1
|
Martins H, Silva RS, Bragança J, Romeiro J, Caldeira S. Spiritual Distress, Hopelessness, and Depression in Palliative Care: Simultaneous Concept Analysis. Healthcare (Basel) 2024; 12:960. [PMID: 38786372 PMCID: PMC11121139 DOI: 10.3390/healthcare12100960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention.
Collapse
Affiliation(s)
- Helga Martins
- Postdoctoral Program in Integral Human Development, Católica Doctoral School, 1649-023 Lisbon, Portugal;
- Health School, Polytechnic Institute of Beja, 7800-000 Beja, Portugal
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
| | - Rita S. Silva
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Joana Bragança
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Joana Romeiro
- Postdoctoral Program in Integral Human Development, Católica Doctoral School, 1649-023 Lisbon, Portugal;
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| | - Sílvia Caldeira
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal;
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (R.S.S.); (J.B.)
| |
Collapse
|
2
|
Rodríguez-Prat A, Pergolizzi D, Crespo I, Julià-Torras J, Balaguer A, Kremeike K, Voltz R, Monforte-Royo C. The wish to hasten death in patients with life-limiting conditions. A systematic overview. J Pain Symptom Manage 2024:S0885-3924(24)00743-7. [PMID: 38703862 DOI: 10.1016/j.jpainsymman.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/07/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
CONTEXT A systematic review of the wish to hasten death among people with life-limiting conditions was published in 2011. Since then, other reviews and primary studies have been published that have added to knowledge regarding the conceptual definition, aetiology and assessment of the wish to hasten death. OBJECTIVES To provide an updated synthesis of the literature on the wish to hasten death in people with life-limiting conditions. METHODS An overview of systematic reviews and primary studies was conducted, using an integrative review method. PubMed, CINAHL, Scopus and Web of Science databases were searched, from their inception until 2023. We included all systematic reviews published to date and all primary studies not included in these systematic reviews. RESULTS Eleven systematic reviews and 35 primary studies were included. We propose that the phenomenon may usefully be considered as existing along a continuum, defined by the extent to which thoughts of dying are linked to action. A total of nine assessment tools have been described. The reported prevalence of the wish to hasten death appears to be influenced by the wording used in assessment instruments, as well as by the cut-off used when applying a particular tool. Depression, pain, functional disability, decreased sense of meaning in life, the sense of being a burden and reduced quality of life are the most widely reported related factors. CONCLUSION This overview underscores the need for clinical strategies that can identify different manifestations of the wish to hasten death among people with life-limiting conditions.
Collapse
Affiliation(s)
- Andrea Rodríguez-Prat
- Faculty of Humanities, Universitat Internacional de Catalunya. Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona. Spain
| | - Iris Crespo
- Department of Psychology, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Joaquim Julià-Torras
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona. Spain; Department of Palliative Care, Institut Català d'Oncologia Badalona, Badalona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona. Spain
| | - Kerstin Kremeike
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain..
| |
Collapse
|
3
|
Ancy KM, Azhar A, Guzman Gutierrez D, Bruera E. "I'm Done": A patient's wish and will to die. Palliat Support Care 2023:1-4. [PMID: 38131142 DOI: 10.1017/s1478951523001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND A desire for hastened death is commonly expressed by cancer patients. Although efforts to define and explore this issue have been undertaken, no standardized approach exists to address these desires. CASE DESCRIPTION Ms. J expressed a wish for accelerated death and subsequently experienced unexpected clinical decline resulting in a quick, natural death. Our team experienced a mixture of both emotional distress and awe after witnessing the pragmatic approach our patient had to her impending decline, that we felt was worthy of further exploration. CONCLUSION Most clinicians lack formal training in communication, potentially making cases like Ms. J's highly distressing. Clinicians should feel comfortable addressing and potentially inquiring about patients' desire to hasten death. While our initial reaction might be to correct this desire, we propose reframing this expression as an opportunity to explore more about our patients.
Collapse
Affiliation(s)
- Kayley M Ancy
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahsan Azhar
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana Guzman Gutierrez
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
4
|
Gupta AK, Bansal D. Euthanasia - Review and update through the lens of a psychiatrist. Ind Psychiatry J 2023; 32:15-18. [PMID: 37274582 PMCID: PMC10236687 DOI: 10.4103/ipj.ipj_259_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 06/06/2023] Open
Abstract
Euthanasia is not infrequent in the modern practice of medicine. Active euthanasia is legal in seven countries worldwide and passive euthanasia has recently been legalized in India by the Supreme Court. In India, physicians and nurses generally have a favorable attitude towards euthanasia but lack in adequate training to deal with such requests. The role of a psychiatrist is very important in evaluation of request for euthanasia on medical as well as psychiatric grounds. Among patients with end-stage medical illnesses who make a request for euthanasia or physician-assisted suicide, many may have underlying untreated depression. In the complex backdrop of long-term chronic medical illnesses, depression can be very difficult to diagnose and treat. Patients with dementia and other neuropsychiatric illnesses have the issue of consent and capacity. Legalizing euthanasia in these patients can heave dire moral implications. There is clear need of adequate training, formulation of guidelines, and supportive pathway for clarity of clinicians regarding euthanasia in India.
