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Liu L, Wang R, Sun Y, Xiao Y, Du G, Zhang Q. Study on the cut-off point and the influencing factors of distress in newly diagnosed breast cancer patients. Front Psychol 2024; 15:1281469. [PMID: 38445051 PMCID: PMC10913590 DOI: 10.3389/fpsyg.2024.1281469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
Objective Our aim is to investigate the cut-off point of distress and the influencing factors associated with distress in patients with newly diagnosed breast cancer. Methods A cross-sectional survey of distress was conducted in 167 patients with newly diagnosed breast cancer admitted to the Department of General Surgery of a tertiary care hospital from July 2020 to March 2022. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) questionnaire within 3 days of admission. The HADS ≥15 was used as the gold standard, and the cut-off point of the DT measure was analyzed using the Receiver Operating Characteristic (ROC) curve. The cut-off point obtained by ROC curve analysis was used to analyze the influencing factors of distress in breast cancer patients by univariate and multivariate regression analysis. Results A total of 167 patients completed the survey, with an average HADS score of 8.43 ± 5.84 and a total HADS score of ≥15 in 37 (22.16%) patients, the mean DT score was 2.96 ± 1.85. ROC curve analysis showed an area under the curve of 0.885, with a maximum Jorden index (0.723) at a DT score of 4, the sensitivity was 100.0% and specificity was 72.3%. There were 73 (43.71%) patients with DT score ≥ 4. Regression analysis showed that insurance/financial problems, dealing with partner problems, tension, bathing/dressing problems, pain, and sleep problems were independent risk factors for l distress in newly diagnosed breast cancer patients. Conclusion A DT score 4 is the cut-off point for distress in patients with newly diagnosed breast cancer. In clinical practice, target intervention should be carried out according to the risk factors of distress of patients.
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Affiliation(s)
- Ling Liu
- Department of General Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Rong Wang
- Department of General Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yiming Sun
- Department of General Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ying Xiao
- Department of General Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Guangsheng Du
- Department of General Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Qingling Zhang
- Department of Medical Psychology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
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Psychosocial Characteristics and Experiences in Patients with Multiple Endocrine Neoplasia Type 2 (MEN2) and Medullary Thyroid Carcinoma (MTC). CHILDREN 2022; 9:children9060774. [PMID: 35740711 PMCID: PMC9221799 DOI: 10.3390/children9060774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/21/2022] [Indexed: 01/09/2023]
Abstract
Multiple Endocrine Neoplasia type 2 (MEN2) is a genetic cancer syndrome for which there are limited data pertaining to the quality of life and psychosocial experiences of persons affected. Medullary thyroid carcinoma (MTC) is a rare disease of the thyroid gland often associated with MEN2. MTC often progresses slowly and may present with a myriad of physical symptoms including hair loss, sleep disturbance, fatigue, weight changes, heart palpitations, and constipation or diarrhea. Like other cancers or rare, inheritable illnesses, patients with MEN2 and MTC may be at risk for psychosocial stressors. The current, cross-sectional study administered a structured psychosocial interview and The Distress Thermometer/Problem Checklist to 63 patients with MEN2 and MTC and their caregivers. Despite reports of overall good health, 46% of adults and 44% of youth reported that pain interferes with their daily life; 53% of adults and 59% of youth reported that pain interferes with their mood. Pediatric patients frequently reported experiencing attention challenges (50%) and difficulty concentrating (65%). Parents reported that mood shifts and becoming upset easily were the most prevalent concerns for their children. The most frequent need for services included education about MTC, treatment and research participation, and the opportunity to meet others with MTC.
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Psychooncological distress in low-grade glioma patients-a monocentric study. Acta Neurochir (Wien) 2022; 164:713-722. [PMID: 34159449 PMCID: PMC8913453 DOI: 10.1007/s00701-021-04863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/22/2021] [Indexed: 12/05/2022]
Abstract
Background Patients diagnosed with low-grade glioma (LGG) must live with constant knowledge of an upcoming malignant tumor transformation which may lead to increased anxiety and reduced quality of life. Here, we (1) analyzed the prevalence and risk factors for distress in LGG patients using (2) different screening tools to subsequently (3) evaluate their need for psychological support. Method Patients with LGG-suspicious findings in MRI studies as well as patients with histopathological confirmed LGG were screened using three established self-assessment instruments (Hospital Anxiety and Depression Scale, Distress Thermometer, EORTC-QLQ-C30-BN20). Screening results were correlated with sociodemographic factors. Results One hundred forty-nine patients (74 men and 75 women) were prospectively included. Patients were further divided into different subgroups regarding the time of screening and diagnosis. An increased level of distress was observed in 20.8% (mean score 1.21, 95% CI 1.15–1.28) of all patients screened by HADS. Significant associated factors were pre-existing psychiatric disorders (p = 0.003) and psychotropic medication (p = 0.029). HRQoL (p = 0.022) and global health item (p = 0.015), as well as future uncertainty (p = 0.047), assessed by the EORTC-QLQ-C30-BN20 were significantly higher in those patients without histopathological diagnosis. Increased distress was significantly correlated with results in chosen sub-items of the HRQoL questionnaire (p < 0.001). Conclusions Our results demonstrate the need for frequent distress screening. If specific tools are not available, HRQoL questionnaires can also be used. Patients with pre-existing psychological stress should be offered additional psychooncological support, irrespectively of the time of screening or tumor diagnosis. Clinical trial registration number: 4087
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Banerjee R, Huang CY, Dunn L, Knoche J, Ryan C, Brassil K, Jackson L, Patel D, Lo M, Arora S, Wong SW, Wolf J, Martin Iii T, Dhruva A, Shah N. Digital Life Coaching during Stem Cell Transplantation: A Pilot Feasibility Study. JMIR Form Res 2022; 6:e33701. [PMID: 35039279 PMCID: PMC8933800 DOI: 10.2196/33701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For patients with multiple myeloma receiving high-dose chemotherapy followed by autologous stem cell transplantation (SCT), acute life disruptions and symptom burden may lead to worsened quality of life (QOL) and increased emotional distress. Digital life coaching (DLC), whereby trained coaches deliver personalized wellbeing-related support via phone calls and text messages, has been shown to improve QOL among SCT survivors. However, DLC has not been investigated during the acute peri-SCT period which is generally characterized by symptomatic exacerbations and 2-week hospitalizations. OBJECTIVE We launched a single-arm pilot study to investigate the feasibility of patient engagement with DLC during this intensive period. METHODS We approached English-speaking adult patients with multiple myeloma undergoing autologous SCT at our center. Enrolled patients received 16 weeks of virtual access to a life coach beginning at Day -5 before SCT. Coaches used structured frameworks to help patients identify and overcome personal barriers to wellbeing. Patients chose the coaching topics and preferred communication styles. Our primary endpoint was ongoing DLC engagement, defined as bidirectional conversations occurring at least once every four weeks during the study period. Secondary endpoints were electronic patient-reported outcome (ePRO) assessments of QOL, distress, and sleep disturbances. Our study was registered as clinicaltrials.gov identifier NCT04432818. RESULTS Of 20 screened patients, 17 patients chose to enroll and 15 underwent SCT as planned. Of these 15 patients (median age 65, range 50-81), 73% (n = 11) demonstrated ongoing DLC engagement. The median frequency of bidirectional conversations during the 3-month study period was once per 6.2 days (range: 3.9-28). During index hospitalizations with median lengths of stay 16 days (range 14-31), the median frequency of conversations was once per 5.3 days (range 2.7-15). ePRO assessments (94% adherence) demonstrated an expected QOL nadir during the second week following SCT. The prevalence of elevated distress was highest immediately before and after SCT, with 69% of patients exhibiting elevated distress at Day -5 and at Day +2. CONCLUSIONS DLC may be feasible for older patients during intensive hospital-based cancer treatments such as autologous stem cell transplantation for multiple myeloma. Limitations of our study include small sample size, selection bias among enrolled patients, and heterogeneity in DLC usage. Based on the positive results of this pilot study, a larger phase 2 randomized study of DLC during SCT is under way to investigate its efficacy with regard to patient wellbeing. CLINICALTRIAL Our study was registered as clinicaltrials.gov identifier NCT04432818.
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Affiliation(s)
- Rahul Banerjee
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | - Chiung-Yu Huang
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, US
| | - Lisa Dunn
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | - Jennifer Knoche
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | - Chloe Ryan
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | | | | | | | - Mimi Lo
- Division of Hematology/Oncology, Department of Pharmacy, University of California San Francisco, San Francisco, US
| | - Shagun Arora
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | - Sandy Wai Wong
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | - Jeffrey Wolf
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | - Thomas Martin Iii
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | - Anand Dhruva
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
| | - Nina Shah
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, 400 Parnassus Avenue, San Francisco, US
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Evaluation of a Nurse-Led Patient Navigation Intervention: Follow-Up of Patients After Autologous and Allogeneic Stem Cell Transplantation. Cancer Nurs 2021; 45:287-296. [PMID: 34608045 DOI: 10.1097/ncc.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complex survivorship cancer care requires nurse-led interventions. Therefore, a nurse-led patient navigation intervention was developed in which trained cancer nurses gave advice and referred to other professionals during the process of recovery and rehabilitation of hematopoietic stem cell transplantation (HSCT) patients. OBJECTIVE The aim of this study was to understand the nature and effect of this nurse-led information and referral intervention. METHODS Of the 199 included patients in the intervention group, 75 completed the quality of life, quality of care, self-efficacy, and self-management behavior questionnaires at baseline and at 6 and 12 months after HSCT. A historical control group of 62 patients completed the same questionnaires 12 months after HSCT. In addition, patients' experiences with the intervention were evaluated in 2 focus groups. RESULTS Patients emphasized the holistic approach of the cancer nurses and the opportunity to discuss psychosocial domains of life. Within the intervention group, a statistically significant effect on quality of life was demonstrated over time. The differences in quality of life, self-efficacy, and self-management were not significant between the intervention group and control group. CONCLUSION The holistic focus of this nurse-led intervention proved to be acceptable to the HSCT patients and promising in supporting the (complex) challenges that these patients face during their process of recovery and rehabilitation. IMPLICATIONS FOR PRACTICE Nurse-led patient navigation interventions with a holistic approach when included in the daily practice of complex survivorship cancer care can support HSCT patients' information and referral needs during their rehabilitation.
