on referral options, 4: discussing DT&PL responses, 5: referral when needed), and on opinions about SDRN and DT&PL. Descriptive and univariate analyses were conducted. Results Of the 498 participants (response = 54%), 81% completed a DT&PL, of whom 86–87% was exposed to steps 2–3 and 76% discussed responses; only three needing care were not offered referral. Sixty-one percent encountered all SDRN steps and 78% would recommend SDRN to others. Recommending SDRN is related to more frequent DT&PL completion (t = -2.5; p≤0.01), receipt of information on SDRN+DT&PL and referral options (X2 = 4.9; p≤0.05 and X2 = 5.9; p≤0.05 respectively), discussion of responses (X2 = 10.2; p≤0.001), and fuller exposure to SDRN process steps (X2 = 14.8; p≤0.01). Percentages (strongly) agreeing were highest on the DT&PL being useful (90%) and suitable (88%), and lowest on burdensome (31%) and time-consuming (28%). Conclusion The majority of participating patients encountered the steps of the SDRN process considered essential, with 3/5 having encountered all steps. Referral is largely targeted to patients’ need. Patients’ perceived benefit of SDRN increases with fuller exposure to all process steps. Therefore, improvements, particularly in DT&PL completion and discussion of responses should be made.
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18
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Bergerot CD, Clark KL, Obenchain R, Philip EJ, Loscalzo M. Breast and gynecological cancer patients' risk factors associated with biopsychosocial problem-related distress. Psychooncology 2017; 27:1013-1020. [PMID: 29226996 DOI: 10.1002/pon.4607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/09/2017] [Accepted: 11/30/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Inequalities exist between breast and gynecological cancer patients' experiences, leading to high levels of distress throughout the cancer journey. The present study aims to identify differences in source of biopsychosocial problem-related distress between women diagnosed with breast or gynecological cancers. METHODS From 2009 to 2016, women with breast (n = 2111) and gynecological (n = 641) cancers were screened using the core items of the instrument You, Your Family, and City of Hope are a Team. This is a touch screen-based instrument that assess problem-related distress due to physical, practical, functional, emotional, and other problems and identifies types of assistance requested. Data were analyzed using the linear regression model. RESULTS A significant difference in overall biopsychosocial problems rated as high distress was found between breast (M = 5.0) and gynecological (M = 6.2) cancer patients (P < .001). Gynecological cancer patients endorsed a greater number of problems to talk with a member of the team (alone or with written information), while both cancer groups requested written information equally. Gynecological cancer was associated with higher physical, functional, emotional, and total distress. Younger patients, non-Asian, and those with lower education and lower household income also reported greater distress. CONCLUSIONS Gynecological cancer patients represent a high-risk group, reporting greater problem-related distress and higher levels of requested assistance. Age, education, race/ethnicity, and income were found to be potential risk factors. Findings highlight the importance of considering characteristics and special needs related to specific types of cancer to assist in the effective treatment of distress throughout the continuum of care.
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Affiliation(s)
- Cristiane Decat Bergerot
- Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Karen Lynn Clark
- Department of Supportive Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Richard Obenchain
- Department of Supportive Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Errol J Philip
- The Notre Dame Laboratory for Psycho-Oncology Research, University of Notre Dame, Notre Dame, IN, USA
| | - Matthew Loscalzo
- Department of Supportive Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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19
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Garvey G, Cunningham J, Janda M, Yf He V, Valery PC. Psychological distress among Indigenous Australian cancer survivors. Support Care Cancer 2017; 26:1737-1746. [PMID: 29243167 DOI: 10.1007/s00520-017-3995-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/24/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study is to identify the level of and factors associated with distress in 155 Indigenous Australian cancer survivors approximately 6 months post-diagnosis. METHODS The distress thermometer (DT) was used to assess clinically significant distress (defined as having a DT score ≥ 4). Logistic regression was used to identify sociodemographic and clinical factors associated with clinically significant distress. RESULTS The mean distress score was 2.7 (SD 2.9), with about one in three Indigenous cancer survivors reporting clinically significant distress (35%; n = 54). After adjusting for age and sex, clinically significant distress was more likely among those who were separated/divorced/widowed than those who were married (odds ratio (OR) = 2.99, 95% confidence intervals (95% CI) 1.21-7.35, p = 0.017) and less likely among those residing in remote areas than those in major cities (OR = 0.23, 95% CI 0.08-0.71, p = 0.001) and in those receiving non-surgical treatment only compared with surgery only (OR = 0.24, 95% CI 0.08-0.68, p = 0.008). CONCLUSIONS Despite increased screening for distress in cancer care, this is, to our knowledge, the first published assessment of distress among Indigenous Australian cancer survivors. The characteristics of Indigenous cancer survivors associated with greater likelihood of clinically significant distress indicate at-risk subgroups who would benefit from screening and early intervention. Further research is required to identify the specific aetiologies of distress. Our findings indicate a need to identify psychological distress and for survivorship care to include culturally sensitive and tailored psychological support for Indigenous cancer survivors.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia.