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Al-Shaaobi A, Alahdal M, Yu S, Pan H. The efficiency of distress thermometer in the determination of supporting needs for cancer inpatients. Libyan J Med 2021; 16:1957199. [PMID: 34347581 PMCID: PMC8344234 DOI: 10.1080/19932820.2021.1957199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Psychological distress scale is highly recommended for cancer patients’ care. Several psychological scales have been implemented in cancer outpatient clinics. However, the use of the psychological distress scale, particularly distress thermometer (DT), in the inpatient has not been reported. In this study, we report the efficacy of DT in the determination of cancer inpatients’ supporting needs. A total of 170 inpatients diagnosed with cancer have been enrolled in this study. Only 132 patients matched the inclusion criteria, while other cases were excluded because of other diseases associated with cancer. The standardized problem list (PL) and Hospital Anxiety and Depression Scale (HADS) were implemented in comparison with DT. Then, the cut-off score of DT was performed to identify clinically significant differences. The analysis of the receiver operating characteristic (ROC) curve revealed that a DT cut-off score of 4 displayed 0.76 under the ROC curve. Sensitivity showed 0.86 sensitivity for cut-off score 4 and a specificity of 0.56 relative to the HADS cut-off score (≥15). DT scores were found independent of medical variables such as cancer type and stage, recurrence, or metastasis. Clinical ECOG-SP showed a significant association with the DT cut-off score (P ≤ 0.05). Regarding PL, patients with scores above DT cut-off were suffering 21 of 40 problems in all categories. Furthermore, patients that scored above the DT cut-off significantly showed an association with high support needs. DT scale showed significant performance in the evaluation of psychological distress among cancer inpatients through the efficient determination of their support needs.
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Affiliation(s)
- Abdullah Al-Shaaobi
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, R. P. China
| | - Murad Alahdal
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopedic Engineering, Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University, Health Science Center), Shenzhen, P. R. China.,Medical Laboratories Department, Faculty of Medicine and Health Sciences, Hodeidah University, Al Hudaydah, Yemen
| | - Shiying Yu
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongming Pan
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, R. P. China
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7
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Zhengkai N, Yajing S. COVID-19 Patient Psychological Pain Factors. Front Psychol 2021; 12:649895. [PMID: 34093337 PMCID: PMC8173037 DOI: 10.3389/fpsyg.2021.649895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/09/2021] [Indexed: 12/18/2022] Open
Abstract
The level of psychological pain in patients with COVID-19 was investigated in this study by hypothesis testing, one-way ANOVA, multi factor ANOVA, and correlation analysis. The psychological pain thermometer and post-traumatic growth assessment scale were used as research tools. Many factors appear to influence the psychological state of COVID-19 patients including practical problems, communication problems, emotional problems, physical problems, and psychiatric/relative concerns. The severity of the disease, the surrounding environment, family health problems, life perceptions, interpersonal relationships, personal strength, mental changes, new possibilities, and the total post-traumatic growth score are also affected. There is a significant negative correlation between psychological pain and post-traumatic growth. There are significant differences in the degree of psychological pain across the demographic data. Practical problems, communication problems, emotional problems, physical problems, and spiritual/religious concerns show significant effects on the degree of psychological pain.
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Affiliation(s)
- Niu Zhengkai
- Institute of Analytical Psychology, City University of Macao, Macao, China
| | - Shen Yajing
- Institute of Analytical Psychology, City University of Macao, Macao, China
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8
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Sun H, Lv H, Zeng H, Niu L, Yan M. Distress Thermometer in breast cancer: systematic review and meta-analysis. BMJ Support Palliat Care 2021; 12:245-252. [DOI: 10.1136/bmjspcare-2021-002960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022]
Abstract
ObjectiveThis meta-analysis aimed to reach a summarised estimate of distress prevalence screened by Distress Thermometer (DT) among patients with breast cancer and compare different pooled prevalence estimated between different subgroups.MethodsTwo independent interviewers conducted a systematic search from PubMed, EMBASE, Ovid and Cochrane Library and checked related reviews and meta-analyses for eligible studies. The studies that identified distress of patients with breast cancer with DT were included. After extracting demographic characteristics and distress prevalence, the pooled analysis and the forest plot were completed by using STATA V.12.0 software. We conducted a subgroup analysis based on demographic and methodological characteristics of the studies. The publication bias was estimated by funnel plot.ResultsSeventeen studies describing 3870 patients with breast cancer were included in this meta-analysis. The distress prevalence of patients with breast cancer varied from 25.3% to 71.7% among these studies. The pooled distress prevalence was 50% (95% CI 49% to 52%) for the overall sample. The pooled distress prevalence rates in DT ≥7, DT ≥5 and DT ≥4 subgroups were 37% (95% CI 35% to 40%), 45% (95% CI 40% to 49%) and 62% (95% CI 60% to 65%), respectively. The distress prevalence had statistically significant differences between subgroups, which were differentiated by the initial time of distress identified, papers’ publication time, patients’ average age and country. There was no publication bias among the included studies.ConclusionThe distress prevalence was high among patients with breast cancer. Routine and timely screening of distress for patients with breast cancer is of great significance in oncology management.
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Markwardt HS, Taghavi SE, Sligar KB, Al Achkar M, Hall BC. Web-Based Psychosocial Care Plan for Adolescent and Young Adult Patients With Cancer: A Proposed Model and Plan for Analysis. JCO Clin Cancer Inform 2021; 5:490-493. [PMID: 33950709 DOI: 10.1200/cci.21.00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Haley S Markwardt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | - Sarah E Taghavi
- UT Southwestern Moncrief Cancer Institute, Fort Worth, TX.,Department of Psychology, Texas Christian University, Fort Worth, TX
| | - Kylie B Sligar
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX
| | | | - Brittany C Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX.,UT Southwestern Moncrief Cancer Institute, Fort Worth, TX.,Fort Worth Adolescent Young Adult Oncology Coalition, Fort Worth, TX
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10
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Tarnasky AM, Troy JD, LeBlanc TW. The patient experience of ABVD treatment in Hodgkin lymphoma: a retrospective cohort study of patient-reported distress. Support Care Cancer 2021; 29:4987-4996. [PMID: 33576877 DOI: 10.1007/s00520-021-06044-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Psychological distress is prevalent in Hodgkin lymphoma (HL). Many patients, regardless of prognosis, receive ABVD chemotherapy as first-line treatment, but few studies have specifically examined the nature of distress during this shared treatment experience. METHODS We conducted a retrospective study of patient-reported distress in HL patients receiving ABVD treatment at a single tertiary care facility. Distress was measured using the National Comprehensive Cancer Network Distress Thermometer and Problem List (PL). We used descriptive statistics and generalized estimating equations to assess the prevalence of distress and specific problem items during treatment and associations with patient- and disease-related factors. RESULTS We collected data from 50 patients comprising 467 unique encounters, with 369/467 (79.0%) reporting a distress thermometer score. Median distress score was 2 (IQR: 0-5), but actionable distress (distress thermometer ≥4) was noted for 118/369 (32.0%) encounters. Actionable distress was only related to having a prior cancer, which conferred lower odds of actionable distress (OR 0.23, 95% CI 0.07-0.74, p=0.01) Physical and emotional problems were reported for 287/369 (77.8%) and 125/369 (33.9%) visits, respectively. Female patients had greater odds of both physical (OR 3.17, 95% CI 1.32-7.66, p=0.01) and emotional (OR 3.31, 95% CI 1.25-8.73, p=0.02) problems. CONCLUSION ABVD treatment is associated with a high frequency of actionable distress, with physical and emotional problems acting as primary drivers. Female patients may be particularly vulnerable, while cancer survivors may be uniquely resilient. These findings demonstrate the need to thoroughly screen for and appropriately tailor distress management strategies for HL patients during treatment with ABVD.
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Affiliation(s)
| | - Jesse D Troy
- Division of Biostatistics, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710, USA. .,Duke Cancer Institute, Box 2715, DUMC,, Durham, NC, 27710, USA.
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11
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Hyer JM, Kelly EP, Paredes AZ, Tsilimigras DI, Diaz A, Pawlik TM. Mental illness is associated with increased risk of suicidal ideation among cancer surgical patients. Am J Surg 2020; 222:126-132. [PMID: 33268055 DOI: 10.1016/j.amjsurg.2020.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mental illness and depression can be associated with increased risk of suicidal ideation (SI). We sought to determine the association between mental illness and SI among cancer surgical patients. METHODS Medicare beneficiaries who underwent resection of lung, esophageal, pancreatic, colon, or rectal cancer were analyzed. Patients were categorized as no mental illness, anxiety and/or depression disorders or bipolar/schizophrenic disorders. RESULTS Among 211,092 Medicare beneficiaries who underwent surgery for cancer, the rate of suicidal ideation was 270/100,000 patients. Antecedent mental health diagnosis resulted in a marked increased SI. On multivariable analysis, patients with anxiety alone (OR 1.49, 95%CI 1.04-2.14), depression alone (OR 2.60, 95%CI 1.92-3.38), anxiety + depression (OR 4.50, 95%CI 3.48-5.86), and bipolar/schizophrenia (OR 7.30, 95%CI 5.27-10.30) had increased odds of SI. CONCLUSIONS Roughly 1 in 370 Medicare beneficiaries with cancer who underwent a wide range of surgical procedures had SI. An antecedent mental health diagnosis was a strong risk factor for SI.
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Affiliation(s)
- J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Elizabeth Palmer Kelly
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Adrian Diaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
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12
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Shahrokni A, Vishnevsky BM, Jang B, Sarraf S, Alexander K, Kim SJ, Downey R, Afonso A, Korc-Grodzicki B. Geriatric Assessment, Not ASA Physical Status, Is Associated With 6-Month Postoperative Survival in Patients With Cancer Aged ≥75 Years. J Natl Compr Canc Netw 2020; 17:687-694. [PMID: 31200361 DOI: 10.6004/jnccn.2018.7277] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The American Society of Anesthesiologists physical status (ASA PS) classification system is the most common method of assessing preoperative functional status. Comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool for preoperative assessment of older adults. The goal of this study was to assess the correlation between ASA classification and CGA deficits among oncogeriatric patients and to determine the association of each with 6-month survival. PATIENTS AND METHODS Oncogeriatric patients (aged ≥75 years) who underwent preoperative CGA in an outpatient geriatric clinic at a single tertiary comprehensive cancer center were identified. All patients underwent surgery, with a hospital length of stay (LOS) ≥1 day and at least 6 months of follow-up. ASA classifications were obtained from preoperative anesthesiology notes. Preoperative CGA scores ranged from 0 to 13. Six-month survival was assessed using the Social Security Death Index. RESULTS In total, 81 of the 980 patients (8.3%) included in the study cohort died within 6 months of surgery. Most patients were classified as ASA PS III (85.4%). The mean number of CGA deficits for patients with PS II was 4.03, PS III was 5.15, and PS IV was 6.95 (P<.001). ASA classification was significantly associated with age, preoperative albumin level, hospital LOS, and 30-day intensive care unit (ICU) admissions. On multivariable analysis, 6-month mortality was associated with number of CGA deficits (odds ratio [OR], 1.14 per each unit increase in CGA score; P=.01), 30-day ICU admissions (OR, 2.77; P=.003), hospital LOS (OR, 1.03; P=.02), and preoperative albumin level (OR, 0.36; P=.004). ASA classification was not associated with 6-month mortality. CONCLUSIONS Number of CGA deficits was strongly associated with 6-month mortality; ASA classification was not. Preoperative CGA elicits critical information that can be used to enhance the prediction of postoperative outcomes among older patients with cancer.
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Affiliation(s)
- Armin Shahrokni
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brian Jang
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Saman Sarraf
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Koshy Alexander
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Soo Jung Kim
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Anoushka Afonso
- Department of Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beatriz Korc-Grodzicki
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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13
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Thiele S, Goebel S, Kröger N, Pedersen A. Fear of disease progression and relevant correlates in acute leukemia patients prior to allogeneic hematopoietic stem cell transplantation. Psychooncology 2020; 29:1248-1254. [PMID: 32323380 DOI: 10.1002/pon.5397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prior to hematopoietic stem cell transplantation (HSCT), and despite the high objective risks associated with HSCT, fear of progression (FoP) has only sparsely been studied in patients with acute leukemia until now. The aim of this study was the assessment of the prevalence of FoP, and any relevant correlates and typical concerns. METHODS We included 59 adult patients with acute leukemia who were tested prior to their first HSCT during an in-patient stay. Patients completed self-report measures assessing FoP (Fear of Progression Questionnaire-Short Form, FoP-Q-SF) and relevant correlates of FoP (eg, patients' physical state, depression, psychosocial distress, or social support). RESULTS About one third of the patients (35.6%; n = 21) had high FoP. Higher FoP was associated with previous cancer diagnosis, as well as depression, anxiety, reduced physical functioning, lower mental health-related quality of life, and lower positive social support. The greatest fears reported by these patients reflected common fears of cancer patients (eg, fear about leaving their families behind), but also specific fears related to the current situation (eg, fear of severe medical treatments during the course of the illness). CONCLUSIONS This was the first study providing an extensive analysis of FoP in leukemia patients prior to the extreme situation of HSCT. FoP is frequent and of major clinical importance for these patients. Hence, we recommend that patients undergo routine screening for FoP, to identify highly distressed patients at an early stage, and to offer targeted support.
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Affiliation(s)
- Sandra Thiele
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany
| | - Simone Goebel
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anya Pedersen
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany
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Battaglia Y, Zerbinati L, Piazza G, Martino E, Provenzano M, Esposito P, Massarenti S, Andreucci M, Storari A, Grassi L. Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients. J Clin Med 2020; 9:jcm9040995. [PMID: 32252326 PMCID: PMC7230823 DOI: 10.3390/jcm9040995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.
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Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
- Correspondence:
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Giulia Piazza
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Elena Martino
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Pasquale Esposito
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Sara Massarenti
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
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15
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Patients’ quality of life: Validation of the functional assessment of cancer therapy-bone marrow transplant (FACT-BMT) instrument for the Mexican population. Palliat Support Care 2020; 18:557-568. [DOI: 10.1017/s1478951520000085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveThe functional assessment of cancer therapy-bone marrow transplant (FACT-BMT) is a widely used instrument to assess quality of life (QOL) in hematopoietic stem cell transplant (HSCT) patients, but there is little evidence of its validity in Latin American populations. This study evaluated the psychometric properties of the Spanish language version of the FACT-BMT in Mexican patients.MethodFirst, the original version was piloted with 15 HSCT patients to obtain an adequate cultural version, resulting in the adaptation of one item. After that, the new version was completed by 139 HSCT patients.ResultsThe results showed a FACT factor structure that explains 70.84% of the total variance, a factor structure similar to the original FACT structure, and with a high internal consistency (Cronbach's alpha = 0.867). For the BMT subscale, the best factor structure included 17 items which explain 61.65% of the total variance with an adequate internal consistency (Cronbach's alpha = 0.696).Significance of the resultsThe FACT-BMT was found to be a valid and reliable instrument to evaluate QOL in Mexican patients. Our results constitute new FACT-BMT empirical evidence that supports its clinical and research uses.
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16
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The use of the Distress Thermometer and the Hospital Anxiety and Depression Scale for screening of anxiety and depression in Italian women newly diagnosed with breast cancer. Support Care Cancer 2020; 28:4997-5004. [DOI: 10.1007/s00520-020-05343-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/02/2020] [Indexed: 11/25/2022]
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17
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Peterson RK, Chung J, Barrera M. Emotional symptoms and family functioning in caregivers of children with newly diagnosed leukemia/lymphomas and solid tumors: Short-term changes and related demographic factors. Pediatr Blood Cancer 2020; 67:e28059. [PMID: 31724323 DOI: 10.1002/pbc.28059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pediatric oncology diagnoses are distressing to caregivers. However, researchers have not investigated the impact that the type of cancer diagnosis has on caregiver anxiety, depression, distress, and family functioning. The purpose of this study was to longitudinally investigate the early trajectory of caregiver psychological symptoms of anxiety, depression, distress, and family functioning near diagnosis and 6 months later by cancer type, and to examine the demographic factors that may be associated with caregiver emotional and family functioning outcomes. METHODS Caregivers (n = 122) of children with a recent diagnosis of leukemia/lymphoma or solid tumor completed self-report measures of psychological and family functioning (Hospital Anxiety and Depression Scale, Distress Thermometer, and Family Environment Scale). RESULTS In general, caregivers endorsed elevated psychological symptoms at the time of diagnosis, which decreased 6 months later. Caregivers of children with solid tumors endorsed greater anxiety across time than caregivers of children with leukemia/lymphoma did. In addition to caring for a child with a solid tumor, female sex, non-White ethnicity, and non-English language spoken in the home were factors associated with anxious and depressive symptoms and poorer family functioning. CONCLUSION When creating psychosocial interventions for families of children with cancer, the unique demands of solid tumor treatments, the caregiver's sex, and cultural characteristics must be considered to promote coping, resiliency, and problem-solving skills around the time of diagnosis, particularly in more vulnerable families.
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Affiliation(s)
- Rachel K Peterson
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Chung
- Department of Psychology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Maru Barrera
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
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18
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The concept of “emotional distress” as a possible indicator of maladaptation in children/adolescents with oncological and oncohematological diseases and their caregivers. ACTA ACUST UNITED AC 2020. [DOI: 10.21682/2311-1267-2019-6-4-76-82] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Tarot A, Van Lander A, Pereira B, Guastella V. Étude de la relation entre détresse et confusion mentale chez les patients en situation palliative (Relation entre détresse et confusion mentale en situation palliative). MÉDECINE PALLIATIVE 2019. [DOI: 10.1016/j.medpal.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Albrecht TA, Bryant AL. Psychological and Financial Distress Management in Adults With Acute Leukemia. Semin Oncol Nurs 2019; 35:150952. [PMID: 31753705 DOI: 10.1016/j.soncn.2019.150952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To review and summarize psychological and financial distress in adults with acute leukemia and provide evidence-based methods that nurses can apply to alleviate distress experienced by patients. DATA SOURCES Oncology and palliative care literature published over the past decade. CONCLUSION Current evidence supports the efficacy of psychosocial interventions to improve psychological well-being and reduce distress for adults undergoing treatment for leukemia. IMPLICATIONS FOR NURSING PRACTICE Nurses play a critical role, not only in identifying patients who are experiencing impaired psychological well-being and high levels of distress, but also in providing prompt support to these patients.