| | - J Cunningham
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia
| | - M Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, QLD, 4006, Australia
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Hahn C, Joo SH, Chae JH, Lee CU, Kim TS. Feasibility of Psychosocial Distress Screening and Management Program for Hospitalized Cancer Patients. Psychiatry Investig 2017; 14:734-745. [PMID: 29209376 PMCID: PMC5714714 DOI: 10.4306/pi.2017.14.6.734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/20/2016] [Accepted: 02/27/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although the diagnosis and treatment of cancer is associated with psychosocial distress, routine distress screening is difficult in hospitalized oncology settings. We developed a consecutive screening program for psychosocial distress to promote psychiatric treatment of cancer patients and evaluated the feasibility of our program by Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS). METHODS Among 777 cancer inpatients recruited from the Catholic Comprehensive Institute of Seoul St. Mary's Hospital, 499 agreed to complete primary distress screening through DT. We conducted secondary distress screening through HADS in 229 patients who had high scores of DT. RESULTS Of the 499 participants, 270 patients with low scores of DT were included in the distress education program. 229 patients with high scores of DT received secondary distress screening through HADS. Among 115 patients with low scores of HADS, 111 patients received distress management. Among 114 patients with high scores in the secondary distress screening, 38 patients received psychiatric consultation service whereas 76 patients refused psychiatric consultation. CONCLUSION Using consecutive screening for psychosocial distress appeared to be feasible in an inpatient oncology setting. Nevertheless, the low participation rate of psychiatric consultation service in cancer patients with high distress level should be improved.
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Affiliation(s)
- Changtae Hahn
- Department of Psychiatry, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Deajeon, Republic of Korea
| | - Soo-Hyun Joo
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Suk Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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21
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Admiraal JM, van der Velden AWG, Geerling JI, Burgerhof JGM, Bouma G, Walenkamp AME, de Vries EGE, Schröder CP, Reyners AKL. Web-Based Tailored Psychoeducation for Breast Cancer Patients at the Onset of the Survivorship Phase: A Multicenter Randomized Controlled Trial. J Pain Symptom Manage 2017; 54:466-475. [PMID: 28711750 DOI: 10.1016/j.jpainsymman.2017.07.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/18/2017] [Accepted: 07/06/2017] [Indexed: 12/29/2022]
Abstract
CONTEXT Many breast cancer patients have unmet informational and psychosocial needs after treatment completion. A psychoeducational intervention may be well suited to support these patients. OBJECTIVES The purpose of this multicenter randomized controlled trial was to examine the effectiveness of a web-based tailored psychoeducational program (ENCOURAGE) for breast cancer patients, which aims to empower patients to take control over prevailing problems. METHODS Female breast cancer patients from two hospitals in The Netherlands who recently completed (neo-)adjuvant chemotherapy were randomly assigned to standard care or 12-week access to the ENCOURAGE program providing fully automated information problem-solving strategies, resources, and services for reported problems. At six and 12 weeks, patients completed self-report questions on optimism and control over the future (primary outcome), feelings of being informed, and acceptance of the illness. At baseline and 12 weeks, distress and quality of life questionnaires were completed. RESULTS About 138 patients were included. Almost all patients (67 of 69) visited ENCOURAGE as requested. No differences between the control and intervention group were observed for primary and secondary outcomes. An unplanned subgroup analysis showed that in clinically distressed patients (N = 57 at baseline; 41%), use of the ENCOURAGE program increased optimism and control over the future at 12 weeks more than in patients in the control group (Cohen's d = 0.65). CONCLUSION Although the effectiveness was not demonstrated, a subgroup of women treated for breast cancer can probably be supported by the program. The results of the present study are a starting point for further development and use of the program.