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Affiliation(s)
| | - Ashley Leak Bryant
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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21
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Van Lander A, Tarot A, Savanovitch C, Pereira B, Vennat B, Guastella V. Assessing the validity of the clinician-rated distress thermometer in palliative care. Palliat Care 2019; 18:81. [PMID: 31623591 PMCID: PMC6798346 DOI: 10.1186/s12904-019-0466-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background The distress of patients suffering from a terminal illness can lead to a state of despair and requests for euthanasia and assisted suicide. It is a major challenge for palliative care workers. The Distress Thermometer (DT) is recommended by the National Comprehensive Cancer Network as a means of more easily assessing distress. It is available as a Self-assessment reported Distress Thermometer, but for a wider use in palliative care it should also be implemented in the form of a clinician-reported outcome (clinRO). Clinicians need to rate patient’s distress when the patient is not able to do so (subject that cannot be addressed, defensive patient…). The primary aim of the quantitative study was to assess the validity of the Clinician-Rated Distress Thermometer in palliative care. Method The assessments were performed by teams working in three palliative care centres. The primary endpoint was concordance between the patient and clinicians’ responses via Lin’s concordance coefficient. Eligible patients were aged 18 years or older, suffering from a severe disease in the palliative phase, and with a sufficient level of awareness to consent to participate in the study. A total of 51 patients were recruited, 55% were male, with a mean age of 65.8 years [39–90 years]. Results Three hundred sixty-four clinician-Rated Distress Thermometer and 467 Self-Reported Distress Thermometer were performed. Only 364 of the 467 Self-Reported Distress Thermometer were used for the study, as investigators did not systematically ask the patient to give an account of his distress. Concordance between patient and clinician responses: The Lin’s concordance coefficient with a threshold (alpha) of 5% was 0.46 [0.38; 0.54]. At the first assessment, it was 0.61 [0.44; 0.79]. The Cohen’s kappa coefficient was 0.52, with a concordance rate of 79.6%. The sensitivity was 82.9% [66.4–93.4] and the specificity 71.4% [41.9–91.6]. Conclusion The first assessment gave the best results in terms of concordance between Clinician-Rated DT and Self-Reported DT. In the next assessments, the Clinician-Rated DT were less consistent with the patients’ Self-Reported DT.
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Affiliation(s)
- A Van Lander
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France. .,University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France.
| | - A Tarot
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France
| | - C Savanovitch
- University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France
| | - B Pereira
- CHU Clermont-Ferrand, DRCI, 63000, Clermont-Ferrand, France
| | - B Vennat
- University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France
| | - V Guastella
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France
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22
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Troy JD, de Castro CM, Pupa MR, Samsa GP, Abernethy AP, LeBlanc TW. Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study. J Natl Compr Canc Netw 2019. [PMID: 29523665 DOI: 10.6004/jnccn.2017.7048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: NCCN defines distress as a multifactorial, unpleasant emotional experience of a psychological nature that may interfere with patients' ability to cope with cancer symptoms and treatment. Patients with myelodysplastic syndromes (MDS) are at risk for distress due to the largely incurable nature of this hematopoietic malignancy and its symptom burden, yet associations with clinical outcomes are unknown. Methods: We retrospectively reviewed patient-reported distress data from adult ambulatory patients with MDS visiting a single, tertiary care medical center from July 2013 to September 2015. Demographic, diagnostic, treatment, and comorbidity information were abstracted from records along with NCCN Distress Thermometer (DT) and Problem List (PL) scores. Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Results: We abstracted 376 DT scores (median, 1; range, 0-10) from 606 visits and 110 patients (median, 2 DT scores/patient; range, 1-16). NCCN Guidelines suggest that patients with DT scores ≥4 should be evaluated for referral to specialty services to address unmet needs. A total of 54 patients (49%) had at least 1 DT score ≥4 and 20 (18%) had 2 or more DT scores ≥4; 98 patients (89.1%) reported 1,379 problems during 23,613 person-days of follow-up (median, 4 problems/patient/visit; range, 1-23). The 5 most frequently reported problems were fatigue (181 times; 78 patients), pain (95 times; 46 patients), worry (80 times; 45 patients), sleep (78 times; 41 patients), and tingling hands/feet (68 times; 33 patients). After adjustment for risk stratification at diagnosis, a single point increase on the DT was associated with an increased risk of death (hazard ratio, 1.18; 95% CI, 1.01-1.36). Conclusions: Patients with MDS experience a high burden of distress, and patient-reported distress is associated with clinical outcomes. Distress should be further studied as a prognostic variable and a marker of unmet needs in MDS.
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Affiliation(s)
- Jesse D Troy
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Carlos M de Castro
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York.,From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Mary Ruth Pupa
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Greg P Samsa
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York.,From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Amy P Abernethy
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Thomas W LeBlanc
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York.,From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
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Hazard Vallerand A, Hasenau SM, Robinson-Lane SG, Templin TN. Improving Functional Status in African Americans With Cancer Pain: A Randomized Clinical Trial. Oncol Nurs Forum 2019; 45:260-272. [PMID: 29466352 DOI: 10.1188/18.onf.260-272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the efficacy of the Power Over Pain-Coaching (POP-C) intervention to improve functional status among African American outpatients with cancer pain.
. SAMPLE & SETTING 310 African American patients were recruited from an urban comprehensive cancer center. The study took place in the patients' homes.
. METHODS & VARIABLES A two-group randomized design with repeated measures was used. Data were analyzed with linear mixed effects regression analysis and structural equation change score models. Variables were pain, pain-related distress, functional status, perceived control over pain, and the following antecedents to control. RESULTS Functional status was improved in POP-C participants relative to control group participants (p < 0.05). Distress also was differentially decreased (p < 0.05). Pain intensity ratings decreased significantly in all patients (p < 0.05). The largest intervention effects were observed in the living with pain component.
. IMPLICATIONS FOR NURSING Perceived control over pain was strongly related to functional status and is amenable to interventions using the POP-C intervention components described in this article.
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24
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Kehoe LA, Xu H, Duberstein P, Loh KP, Culakova E, Canin B, Hurria A, Dale W, Wells M, Gilmore N, Kleckner AS, Lund J, Kamen C, Flannery M, Hoerger M, Hopkins JO, Liu JJ, Geer J, Epstein R, Mohile SG. Quality of Life of Caregivers of Older Patients with Advanced Cancer. J Am Geriatr Soc 2019; 67:969-977. [PMID: 30924548 PMCID: PMC7818364 DOI: 10.1111/jgs.15862] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/03/2018] [Accepted: 12/09/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the relationships between aging-related domains captured by geriatric assessment (GA) for older patients with advanced cancer and caregivers' emotional health and quality of life (QOL). DESIGN In this cross sectional study of baseline data from a nationwide investigation of older patients and their caregivers, patients completed a GA that included validated tests to evaluate eight domains of health (eg, function, cognition). SETTING Thirty-one community oncology practices throughout the United States. PARTICIPANTS Enrolled patients were aged 70 and older, had one or more GA domain impaired, and had an incurable solid tumor malignancy or lymphoma. Each could choose one caregiver to enroll. MEASUREMENTS Caregivers completed the Generalized Anxiety Disorder-7, Distress Thermometer, Patient Health Questionnaire-2 (depression), and Short Form Health Survey-12 (SF-12 for QOL). Separate multivariate linear or logistic regression models were used to examine the association of the number and type of patient GA impairments with caregiver outcomes, controlling for patient and caregiver covariates. RESULTS A total of 541 patients were enrolled, 414 with a caregiver. Almost half (43.5%) of the caregivers screened positive for distress, 24.4% for anxiety, and 18.9% for depression. Higher numbers of patient GA domain impairments were associated with caregiver depression (adjusted odds ratio [aOR] = 1.29; P < .001], caregiver physical health on SF-12 (regression coefficient [β] = -1.24; P < .001), and overall caregiver QOL (β = -1.14; P < .01). Impaired patient function was associated with lower caregiver QOL (β = -4.11; P < .001). Impaired patient nutrition was associated with caregiver depression (aOR = 2.08; P < .01). Lower caregiver age, caregiver comorbidity, and patient distress were also associated with worse caregiver outcomes. CONCLUSION Patient GA impairments were associated with poorer emotional health and lower QOL of caregivers. J Am Geriatr Soc 67:969-977, 2019.
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Affiliation(s)
- Lee A. Kehoe
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | - Huiwen Xu
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | | | - Kah Poh Loh
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | - Eva Culakova
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | - Beverly Canin
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, CA
| | - William Dale
- City of Hope National Medical Center, Duarte, CA
| | - Megan Wells
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | - Nikesha Gilmore
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | - Amber S. Kleckner
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | | | - Charles Kamen
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | - Marie Flannery
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | | | - Judith O. Hopkins
- Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP); Novant Health-GWSM
| | | | - Jodi Geer
- Metro-Minnesota NCORP, St Louis Park, MN
| | - Ron Epstein
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
| | - Supriya G. Mohile
- URCC NCORP Research Base, University of Rochester Medical Center, Rochester, NY
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Ostroff JS, Riley KE, Shen MJ, Atkinson TM, Williamson TJ, Hamann HA. Lung cancer stigma and depression: Validation of the Lung Cancer Stigma Inventory. Psychooncology 2019; 28:1011-1017. [PMID: 30779396 DOI: 10.1002/pon.5033] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In an effort to provide further evidence for the validity of the Lung Cancer Stigma Inventory (LCSI), this paper examined group differences in lung cancer stigma for patients who report clinically significant depressive symptoms and established a suggested scoring benchmark to identify patients with clinically meaningful levels of lung cancer stigma. METHODS Patients (N = 231) who were diagnosed with lung cancer and treated within the past 12 months at one of two National Cancer Institute (NCI)-designated Cancer Centers located in the northeast and southern parts of the United States completed a single battery of questionnaires examining lung cancer stigma and depressed mood. Group differences, bivariate correlations, and receiver operating characteristic (ROC) analyses were conducted. RESULTS Slightly more than a third of patients (35.9%) reported an elevated level of depression. There was a significant correlation (r = 0.44) between lung cancer stigma and depressive mood. The ROC curve analysis indicated an area under curve (AUC) of 0.71. A LCSI cutoff score of 37.5 yielded the optimal ratio of sensitivity (0.93) to specificity (0.70) for identifying patients with clinically meaningful lung cancer stigma. CONCLUSIONS Consistent with prior work, lung cancer stigma, as measured by the LCSI, was found to be moderately associated with depressed mood. Clinical investigators may use an LCSI total score above 37.5 (ie, greater than or equal to 38 on the LCSI scale of integer scores) as a clinical threshold for identifying patients who may be experiencing clinically meaningful stigma and may benefit from stigma-reducing interventions.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kristen E Riley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Megan J Shen
- Medicine Department, Weill Cornell Medical College, New York, New York
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy J Williamson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heidi A Hamann
- Department of Psychology and Department of Family & Community Medicine, University of Arizona, Tucson, Arizona
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Guan B, Wang K, Shao Y, Cheng X, Hao J, Tian C, Chen L, Ji K, Liu W. The use of distress thermometer in advanced cancer inpatients with pain. Psychooncology 2019; 28:1004-1010. [PMID: 30762263 DOI: 10.1002/pon.5032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study aimed to provide support for the extensive application of Distress Thermometer (DT) in advanced cancer inpatients with pain and explored factors associated with high DT scores among this population. METHODS Advanced cancer patients with pain were recruited from Department of Pain Relief in Tianjin Cancer Hospital and Institute, China. They completed the DT with problems list and HADS within 48 h after admission. The cutoff score of DT was evaluated against Hospital Anxiety and Depression Scale (HADS) for its sensitivity and specificity by using receiver operating characteristic (ROC) curves. Multiple logistic regression model analysis was performed to investigate correlates of DT scores. RESULTS Four hundred forty one inpatients with mixed diagnoses were recruited. Referring to the cutoff of 15 on HADS, DT cutoff score of 5 yielded AUC of 0.757, with an optimal sensitivity of 0.861 and specificity of 0.531. Using the cutoff scores of greater than or equal to 5, 70.5% of the patients were distressed. Logistic regression analysis of DT found that the breakthrough pain, poorer KPS, higher pain degree, and emotional problems were the predictive factor for current distress. CONCLUSION DT is efficacious in screening for psychological distress in advanced cancer inpatients with pain. Psychological distress is prevalent with a cutoff score of greater than or equal to five. To better identify the distressed cancer patients with pain, pain degree, performance status, and emotional problems should be considered together.
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Affiliation(s)
- Bingqing Guan
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Kun Wang
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Yuejuan Shao
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Xianjiang Cheng
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Jianlei Hao
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Chang Tian
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Lei Chen
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Kai Ji
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
| | - Weishuai Liu
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy (Tianjin), Tianjin's Clinical Research Center for Cancer, Tianjin
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Vallerand AH, Templin TN, Hasenau SM, Maly A. Modifiable pathways from pain to functional status: Confirmatory baseline results from a randomised trial of African American patients with cancer pain. Eur J Cancer Care (Engl) 2019; 28:e12994. [PMID: 30719796 PMCID: PMC8373261 DOI: 10.1111/ecc.12994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/18/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study tested a model of cancer-related pain and functional status in African American patients, including beliefs about the ability to control pain as a key determinant of distress and functional status. METHODS Baseline data from a randomised clinical trial consisting of clinical and patient-reported outcomes were used. Participants were 228 African American patients experiencing moderate to severe pain within the past 2 weeks. The model comprised four latent constructs: pain, perceived control over pain, pain-related distress and functional status. Confirmatory factor analysis was used to validate the factor structure of the measurement model. Structural equation modelling was used to estimate direct and mediated effects. RESULTS The measurement model fit well (RMSEA = 0.06, SRMR = 0.05) with all loadings significant (p < 0.05). The structural model also fit well (RMSEA = 0.04, SRMR = 0.05). The complex mediated pathway from pain to functional status through perceived control over pain and pain-related distress was strong and significant (specific indirect effect = -0.456, p = 0.004). Mediation by perceived control accounted for a 47% reduction of the effects of pain on functional status. CONCLUSION If these results hold up longitudinally, interventions to increase perceived control over pain have the potential to improve functional status by decreasing pain-related distress.
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Affiliation(s)
| | | | - Susan M Hasenau
- College of Nursing, Wayne State University, Detroit, Michigan
| | - Angelika Maly
- College of Nursing, Wayne State University, Detroit, Michigan
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Vanlander A. La détresse des patients gravement malades est-elle mesurable et par qui ? PSYCHO-ONCOLOGIE 2019. [DOI: 10.3166/pson-2018-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Alosaimi FD, Abdel-Aziz N, Alsaleh K, AlSheikh R, AlSheikh R, Abdel-Warith A. Validity and feasibility of the Arabic version of distress thermometer for Saudi cancer patients. PLoS One 2018; 13:e0207364. [PMID: 30427918 PMCID: PMC6241127 DOI: 10.1371/journal.pone.0207364] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/30/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The distress thermometer (DT) has been studied and validated as an effective screening instrument for identifying distress among cancer patients worldwide. This study aims to evaluate the validity of the Arabic version of the DT in Saudi cancer patients, to define the optimal cutoff point of the Arabic DT for detecting clinically significant distress and to determine whether there is any correlation between clinically significant distress and other demographic and Problem List variables. METHODS The original form of the DT was translated to Arabic using a forward and backward translation method. Then, a group of 247 cancer patients who were followed up at the Outpatient Oncology Clinic at King Saud Medical City in Riyadh, Saudi Arabia, completed a socio-demographic and clinical status questionnaire, the DT and the Problem List scale, and the Hospital Anxiety and Depression Scale (HADS). RESULTS Receiver operating characteristic (ROC) curve analyses picked out an area under the curve of 0.76 when compared with a HADS cutoff score of 15. The DT had the best sensitivity (0.70) and specificity (0.63) with cutoff score of 4. A DT score of 4 or more was found to have a statistically significant correlation with female gender, advanced cancer stages and most of the Problem List items, including child care, work or school, treatment decision, dealing with children and partners, depression, fears, nervousness, sadness, loss of interest in usual activity, religious concerns, appearance, bathing/dressing, breathing, diarrhea, fatigue, feeling swollen, fever, getting around, indigestion, memory and concentration, nausea, dry nose, pain, and sexual problems. In contrast, a multivariate regression analysis confirmed only advanced cancer stages, treatment decision, depression, fear, sadness, worry, breathing, feeling swollen, fever, indigestion, memory and concentration, dry nose and congestion, pain and sleep as independent factors associated with distress in cancer patients. CONCLUSIONS We found the Arabic version of the DT to be a valid instrument for screening distress in Saudi patients with cancer. Our study proposes using a cutoff score of 4 as an indicator of clinically significant distress in this population.
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Affiliation(s)
| | - Nashwa Abdel-Aziz
- Hematology Oncology center, King Saud University, Riyadh, Saudi Arabia
- Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Khalid Alsaleh
- Hematology Oncology center, King Saud University, Riyadh, Saudi Arabia
| | - Rawan AlSheikh
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Rana AlSheikh
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
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Patient-reported distress in Hodgkin lymphoma across the survivorship continuum. Support Care Cancer 2018; 27:2453-2462. [PMID: 30377801 PMCID: PMC6541572 DOI: 10.1007/s00520-018-4523-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/19/2018] [Indexed: 12/25/2022]
Abstract
Purpose Hodgkin lymphoma (HL) survivors face long-term, elevated risk of treatment-related sequelae, including psychosocial distress associated with poor health outcomes. The magnitude and sources of distress are not well described in the routine care of HL outside of clinical trials. Methods We conducted a retrospective cohort study of patients visiting a tertiary-care center for treatment or long-term follow-up of HL. Patient-reported distress was documented using the National Comprehensive Cancer Network Distress Thermometer (DT) and Problem List. Three survivor groups were compared using descriptive methods: on treatment, surviving < 5 years, and surviving ≥ 5 years since diagnosis. Results A total of 1524 DT were abstracted for 304 patients (106 on treatment, 77 surviving < 5 years, and 121 surviving ≥ 5 years). Distress was low overall (median DT = 1, inter-quartile range 0–4) and was similar across survivor groups. However, actionable distress (score ≥ 4) was reported at 29.5% of clinical encounters. Patients on treatment more frequently reported actionable distress (32.5% of visits) compared with patients surviving < 5 years (20.4%) and ≥ 5 years (28.7%) (P = 0.065). Distress was associated primarily with physical and emotional problems, especially fatigue, worry, and sleep. We did not observe any associations between distress and clinical prognostic factors. Conclusions Distress burden is low in HL, but survivorship is marked by periods of actionable distress, largely related to physical symptoms and emotional issues. This burden may be higher when on treatment and is unrelated to disease-related prognostic factors. Survivorship research typically focuses on the post-therapy period, but our results support testing the efficacy of interventions to address distress in HL during active treatment as well.