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Affiliation(s)
- Jolien M Admiraal
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette W G van der Velden
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Medical Oncology, Martini Hospital, Groningen, The Netherlands
| | - Jenske I Geerling
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Grietje Bouma
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Abstract
BACKGROUND High levels of distress are expected shortly after the diagnosis breast cancer. The Distress Thermometer (DT) is commonly used to screen for distress, using a cutoff score of 4 or 5; however, this score might not be appropriate for detecting distress in women with recently diagnosed breast cancer. OBJECTIVES The aims of this study were to establish the optimal DT cutoff score for detecting high distress shortly after breast cancer diagnosis and to correlate this score with the reported problems. METHODS We selected for this study Dutch women who completed the DT and the Hospital Anxiety and Depression Scale within 1 month after breast cancer diagnosis. Receiver operating characteristic analysis of DT scores was performed, with the Hospital Anxiety and Depression Scale being used as the criterion standard for the level of distress. The sensitivity, specificity, positive predictive value, and negative predictive value of each DT score were calculated. RESULTS In total, 181 women participated in the study. The optimal DT cutoff score for detecting distress was 7 with a sensitivity of 0.73, specificity of 0.84, positive predictive value of 69%, and negative predictive value of 87%. Emotional problems were the most frequently reported concerns. CONCLUSION We consider a cutoff score of 7, shortly after breast cancer is diagnosed, optimal to identify those women with high distress and therefore at risk of chronic distress. IMPLICATIONS FOR PRACTICE The findings are clinically important because they can enable healthcare professionals to direct their time and resources to those most in need of their assistance.
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Predictors of psychological distress among cancer patients receiving care at a safety-net institution: the role of younger age and psychosocial problems. Support Care Cancer 2017; 25:2305-2312. [DOI: 10.1007/s00520-017-3641-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/10/2017] [Indexed: 01/30/2023]
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Chagani P, Parpio Y, Gul R, Jabbar AA. Quality of Life and Its Determinants in Adult Cancer Patients Undergoing Chemotherapy Treatment in Pakistan. Asia Pac J Oncol Nurs 2017; 4:140-146. [PMID: 28503647 PMCID: PMC5412152 DOI: 10.4103/2347-5625.204499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: Cancer is a leading cause of death worldwide. Likewise, in Pakistan, it is a major health problem, with an approximate increase each year. Cancer treatment, particularly chemotherapy, produces a detrimental effect on individuals’ well-being. Since the past few years, quality of life (QOL) is considered as the primary goal of cancer treatment in patients’ survival. This study aimed to assess the QOL and its determinants in adult cancer patients undergoing chemotherapy treatment. Methods: An analytical cross-sectional design was employed to achieve the study objectives, utilizing consecutive sampling technique. A total of 150 adult (>19 years) cancer patients were recruited from a Tertiary Care Hospital in Karachi, Pakistan. The data were collected using the Functional Assessment of Cancer Therapy-General, a QOL questionnaire. Multiple linear regression was run to determine the effect of predictor variables, with a mean QOL score. Results: The overall mean score of QOL as 57.37. The domains of physical and emotional well-being were mainly affected by the chemotherapy treatment. Variables such as no previous hospitalization and no significant changes in life events were positively associated with the QOL. On the other hand, being female, unemployed, chemotherapy side effects (>1 week), impaired socialization, and discrimination by family/relatives were negatively associated with the QOL. Conclusions: The study findings suggested an overall low QOL among adult cancer patients undergoing chemotherapy treatment. It is recognized as a stressful treatment, which adversely affects the QOL of cancer patients. Interventions should focus on both the physical and psychological issues and need to be addressed to improve the QOL of adult cancer patients.
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Affiliation(s)
- Parveen Chagani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Yasmin Parpio
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Raisa Gul
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Adnan A Jabbar
- Department of Oncology Medicine, Aga Khan University, Karachi, Pakistan
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Contraception counseling for young breast cancer patients: A practical needs assessment and a survey among medical oncologists. Breast 2016; 30:217-221. [DOI: 10.1016/j.breast.2015.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/16/2015] [Accepted: 10/01/2015] [Indexed: 12/18/2022] Open
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Musiello T, Dixon G, O'Connor M, Cook D, Miller L, Petterson A, Saunders C, Joske D, Johnson C. A pilot study of routine screening for distress by a nurse and psychologist in an outpatient haematological oncology clinic. Appl Nurs Res 2016; 33:15-18. [PMID: 28096010 DOI: 10.1016/j.apnr.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/28/2016] [Accepted: 09/22/2016] [Indexed: 10/21/2022]
Abstract
AIM To explore the: 1) prevalence of distress, type of problems experienced by haematological patients, and referrals for supportive care; 2) effect of demographic and clinical variables on distress, and 3) effect on the time of health professionals conducting the screening in the ambulatory chemotherapy setting. METHODS Participants completed the National Comprehensive Cancer Network Distress Thermometer and Problem List and had a follow-up screening discussion with a health professional. RESULTS Of 68 participants, 40% reported significant distress (≥4) on the Distress Thermometer (mean 3.2, SD 2.4). All patients reported physical problems and 72% reported emotional problems-the major contributors to distress and to time spent with the health professional. Distress was unrelated to age, gender or cancer type. Patients were less likely to have significant distress at the end of treatment than at the beginning (OR=0.15, 95% CI: 0.03; 0.72,). Forty patients (59%) were referred to supportive services. The psychologist spent less time with patients compared to the nurse (18 vs 48min, p<0.001). The more emotional problems reported, the greater the time spent with the patient (rs=0.34, p=0.009). CONCLUSIONS Nurses can appropriately screen for distress and address significant distress reported by haematology patients undergoing chemotherapy without over burdening the nurse or patient.
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Affiliation(s)
- Toni Musiello
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Glenys Dixon
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Kent St, Bentley, Western Australia 6102, Australia
| | - Deb Cook
- Department of Haematology, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Lisa Miller
- Department of Psychiatry, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Anna Petterson
- SolarisCare, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Christobel Saunders
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - David Joske
- Department of Haematology, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia; SolarisCare, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Claire Johnson
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
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van Nuenen FM, Donofrio SM, Tuinman MA, van de Wiel HBM, Hoekstra-Weebers JEHM. Feasibility of implementing the 'Screening for Distress and Referral Need' process in 23 Dutch hospitals. Support Care Cancer 2016; 25:103-110. [PMID: 27565789 PMCID: PMC5127859 DOI: 10.1007/s00520-016-3387-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/17/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE In the Netherlands, the three-step process 'Screening for Distress and Referral Need' (SDRN) was developed for helping identifying, and referring cancer patients suffering from clinically relevant distress or needing a referral. This process includes (1) instrument completion, (2) patient-care provider discussion of the responses, and (3) referral based on 1 and 2. The Netherlands Comprehensive Cancer Organisation, location Groningen (IKNL-G), initiated the implementation of SDRN and developed an implementation roadmap, including procedure and materials. This exploratory study examines the feasibility of SDRN implementation in hospitals, seen from healthcare providers' perspective, responsible for implementation, and those executing SDRN. METHODS Healthcare providers, from 22 hospitals and from 5 oncology departments of the University Medical Center Groningen (=25 % of Dutch hospitals), evaluated their experiences by responding to a 26-item internet survey. RESULTS Twenty-five participants (response = 93 %) completed the survey. SDRN was implemented in 21 hospitals (implementation = 91 %), in two thirds of these hospitals in more than one patient group. Adoption of IKNL-G's roadmap elements varied between 84 and 100 %. Participants' average satisfaction score with SDRN was 6.5 (possible range = 0-10, range found = 5-8). Significant positive relationships were found between this satisfaction and participants' satisfaction with frequency of SDRN (p = 0.02), and keeping logistical agreements (p = 0.04). Participants were dissatisfied with SDRN's limited current availability to only select patient groups and only certain disease phases. CONCLUSIONS The implementation of SDRN in daily practice, supported by a pre-developed implementation roadmap, is highly feasible. Continuous attention to SDRN execution, broadening implementation to all forms of cancer, and during the total disease trajectory seems vital to improve healthcare providers' satisfaction.