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Rapp M, Schipmann S, Hoffmann K, Wiewrodt R, Steiger HJ, Kamp M, Stummer W, Wiewrodt D, Sabel M. Impact of distress screening algorithm for psycho-oncological needs in neurosurgical patients. Oncotarget 2018; 9:31650-31663. [PMID: 30167085 PMCID: PMC6114967 DOI: 10.18632/oncotarget.25833] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/09/2018] [Indexed: 11/25/2022] Open
Abstract
Background Cerebral tumors are associated with high rates of anxiety, depression and reduced health related quality of life. Nevertheless psychooncological screening instruments are neither implemented nor well defined in the daily routine of neurosurgical departments. Therefore, we tried (1) to identify a suitable screening algorithm for neurosurgical patients, (2) to define clinical risk factors for increased distress and (3) to analyze the optimal screening time point. Results Between October 2013 and January 2015 472 elective neurosurgical in-patients (median age 55.85 years) of the neurosurgical departments of the University Hospitals Duesseldorf and Muenster were prospectively included into this study. Regarding their diagnosis 244 (51.7%) patients were identified with malignant lesions and 228 (48.3%) patients with benign lesions. Increased distress was diagnosed in 63.1% of all patients via DT, in 13.6% via HADS and 27.8% via PO-Bado. Combining the cut-off criteria with the problem list increased sensitivity (90%) and specificity (70%) of the DT assessment. Regarding risk factors pre-existing psychiatric disorders, ataractic medication and a decreased clinical performance status were associated with increased distress. Patients and methods Patients with diagnosis of an intracranial lesion with elective surgical indication were screened for psychological distress via three assessment-instruments the Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer (DT), and the Basic Documentation for Psycho-Oncology (PO-Bado). Screening results were correlated with clinical and demographic data. Conclusion Postoperative distress screening for neurosurgical patients is important independent from the neurosurgical diagnosis. The DT represents a suitable, non time-consuming instrument for daily routine in a neurosurgical department.
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Affiliation(s)
- Marion Rapp
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | | | - Kira Hoffmann
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - Rainer Wiewrodt
- Pulmonary Division, Dpt. of Medicine A, University Hospital Muenster, Muenster, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - Marcel Kamp
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Dorothee Wiewrodt
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Michael Sabel
- Department of Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
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McDonagh PR, Slade AN, Anderson J, Burton W, Fields EC. Racial differences in responses to the NCCN Distress Thermometer and Problem List: Evidence from a radiation oncology clinic. Psychooncology 2018; 27:2513-2516. [PMID: 30067307 DOI: 10.1002/pon.4846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Philip Reed McDonagh
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Justin Anderson
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Whitney Burton
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Emma C Fields
- Massey Cancer Center, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
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Wright NL, Flynn KE, Brazauskas R, Hari P, D'Souza A. Patient-reported distress is prevalent in systemic light chain (AL) amyloidosis but not determined by severity of disease. Amyloid 2018; 25:129-134. [PMID: 30032653 DOI: 10.1080/13506129.2018.1486298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We conducted this retrospective study to assess patient-reported distress in light chain (AL) amyloidosis, using the Distress Thermometer (DT) survey at first evaluation at our center. Of 78 patients who completed the survey, 75 scored their distress (distress: <4 - low, 4-6 - moderate, >6 - high). Moderate and high distress were self-reported by 30% and 17% patients, respectively. More patients with distress lived alone and had lower haemoglobin than patients without. AL stage did not correlate with distress (Stage I/II median DT 4 compared to 3 in Stage III/IV, p = .09), while cardiac AL was associated with lower distress at 3 compared to 5 in those without (p = .02). Karnofsky performance score (KPS) was concordant with stage (KPS ≥90 in 60% stage I/II versus 19% stage III/IV, p = .005) and cardiac involvement (26% with versus 63% without cardiac involvement had KPS ≥90, p = .01). Significant correlates of high distress included dealing with children, family health, depression, fears, nervousness, sadness, appearance, nausea, dry nose/congestion, memory/concentration, pain, sleep, neuropathy symptoms, and bathing/dressing. In conclusion, we demonstrate moderate to high distress in 47% of AL population at initial evaluation. Distress in amyloidosis is not influenced by amyloid stage or type of organ involvement.
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Affiliation(s)
- Nicholas L Wright
- a Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin , Milwaukee , WI , USA
| | - Kathryn E Flynn
- a Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin , Milwaukee , WI , USA
| | - Ruta Brazauskas
- b Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin , Milwaukee , WI , USA
| | - Parameswaran Hari
- a Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin , Milwaukee , WI , USA
| | - Anita D'Souza
- a Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin , Milwaukee , WI , USA
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Petzel SV, Isaksson Vogel R, Cragg J, McClellan M, Chan D, Jacko JA, Sainfort F, Geller MA. Effects of web-based instruction and patient preferences on patient-reported outcomes and learning for women with advanced ovarian cancer: A randomized controlled trial. J Psychosoc Oncol 2018; 36:503-519. [PMID: 29791275 DOI: 10.1080/07347332.2018.1457125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A randomized controlled trial was conducted of a web-based intervention to improve advanced care planning in women with ovarian cancer. A secondary analysis of 35 randomized women focused on changes in distress and knowledge about ovarian cancer through distress monitoring and information tailored to patients' cognitive coping style (monitoring, blunting). Pre-/postresults indicated the Intervention group demonstrated lower distress (p = 0.06); blunting was associated with lower depression (p = 0.04); knowledge in both groups was unchanged. Women in the Intervention vs. Control group reported their family was less likely to be upset by cancer information (p = 0.0004). This intervention reduced distress while incorporating patient preferences.
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Affiliation(s)
- Sue V Petzel
- a Masonic Cancer Center, University of Minnesota , Minneapolis , USA.,b Department of Obstetrics , Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota , Minneapolis , USA
| | - Rachel Isaksson Vogel
- a Masonic Cancer Center, University of Minnesota , Minneapolis , USA.,b Department of Obstetrics , Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota , Minneapolis , USA
| | - Julie Cragg
- c Institute for Health Informatics, University of Minnesota , Minneapolis , USA
| | - Molly McClellan
- d Department of Urology , University of Minnesota , Minneapolis , USA
| | - Daniel Chan
- e Division of Environmental Health Sciences, School of Public Health , University of Minnesota , Minneapolis , USA
| | - Julie A Jacko
- e Division of Environmental Health Sciences, School of Public Health , University of Minnesota , Minneapolis , USA
| | - François Sainfort
- a Masonic Cancer Center, University of Minnesota , Minneapolis , USA.,f Division of Health Policy and Management, School of Public Health , University of Minnesota , Minneapolis , USA
| | - Melissa A Geller
- a Masonic Cancer Center, University of Minnesota , Minneapolis , USA.,b Department of Obstetrics , Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota , Minneapolis , USA
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Bekelman DB, Johnson-Koenke R, Bowles DW, Fischer SM. Improving Early Palliative Care with a Scalable, Stepped Peer Navigator and Social Work Intervention: A Single-Arm Clinical Trial. J Palliat Med 2018; 21:1011-1016. [PMID: 29461908 DOI: 10.1089/jpm.2017.0424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with cancer could benefit from early primary (i.e., basic) palliative care. Scalable models of care delivery are needed. OBJECTIVE Examine the feasibility of a stepped peer navigator and social work intervention developed to improve palliative care outcomes. DESIGN Single-arm prospective clinical trial. The peer navigator educated patients to advocate for pain and symptom management with their healthcare providers, motivated patients to pursue advance care planning, and discussed the role of hospice. The social worker saw patients with persistent psychosocial distress. SETTING/SUBJECTS Patients with advanced cancer at a VA Medical Center not currently in palliative care or hospice whose oncologist would not be surprised if the patient died in the subsequent year. MEASUREMENTS Participation and retention rates, patient-reported symptoms and quality of life, advance directive documentation, patient satisfaction survey, and semistructured interviews. RESULTS The participation rate was 38% (17/45), and 35% (7/17) completed final survey measures. Patients had stage IV (81%) and primarily genitourinary (47%) and lung (24%) malignancies. Median Eastern Cooperative Oncology Group performance status was 0. Patient-reported surveys indicated low distress (mean scores: Functional Assessment of Cancer Therapy-General, 75.3 [standard deviation {SD} 17.6]; Edmonton Symptom Assessment Scale symptom scores ranged from 1.6 to 3.8; Patient Health Questionnaire-9, 5.7 [SD 5.2]; and Generalized Anxiety Disorder-7, 2.8 [SD 4.1]). Of those who had not completed advance directives at baseline (n = 11, 65%), five completed them by the end of study (5/11, 45%). Patients who completed satisfaction surveys (n = 7) and interviews (n = 4) provided mixed reviews of the intervention. CONCLUSIONS At a single site, a stepped peer navigator and social work palliative care study had several challenges to feasibility, including low patient-reported distress and loss to follow-up.