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Affiliation(s)
- F M van Nuenen
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - S M Donofrio
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,University of Groningen, Department of Psychology, Groningen, The Netherlands
| | - M A Tuinman
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
| | - H B M van de Wiel
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
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Richardson EM, Schüz N, Sanderson K, Scott JL, Schüz B. Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis. Psychooncology 2016; 26:724-737. [PMID: 27412423 DOI: 10.1002/pon.4213] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 06/27/2016] [Accepted: 07/07/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer. METHODS A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted. RESULTS Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results. CONCLUSIONS The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer.
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Affiliation(s)
- Emma M Richardson
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Natalie Schüz
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer L Scott
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Benjamin Schüz
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Lo-Fo-Wong DNN, de Haes HCJM, Aaronson NK, van Abbema DL, den Boer MD, van Hezewijk M, Immink M, Kaptein AA, Menke-Pluijmers MBE, Reyners AKL, Russell NS, Schriek M, Sijtsema S, van Tienhoven G, Sprangers MAG. Predictors of enduring clinical distress in women with breast cancer. Breast Cancer Res Treat 2016; 158:563-72. [PMID: 27417105 PMCID: PMC4963436 DOI: 10.1007/s10549-016-3896-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/02/2016] [Indexed: 10/25/2022]
Abstract
To date, little is known about enduring clinical distress as measured with the commonly used distress thermometer. We therefore used the distress thermometer to examine: (a) the prevalence of enduring clinical distress, distress-related problems, and subsequent wish for referral of women with breast cancer, and (b) sociodemographic, clinical, and psychosocial predictors of enduring clinical distress. The study had a multicenter, prospective, observational design. Patients with primary breast cancer completed a questionnaire at 6 and 15 months postdiagnosis. Medical data were retrieved from chart reviews. Enduring clinical distress was defined as heightened distress levels over time. The prevalence of enduring clinical distress, problems, and wish for referral was examined with descriptive analyses. Associations between predictors and enduring clinical distress were examined with multivariate analyses. One hundred sixty-four of 746 patients (22 %) reported having enduring clinical distress at 6 and 15 months postdiagnosis. Of these, 10 % wanted to be referred for care. Fatigue was the most frequently reported problem by patients with and without clinical distress, at both time points. Lack of muscle strength (OR = 1.82, 95 % CI 1.12-2.98), experience of a low level of life satisfaction (OR = 0.77, 95 % CI 0.67-0.89), more frequent cancer worry (OR = 1.40, 95 % CI 1.05-1.89), and neuroticism (OR = 1.09, 95 % CI 1.00-1.18) were predictors of enduring clinical distress. In conclusion, one in five women with breast cancer develops enduring clinical distress. Oncologists, nurse practitioners, and cancer nurses are advised to use single-item questions about distress and distress-related problems to ensure timely detection of high-risk patients. Providers should also routinely assess fatigue and its causes, as fatigue is the most frequently reported distress-related problem over time.
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Affiliation(s)
- Deborah N N Lo-Fo-Wong
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands.
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
| | - Neil K Aaronson
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Doris L van Abbema
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Mathilda D den Boer
- Erasmus MC - Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - Marjan van Hezewijk
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Marcelle Immink
- Reinier de Graaf Hospital, Reinier de Graafweg 3-11, 2625 AD, Delft, The Netherlands
| | - Ad A Kaptein
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | | | - Anna K L Reyners
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Nicola S Russell
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Manon Schriek
- St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Sieta Sijtsema
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Geertjan van Tienhoven
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
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30
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Ploos van Amstel FK, Prins JB, van der Graaf WTA, Peters MEWJ, Ottevanger PB. The effectiveness of a nurse-led intervention with the distress thermometer for patients treated with curative intent for breast cancer: design of a randomized controlled trial. BMC Cancer 2016; 16:520. [PMID: 27455960 PMCID: PMC4960715 DOI: 10.1186/s12885-016-2565-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 07/14/2016] [Indexed: 12/14/2022] Open
Abstract
Background Distress in patients with cancer influences their quality of life. Worldwide, screening on distress with the Distress Thermometer (DT) in patients with cancer is recommended. However, the effects of the use of the DT on the psychosocial wellbeing of the patient are unknown. A study to assess the psychosocial consequences of the systematic use of the DT and its discussion by a nurse as compared to the usual care provided to outpatients who are treated for primary breast cancer is needed. Methods/design The effectiveness of a nurse-led intervention with the DT will be tested in a non-blinded randomized controlled trial. Patients treated with curative intent for breast cancer will be recruited from the Radboud University Medical Center. The intervention consists of the DT together with discussion of the results with the patient by a trained oncology nurse added to the usual care. Patients will be randomly allocated (1:1) to either receive usual care or the usual care plus the intervention. Primary outcome measure is global quality of life measured with the EORTC QLQ-C30. The functional and symptom scales of the EORTC QLQ-C30 and BR23, Hospital Anxiety and Depression Scale, Impact of Event Scale, Illness Cognition Questionnaire and DT (baseline and final measurement only) will be used to measure secondary outcomes. Questionnaires are obtained in both arms at baseline, after completion of each type of cancer treatment modality and during follow up, with a three and six months’ interval during the first and second year respectively. Discussion This study will be the first randomized controlled longitudinal study about the effectiveness of the DT as nurse led-intervention. In case of proven effectiveness, future implementation and standardization of use of the DT as part of routine care will be recommended. Trial registration This study is registered at clinicaltrial.gov march 17, 2010 (NCT01091584).