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Affiliation(s)
- David B Bekelman
- 1 Department of Medicine, Veterans Affairs Eastern Colorado Health Care System , Denver, Colorado.,2 Department of Medicine, University of Colorado School of Medicine , Anschutz Medical Campus, Aurora, Colorado
| | - Rachel Johnson-Koenke
- 1 Department of Medicine, Veterans Affairs Eastern Colorado Health Care System , Denver, Colorado
| | - Daniel W Bowles
- 1 Department of Medicine, Veterans Affairs Eastern Colorado Health Care System , Denver, Colorado.,2 Department of Medicine, University of Colorado School of Medicine , Anschutz Medical Campus, Aurora, Colorado
| | - Stacy M Fischer
- 2 Department of Medicine, University of Colorado School of Medicine , Anschutz Medical Campus, Aurora, Colorado
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Liu F, Huang J, Zhang L, Fan F, Chen J, Xia K, Liu Z. Screening for distress in patients with primary brain tumor using distress thermometer: a systematic review and meta-analysis. BMC Cancer 2018; 18:124. [PMID: 29394923 PMCID: PMC5797347 DOI: 10.1186/s12885-018-3990-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/16/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with primary brain tumors are reported to have an elevated level of distress prevalence, due to the functional sequelae and the unfavorable prognosis, but the estimated prevalence of this disorder varies among studies. The Distress Thermometer (DT) is widely used distress screening tools to identify patients suffering from elevated psychosocial distress. The objective of this meta-analysis is to get a summarized estimate of distress prevalence in adult primary brain tumor patients screened by the DT instrument to identify distress in brain tumor patients. METHOD We searched studies published in PubMed, PsycINFO, and Cochrane library through August 2017 and checked related reviews and meta-analyses for eligible studies. Studies were eligible if they were published in the peer-reviewed literature and evaluated distress level by Distress Thermometer. The prevalence of distress symptoms in patients with the intracranial tumor was estimated by study-level characteristics using stratified meta-analysis. The prevalence of distress level or symptoms during the follow-up examination at different time points was detected by secondary analysis of the longitudinal studies included. RESULTS Twelve studies including a total of 2145 brain tumor patients were included in this analysis. Eight used a cross-sectional design and four were longitudinal. The pooled prevalence of distress was 38.2% (95% confidence interval (CI) 28.7%-47.7%) for the overall sample. The pooled prevalence of distress DT ≥4 was 41.1% (642/1686, 95% CI 28.6%-53.5%) and the pooled prevalence of distress by DT ≥6 was 29.7% (137/459, 95% CI 19.5%-39.9%). The distress symptom did not decrease in follow-up studies (Relative Increase Ratio:1.02, 95% CI, (0.78, 1.35)). A huge heterogeneity in different studies was detected, and different screening scales were not compared. CONCLUSION The high prevalence of distress becomes an enormous challenge for primary brain tumor patients. Routine screening and evaluation of distress in brain tumor patients may assist medical workers to develop proper interventions, which may lead to better quality of life and oncology management.
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Affiliation(s)
- Fangkun Liu
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Jing Huang
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.,Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (xiangya), Changsha, Hunan, 410011, China
| | - Liyang Zhang
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Fan Fan
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Jindong Chen
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.,Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (xiangya), Changsha, Hunan, 410011, China
| | - Kun Xia
- The State Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China.
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Van Den Broeke C, De Burghgraeve T, Ummels M, Gescher N, Deckx L, Tjan-Heijnen V, Buntinx F, van den Akker M. Occurrence of Malnutrition and Associated Factors in Community-Dwelling Older Adults: Those with a Recent Diagnosis of Cancer Are at Higher Risk. J Nutr Health Aging 2018; 22:191-198. [PMID: 29380845 DOI: 10.1007/s12603-017-0882-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES In older adults, nutritional health is essential for good quality of life and living independently at home. Especially in cancer patients, malnutrition is common and known to complicate treatment. This study aims to evaluate the nutritional status and its associated factors in community-dwelling older adults with and without cancer. DESIGN This is an observational study. SETTING This study focuses on older community-dwelling people. PARTICIPANTS This study included older people with and without cancer (≥70 years). Cancer patients included patients with a new diagnosis of breast, lung, prostate, or colorectal cancer. MEASUREMENTS Data collection included measures of nutritional status, quality of life, depression, fatigue, distress and functional status. We used multivariate logistic regression analysis to assess the association between personal characteristics and malnutrition. RESULTS Data were available for 657 people; 383 people without cancer and 274 with a cancer diagnosis. Overall, malnutrition was detected in 245 (37.5%) people; in cancer patients this was 66.1%. Multivariate analysis showed that having cancer (OR 14.4, 95% CI: 8.01 - 23.3), being male (OR 2.38, 95% CI: 1.49 - 3.70), having depression (OR 13.5, 95% CI: 6.02-30.0), distress (OR 2.60, 95% CI: 1.55 - 4.37) and impaired instrumental activities of daily living (IADL) (OR 2.63, 95% CI: 1.63 - 4.24) were associated with a higher risk of malnutrition. CONCLUSION The prevalence of malnutrition in community-dwelling older people is high, particularly in patients with cancer. Benchmarking and routine screening of older patients may be helpful strategies to increase awareness of (risk of) malnutrition among professionals.
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Affiliation(s)
- C Van Den Broeke
- Marjan van den Akker, Department of Family Medicine, Maastricht University, PO Box 616 6200 MD Maastricht, the Netherlands. E-mail: . Phone +31 43 388 2321. Fax: +31 43 361 9344
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Gonzales MJ, Gross DM, Cooke E. Psychosocial Aspects of Hematologic Disorders. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Stapleton SJ, Valerio TD, Astroth K, Woodhouse S. Distress During Radiation Therapy: Assessment Among Patients With Breast or Prostate Cancer. Clin J Oncol Nurs 2017; 21:93-98. [PMID: 28107334 DOI: 10.1188/17.cjon.93-98] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Distress is regarded as the sixth vital sign in cancer care, but few studies describe distress in patients undergoing radiation therapy. OBJECTIVES The purpose of this study was to assess distress levels among patients with breast or prostate cancer undergoing radiation therapy and investigate which problems contribute to patients' distress levels. METHODS A retrospective medical record review was conducted for 217 patients with breast or prostate cancer at a midwestern community cancer center. Demographic data, distress scores, and problems or concerns from the patient-completed Distress Thermometer and associated Problem List were collected. Descriptive and bivariate statistics were calculated. FINDINGS The average distress of patients with breast cancer was significantly higher than that of patients with prostate cancer, and patients with breast cancer reported more problems than those with prostate cancer.
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Owen JE, O'Carroll Bantum E, Pagano IS, Stanton A. Randomized Trial of a Social Networking Intervention for Cancer-Related Distress. Ann Behav Med 2017; 51:661-672. [PMID: 28244002 PMCID: PMC5572555 DOI: 10.1007/s12160-017-9890-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Web and mobile technologies appear to hold promise for delivering evidence-informed and evidence-based intervention to cancer survivors and others living with trauma and other psychological concerns. Health-space.net was developed as a comprehensive online social networking and coping skills training program for cancer survivors living with distress. PURPOSE The purpose of this study was to evaluate the effects of a 12-week social networking intervention on distress, depression, anxiety, vigor, and fatigue in cancer survivors reporting high levels of cancer-related distress. METHODS We recruited 347 participants from a local cancer registry and internet, and all were randomized to either a 12-week waiting list control group or to immediate access to the intervention. Intervention participants received secure access to the study website, which provided extensive social networking capabilities and coping skills training exercises facilitated by a professional facilitator. RESULTS Across time, the prevalence of clinically significant depression symptoms declined from 67 to 34 % in both conditions. The health-space.net intervention had greater declines in fatigue than the waitlist control group, but the intervention did not improve outcomes for depression, trauma-related anxiety symptoms, or overall mood disturbance. For those with more severe levels of anxiety at baseline, greater engagement with the intervention was associated with higher levels of symptom reduction over time. CONCLUSIONS The intervention resulted in small but significant effects on fatigue but not other primary or secondary outcomes. Results suggest that this social networking intervention may be most effective for those who have distress that is not associated with high levels of anxiety symptoms or very poor overall psychological functioning. TRIAL REGISTRATION NUMBER The trial was registered with the ClinicalTrials.gov database ( ClinicalTrials.gov #NCT01976949).
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Affiliation(s)
- Jason E Owen
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Erin O'Carroll Bantum
- Cancer Prevention & Control Program, University of Hawai'i Cancer Center, Honolulu, HI, USA
| | - Ian S Pagano
- Cancer Prevention & Control Program, University of Hawai'i Cancer Center, Honolulu, HI, USA
| | - Annette Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
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Lester J, Stout R, Crosthwaite K, Andersen B. Self-Reported Distress: Adult Acute Leukemia Survivors During and After Induction Therapy. Clin J Oncol Nurs 2017; 21:211-218. [DOI: 10.1188/17.cjon.211-218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rocque GB, Taylor RA, Acemgil A, Li X, Pisu M, Kenzik K, Jackson BE, Halilova KI, Demark-Wahnefried W, Meneses K, Li Y, Martin MY, Chambless C, Lisovicz N, Fouad M, Partridge EE, Kvale EA. Guiding Lay Navigation in Geriatric Patients With Cancer Using a Distress Assessment Tool. J Natl Compr Canc Netw 2016; 14:407-14. [PMID: 27059189 DOI: 10.6004/jnccn.2016.0047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/27/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing interest in psychosocial care and evaluating distress in patients with cancer. As of 2015, the Commission on Cancer requires cancer centers to screen patients for distress, but the optimal approach to implementation remains unclear. METHODS We assessed the feasibility and impact of using distress assessments to frame lay navigator interactions with geriatric patients with cancer who were enrolled in navigation between January 1, 2014, and December 31, 2014. RESULTS Of the 5,121 patients enrolled in our lay patient navigation program, 4,520 (88%) completed at least one assessment using a standardized distress tool (DT). Navigators used the tool to structure both formal and informal distress assessments. Of all patients, 24% reported distress scores of 4 or greater and 5.5% reported distress scores of 8 or greater. The most common sources of distress at initial assessment were pain, balance/mobility difficulties, and fatigue. Minority patients reported similar sources of distress as the overall program population, with increased relative distress related to logistical issues, such as transportation and financial/insurance questions. Patients were more likely to ask for help with questions about insurance/financial needs (79%), transportation (76%), and knowledge deficits about diet/nutrition (76%) and diagnosis (66%) when these items contributed to distress. CONCLUSIONS Lay navigators were able to routinely screen for patient distress at a high degree of penetration using a structured distress assessment.