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Affiliation(s)
- Floortje K Ploos van Amstel
- Department of Medical Oncology, Radboud University Medical Center, P.O. Box 9101, 6500, Nijmegen, The Netherlands.
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, P.O. Box 9101, 6500, Nijmegen, The Netherlands.,Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Marlies E W J Peters
- Department of Medical Oncology, Radboud University Medical Center, P.O. Box 9101, 6500, Nijmegen, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, P.O. Box 9101, 6500, Nijmegen, The Netherlands
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Don't forget the dentist: Dental care use and needs of women with breast cancer. Breast 2016; 29:1-7. [PMID: 27376886 DOI: 10.1016/j.breast.2016.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Patients with breast cancer may develop dental problems due to treatment. We examined the prevalence of their dental care use and needs, compared the prevalence of use with that of the general population, and examined which factors predict patients' dental care use. METHODS Patients with primary breast cancer completed a questionnaire at 6 and 15 months post-diagnosis. Medical data were retrieved from medical records. The prevalence of dental care use and needs was examined with descriptive analyses. Associations between predictors and dental care use were examined with multivariate analyses. RESULTS Twenty-one percent of 746 participants visited their dentist at least once in the past three months at 6 months, and 23% at 15 months post-diagnosis. The estimated percentage of women with at least one contact with their dentist in 12 months was low compared to the general female population (31.9% versus 79.5%). One to two percent of the respondents wanted more contact. Having dental care insurance (odds ratio 1.80; 95% CI, 1.08-3.00), chemotherapy (odds ratio 1.93; 95% CI, 1.21-3.06), and clinical distress 6 months post-diagnosis (odds ratio 2.53; 95% CI, 1.70-3.79) predicted use of dental care 9 months later. CONCLUSIONS Up to 15 months post-diagnosis, breast cancer patients' dental care use is lower than warranted. Oncologists and cancer nurses are recommended to inform patients about dental risks, and to encourage them - particularly those without insurance - to visit their dentist. Occurrence of dental problems should be monitored, especially in patients who receive chemotherapy or who are clinically distressed.
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Güth U, Huang DJ, Bitzer J, Moffat R. Unintended pregnancy during the first year after breast cancer diagnosis. EUR J CONTRACEP REPR 2016; 21:290-4. [PMID: 27227578 DOI: 10.1080/13625187.2016.1180678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Young women experience high levels of anxiety and distress during cancer diagnosis and therapy, and it can be devastating to become pregnant in this vulnerable state. Pregnancy during cancer treatment is strongly discouraged, as radiotherapy and chemotherapy administered during the first trimester of pregnancy result in increased congenital malformations. METHODS In this study, we analysed an unselected, consecutive cohort of young breast cancer (BC) patients with regard to unintended pregnancy during the first year after BC diagnosis. We analysed all patients who were ≤40 years of age at initial BC diagnosis (n = 100, mean age at diagnosis: 35.9 years), according to data from the Basel Breast Cancer Database. The frequency of unintended pregnancy was assessed, and particular attention was given to patients' obstetric and reproductive history. RESULTS Forty-two percent of the cohort (mean age 36.5 years) were identified as not at risk of unintended pregnancy during the first year after BC diagnosis. However, 58% of the cohort (mean age 35.6 years) were using an ineffective contraceptive method and thus were at risk of unintended pregnancy. The rate of unintended pregnancy was 3.5% in this group (two patients). Oncologists should be aware that the use of reliable contraception should be discussed before starting, and also during, adjuvant therapy. CONCLUSIONS Oncologists should consider actively referring young BC patients to a gynaecologist to ensure proper contraceptive counselling.