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Affiliation(s)
- Gabrielle B Rocque
- University of Alabama at Birmingham Comprehensive Cancer Center,Hematology and Oncology, University of Alabama at Birmingham School of Medicine
| | - Richard A Taylor
- University of Alabama at Birmingham Comprehensive Cancer Center,Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | - Aras Acemgil
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Xuelin Li
- University of Alabama at Birmingham School of Nursing
| | - Maria Pisu
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Kelly Kenzik
- University of Alabama at Birmingham School of Nursing
| | - Bradford E Jackson
- Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | | | | | - Karen Meneses
- University of Alabama at Birmingham Comprehensive Cancer Center,Preventive Medicine, University of Alabama at Birmingham School of Medicine
| | - Yufeng Li
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | | | - Carol Chambless
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Nedra Lisovicz
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | - Mona Fouad
- University of Alabama at Birmingham Comprehensive Cancer Center,University of Alabama at Birmingham School of Nursing
| | | | - Elizabeth A Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center,Birmingham VA Medical Center, Birmingham, Alabama
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Smith SR, Hobson ME, Haig AJ. Distress prior to undergoing hematopoietic stem cell transplantation: demographic and symptom correlations and establishing a baseline. PATIENT-RELATED OUTCOME MEASURES 2016; 7:137-144. [PMID: 27695376 PMCID: PMC5029835 DOI: 10.2147/prom.s109877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Distress can arise from physical and/or psychosocial impairments and has been documented in patients after hematopoietic stem cell transplantation in the outpatient setting. It has not been evaluated in inpatients admitted to undergo the transplant, nor has potential correlations with length of hospital stay, physical function, and pain after receiving the transplant. OBJECTIVES To measure distress in patients admitted to the hospital to undergo hematopoietic stem cell transplantation, and to evaluate potential correlations with length of hospital stay, physical function, pain, and depression/anxiety. METHODS Eighty patients were given a questionnaire to report levels of distress and physical and psychosocial functioning. Hierarchical multiple regression analysis was used to test the relationship of demographic and transplant factors with length of stay (LOS), distress, presence of pain, and depression/anxiety. RESULTS Patients reported pretransplant distress with an average score of 2.2 out of 10, and 16 out of 80 patients reported clinically relevant distress. Pain was reported by 42.5% of patients, and 28.8% reported depression/anxiety. Physical functioning was generally high. Distress was correlated with depression/anxiety (P-value <0.01) and pain (0.04) but not with LOS, physical function, patient age, or transplant type. CONCLUSION LOS after receiving stem cell transplant was not related to pretransplant distress. Distress exists pretransplant but is generally low. Pain and the presence of depression/anxiety may be risk factors for distress. Measuring distress prior to transplant gives a baseline from which to measure changes, potentially leading to earlier intervention.
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Affiliation(s)
| | - Mary Elizabeth Hobson
- Adult Blood and Marrow Transplantation Program, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
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Johnson RL, Larson C, Black LL, Doty KG, VanHoose L. Significance of Nonphysical Predictors of Distress in Cancer Survivors. Clin J Oncol Nurs 2016; 20:E112-7. [PMID: 27668382 DOI: 10.1188/16.cjon.e112-e117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Distress Thermometer (DT) is a well-validated tool that is frequently used in patients with cancer to screen for general distress and to generate referrals. However, a majority of the DT problem list items relate to physical concerns; this may lead to psychosocial issues being overshadowed. OBJECTIVES The purpose of the current study is to examine the endorsement rates for nonphysical items, as well as the relationship between these items and overall DT scores. METHODS A multiple logistic regression analysis of the first-time distress rating scale of 1,209 patients from 2005-2009 was conducted to determine whether nonphysical items on the DT significantly contributed to a patient falling into one of two categories. FINDINGS This study provides evidence that emotional variables are particularly significant for patients who are at risk for distress and, consequently, should be prioritized for intervention when endorsed on the DT problem list.
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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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Edvardsson D, Watt E, Pearce F. Patient experiences of caring and person-centredness are associated with perceived nursing care quality. J Adv Nurs 2016; 73:217-227. [DOI: 10.1111/jan.13105] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2016] [Indexed: 12/28/2022]
Affiliation(s)
- David Edvardsson
- La Trobe University/Austin Health Clinical School of Nursing; Melbourne Victoria Australia
- Department of Nursing; Umea University; Sweden
| | - Elizabeth Watt
- La Trobe University/Austin Health Clinical School of Nursing; Melbourne Victoria Australia
| | - Frances Pearce
- Clinical Education Unit; Austin Health; Melbourne Victoria Australia
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Clover KA, Oldmeadow C, Nelson L, Rogers K, Mitchell AJ, Carter G. Which items on the distress thermometer problem list are the most distressing? Support Care Cancer 2016; 24:4549-57. [PMID: 27260016 DOI: 10.1007/s00520-016-3294-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/30/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The importance of distress identification and management in oncology has been established. We examined the relationship between distress and unmet bio-psychosocial needs, applying advanced statistical techniques, to identify which needs have the closest relationship to distress. METHODS Oncology outpatients (n = 1066) undergoing QUICATOUCH screening in an Australian cancer centre completed the distress thermometer (DT) and problem list (PL). Principal component analysis (PCA), logistic regression and classification and regression tree (CART) analyses tested the relationship between DT score (at a cut-off point of 4) and PL items. RESULTS Sixteen items were reported by <5 % of participants. PCA analysis identified four major components. Logistic regression analysis indicated three of these component scores, and four individual items (20 items in total) demonstrated a significant independent relationship with distress. The best CART model contained only two PL items: 'worry' and 'depression'. CONCLUSIONS The DT and PL function as intended, quantifying negative emotional experience (distress) and identifying bio-psychosocial sources of distress. We offer two suggestions to minimise PL response time whilst targeting PL items most related to distress, thereby increasing clinical utility. To identify patients who might require specialised psychological services, we suggest the DT followed by a short, case-finding instrument for patients over threshold on the DT. To identify other important sources of distress, we suggest using a modified PL of 14 key items, with the 15th item 'any other problem' as a simple safety net question. Shorter times for patient completion and clinician response to endorsed PL items will maximise acceptance and clinical utility.
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Affiliation(s)
- Kerrie Ann Clover
- Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia. .,Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia.
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, Australia
| | - Louise Nelson
- Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia
| | - Kerry Rogers
- Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia
| | - Alex J Mitchell
- Department of Psycho-oncology, University of Leicester and Leicestershire Partnership Trust, Leicester, UK
| | - Gregory Carter
- Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia.,Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia
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Huang B, Chen H, Deng Y, Yi T, Wang Y, Jiang Y. Diagnosis, disease stage, and distress of Chinese cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:73. [PMID: 27004220 DOI: 10.3978/j.issn.2305-5839.2016.02.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective is to assess how cancer patients know about their diagnosis what they know about their real stage, and the relationship between cancer stage and psychological distress. METHODS A questionnaire including the Distress Thermometer was delivered to 422 cancer inpatients. Multivariate logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Most of patients (68.7%) knew the bad news immediately after diagnosis. Half of patients knew their diagnosis directly from medical reports. Nearly one third of patients were informed by doctors. Cancer stages, which patients believed, differed significantly from their real disease stages (P<0.001). Over half of patients did not know their real disease stages. Patients with stage I-III cancer were more likely to know their real disease stage than patients with stage IV cancer (P<0.001). Distress scores of cancer patients were determined by the real cancer stage (P=0.012), not the stage which patients believed. CONCLUSIONS Although most of participants knew the bad news immediately after diagnosis, less than half of them knew their real disease stage. Patient with stage I-III cancer was more likely to know the real disease stage and had a DT score <4 than patient with stage IV disease.
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Affiliation(s)
- Boyan Huang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Huiping Chen
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yaotiao Deng
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Tingwu Yi
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yuqing Wang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yu Jiang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Owen JE, Bantum EO, Gorlick A, Stanton AL. Engagement with a social networking intervention for cancer-related distress. Ann Behav Med 2015; 49:154-64. [PMID: 25209353 DOI: 10.1007/s12160-014-9643-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Understanding patterns and predictors of engagement could improve the efficacy of Internet interventions. PURPOSE The purpose of the study was to characterize engagement in a multi-component Internet intervention for cancer survivors with distress. METHODS Data were derived from 296 cancer survivors provided with access to the Internet intervention and included self-report measures and directly-measured engagement with each component of the intervention. RESULTS Over 12 weeks, average total engagement was 7.3 h (sd = 11.7), and 42 % of participants spent >3 h on the website. Participants spent more time using social networking components than structured intervention content. Greater early and total engagement was associated with previous chemotherapy, being female, and being recruited via the Internet. Early engagement was associated with greater fatigue and more social constraints. CONCLUSIONS For many users, engagement with an Internet intervention was quite high. Reducing attrition and tailoring content to better meet the needs of those who do not engage should be a focus of future efforts.
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Affiliation(s)
- Jason E Owen
- Department of Psychology, Loma Linda University, Loma Linda, CA, USA,
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Effects of stress, health competence, and social support on depressive symptoms after cardiac hospitalization. J Behav Med 2015; 39:441-52. [PMID: 26660867 DOI: 10.1007/s10865-015-9702-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/25/2015] [Indexed: 12/23/2022]
Abstract
Little is known about the role of stress on the psychological well-being of patients after cardiac hospitalization or about factors that protect against or exacerbate the effects of stress. We use prospective data from 1542 patients to investigate the relationship between post-discharge stress and changes in depressive symptoms, and whether the level of prior depressive symptoms, health competence, and perceived social support moderate this relationship. Net of depressive symptoms in the 2 weeks prior to hospitalization, higher levels of post-discharge stress significantly increase depressive symptoms 30 days after discharge. The level of prior depressive symptoms moderates the effect of stress. On the other hand, perceived health competence and social support buffer the negative effects of post-discharge stress. Knowing which patients are particularly vulnerable to experiencing stress and a subsequent increase in depressive symptoms can help trigger interventions prior to discharge and possibly ameliorate the prevalence of depression.
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