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Affiliation(s)
- Uwe Güth
- a Zürich Breast Centre , Zürich , Switzerland ;,b Clinic for Gynaecology and Gynaecological Oncology, Women's Hospital, Basel University Hospital , Basel , Switzerland
| | - Dorothy Jane Huang
- b Clinic for Gynaecology and Gynaecological Oncology, Women's Hospital, Basel University Hospital , Basel , Switzerland
| | - Johannes Bitzer
- c Clinic for Gynaecological Social Medicine and Psychosomatics, Women's Hospital, Basel University Hospital , Basel , Switzerland
| | - Rebecca Moffat
- d Clinic for Gynaecological Endocrinology and Reproductive Medicine, Women's Hospital, Basel University Hospital , Basel , Switzerland ;,e Fertisuisse Centre for Reproductive Medicine , Olten , Switzerland
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Admiraal JM, van Nuenen FM, Burgerhof JGM, Reyners AKL, Hoekstra-Weebers JEHM. Cancer patients' referral wish: effects of distress, problems, socio-demographic and illness-related variables and social support sufficiency. Psychooncology 2016; 25:1363-1370. [DOI: 10.1002/pon.4067] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 12/29/2022]
Affiliation(s)
- J. M. Admiraal
- Department of Medical Oncology; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - F. M. van Nuenen
- Wenckebach Institute; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
- Netherlands Comprehensive Cancer Organisation; Groningen The Netherlands
| | - J. G. M. Burgerhof
- Department of Epidemiology; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - A. K. L. Reyners
- Department of Medical Oncology; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | - J. E. H. M. Hoekstra-Weebers
- Wenckebach Institute; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
- Netherlands Comprehensive Cancer Organisation; Groningen The Netherlands
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35
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Blanco-Piñero N, Antequera-Jurado R, Rodríguez-Franco L, Ibáñez-Guerra E, Herrero-Salado TF, Sánchez-Gómez S. Alteraciones emocionales y psicopatológicas en pacientes oncológicos laringectomizados. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:210-7. [DOI: 10.1016/j.otorri.2014.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
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Transitions in Symptom Cluster Subgroups Among Men Undergoing Prostate Cancer Radiation Therapy. Cancer Nurs 2015; 39:3-11. [PMID: 25730597 DOI: 10.1097/ncc.0000000000000236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prostate cancer is a common type of cancer worldwide and in the United States. However, little information has been reported on the symptoms of men over time who receive radiation therapy. OBJECTIVE The objectives of this study were to identify subgroups of men at pre- and post-radiation therapy on general and treatment-related symptoms and to determine transitions in subgroup membership over time. METHODS Men (n = 84) receiving radiation therapy completed questionnaires on fatigue, insomnia, pain, depression, anxiety, and sexual, urinary, and bowel problems at pretreatment and posttreatment. Latent class analysis identified subgroups. One-way analyses of variance determined subgroups differed on symptoms, participant characteristics, and quality of life. Latent transition analysis examined subgroup transitions over time. RESULTS At pretreatment, 4 subgroups were identified: resilient group, with little to no symptom reporting; adjusted group, with moderately high treatment-related symptoms, low insomnia, depression, and anxiety; distressed group, consistently high on most symptoms; and emerging group, with moderately high fatigue, depression, and anxiety with few treatment-related symptoms. At posttreatment, similar results were seen in groups to those at pretreatment: resilient, adjusted. and distressed groups with an impacted group having high pain, insomnia, depression, and urinary and bowel symptoms. Quality of life and participant characteristics further distinguished groups at pretreatment and posttreatment. Income level predicted a transition in group membership. CONCLUSIONS Men can be classified into distinctly different subgroups over time. IMPLICATIONS FOR PRACTICE Assessment and intervention with men in subgroups such as distressed and emerging before and during treatment may lessen potential for remaining distressed or moving into impacted group where symptom severity is high at posttreatment. Interventions to reduce multiple symptoms are vitally needed.
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Tuinman MA, Van Nuenen FM, Hagedoorn M, Hoekstra-Weebers JEHM. Distress, problems and referral wish of cancer patients: differences according to relationship status and life phase. Psychooncology 2014; 24:699-704. [DOI: 10.1002/pon.3712] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 09/03/2014] [Accepted: 09/26/2014] [Indexed: 01/11/2023]
Affiliation(s)
- Marrit A. Tuinman
- Health Psychology Section; University of Groningen, University Medical Center Groningen (UMCG); Groningen the Netherlands
| | - F. M. Van Nuenen
- Comprehensive Cancer Center Netherlands; location Groningen; the Netherlands
- Wenckebach Institute; University of Groningen, University Medical Center Groningen (UMCG); Groningen the Netherlands
| | - M. Hagedoorn
- Health Psychology Section; University of Groningen, University Medical Center Groningen (UMCG); Groningen the Netherlands
| | - J. E. H. M. Hoekstra-Weebers
- Comprehensive Cancer Center Netherlands; location Groningen; the Netherlands
- Wenckebach Institute; University of Groningen, University Medical Center Groningen (UMCG); Groningen the Netherlands
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Brocken P, van der Heijden EHFM, Oud KTM, Bootsma G, Groen HJM, Donders ART, Dekhuijzen PNR, Prins JB. Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study. Psychooncology 2014; 24:433-41. [DOI: 10.1002/pon.3660] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/14/2014] [Accepted: 08/01/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Pepijn Brocken
- Dept. of Pulmonary Diseases; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | | | - Karen T. M. Oud
- Dept. of Pulmonary Diseases; Gelderse Vallei Medical Centre; Ede The Netherlands
| | - Gerben Bootsma
- Dept. of Pulmonary Diseases; Atrium Medical Centre; Heerlen The Netherlands
| | - Harry J. M. Groen
- Dept. of Pulmonary Diseases; University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - A. Rogier T. Donders
- Dept. of Epidemiology, Biostatistics and Health Technology Assessment; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - P. N. Richard Dekhuijzen
- Dept. of Pulmonary Diseases; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Judith B. Prins
- Dept. of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
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Fujinami R, Sun V, Zachariah F, Uman G, Grant M, Ferrell B. Family caregivers' distress levels related to quality of life, burden, and preparedness. Psychooncology 2014; 24:54-62. [PMID: 24789500 DOI: 10.1002/pon.3562] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 03/26/2014] [Accepted: 04/01/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Family caregivers (FCGs) caring for loved ones with lung cancer are at risk for psychological distress and impaired quality of life (QOL). This study explores the relationship between FCGs' distress, per the distress thermometer (DT) and FCGs' QOL, burden, and preparedness. The purpose is to identify types of problems unique to FCGs in cancer care. METHODS Family caregivers of patients diagnosed with non-small cell lung cancer were recruited from an adult outpatient setting at a comprehensive cancer center. Questionnaires included demographic information, City of Hope QOL Scale-Family Version, Caregiver Burden Scale, FCG preparedness, and DT. Baseline data were utilized for this analysis. RESULTS Of the FCGs (N = 163), 68% were spouses, 64% female, and 34% worked full-time. FCG age ranged from 21 to 88 years with a mean of 57 years. FCGs cared for patients with non-small cell lung cancer stage I-III (44%) and stage IV (56%). Psychological distress (DT mean = 4.40) was moderate. DT scores were highly correlated with seven of the eight explanatory variables. Secondary principal components analysis of the explanatory variables combined correlated variables into three constructs identified as self-care component, FCG role component, and FCG stress component. Simultaneous multiple regression of distress onto the three components showed they accounted for 49% of the variance in distress. CONCLUSION This exploration of FCGs' concerns associated with elevated distress scores, as measured by the DT, helped identify three component problem areas. These areas warrant further psychosocial assessment and intervention to support FCGs as they care for the patient with cancer.
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Affiliation(s)
- Rebecca Fujinami
- Research specialist, Nursing Research & Education, Department of Population Sciences, City of Hope, Duarte, CA, USA
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Ma X, Zhang J, Zhong W, Shu C, Wang F, Wen J, Zhou M, Sang Y, Jiang Y, Liu L. The diagnostic role of a short screening tool—the distress thermometer: a meta-analysis. Support Care Cancer 2014; 22:1741-55. [DOI: 10.1007/s00520-014-2143-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
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