Collapse
Affiliation(s)
- Anindya K. Gupta
- Department of Psychiatry, Army College of Medical Sciences and Base Hospital, Delhi Cantt, Delhi, India
| | - Deepali Bansal
- Department of Psychiatry, Army College of Medical Sciences and Base Hospital, Delhi Cantt, Delhi, India
| |
Collapse
|
5
|
Li YZ, Qin X, Liu FH, Chen WX, Wei YF, Wang N, Yan S, Kang Y, Zhao YH, Gao S, Gong TT, Wu QJ. Prediagnosis Depression Rather Than Anxiety Symptoms Is Associated with Decreased Ovarian Cancer Survival: Findings from the Ovarian Cancer Follow-Up Study (OOPS). J Clin Med 2022; 11:jcm11247394. [PMID: 36556009 PMCID: PMC9781310 DOI: 10.3390/jcm11247394] [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: 11/08/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background: The relationship between prediagnosis depression, anxiety symptoms, and ovarian cancer (OC) survival is unknown. We aimed to explore these associations to provide further epidemiological evidence. Methods: We investigated the relationship between prediagnosis depression, anxiety symptoms, and OC survival in a prospective cohort study of newly diagnosed OC patients aged 18−79 years. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7 at diagnosis, respectively. Deaths were ascertained until 31 March 2021 via medical records and active follow-up. Multivariable-adjusted Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with prediagnosis depression and anxiety symptoms and all-cause mortality of OC. Results: We found 56 (9.4%) and 235 (39.3%) OC patients with depression and anxiety symptoms, respectively. During a median follow-up of 37.2 months (interquartile range 24.7−50.2 months), 130 deaths were confirmed. Compared with non-depression symptoms, patients with prediagnosis depressive symptoms showed a significantly increased risk of OC mortality (HR = 2.10, 95% CI: 1.20−3.70). Of note, the association was still robust when focusing on the OC patients with severe depressive symptoms (HR = 2.10, 95% CI: 1.07−4.12). However, we observed no association between prediagnosis anxiety symptoms of different severity and OC mortality. Interestingly, OC patients with combined moderate depression and anxiety symptoms had a significantly increased risk of OC mortality (HR = 3.23, 95% CI: 1.14−9.11) compared to those with no symptoms of depression and anxiety. Notably, Wilms’s tumor 1 was significantly associated with depression and anxiety symptoms (p < 0.05). Conclusions: Prediagnosis depression increases the risk of OC mortality. Large multicenter studies are required to confirm this finding.
Collapse
Affiliation(s)
- Yi-Zi Li
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xue Qin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Fang-Hua Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wen-Xiao Chen
- Department of Sports Medicine and Joint Surgery, The People’s Hospital of Liaoning Province, Shenyang 110000, China
| | - Yi-Fan Wei
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Na Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200433, China
| | - Shi Yan
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Ye Kang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Song Gao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Correspondence: (T.-T.G.); (Q.-J.W.); Tel.: +86-24-96615-13652 (T.-T.G.); +86-24-96615-13652 (Q.-J.W.)
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Key Laboratory of Reproductive and Genetic Medicine, National Health Commission, China Medical University, Shenyang 110004, China
- Correspondence: (T.-T.G.); (Q.-J.W.); Tel.: +86-24-96615-13652 (T.-T.G.); +86-24-96615-13652 (Q.-J.W.)
| |
Collapse
|
6
|
Borza T, Harneshaug M, Kirkhus L, Šaltytė Benth J, Selbæk G, Bergh S, Slaaen M. The course of depressive symptoms and mortality in older patients with cancer. Aging Ment Health 2022; 26:1153-1160. [PMID: 34139140 DOI: 10.1080/13607863.2021.1932739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The Geriatric Depression Scale (GDS-15), a self-report questionnaire, emphasizes the psychological dimension of depression. We aimed to investigate whether GDS-15 scores were associated with mortality in older patients with cancer and describe the course of individual symptoms on the GDS-15. METHODS An observational, multicenter, prospective study of 288 patients 70 years or older with cancer followed over 24 months. The patients were assessed with the GDS-15 at inclusion, and after four and 12 months. An extended Cox regression model assessed the association between time-dependent GDS-15 scores and mortality. RESULTS After adjusting for cancer-related prognostic factors, a one-point increase in GDS-15 sum score increased risk of death by 12%. GDS-15 mean score increased during the first four months of the study, as did odds for the presence of the GDS-15 symptoms 'feel you have more problems with memory than most', 'not feel full of energy', and 'think that most people are better off than you'. The most prevalent and persistent GDS-15 symptom was 'prefer to stay at home, rather than going out and doing new things', and 'not to be in good spirits most of the time' was the least prevalent. CONCLUSIONS More severe depressive symptoms, as measured by the GDS-15, were associated with higher mortality in older patients with cancer. The importance of emotional distress and how to alleviate it should be investigated further in these patients.
Collapse
Affiliation(s)
- Tom Borza
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Magnus Harneshaug
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene Kirkhus
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Geir Selbæk
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Sverre Bergh
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marit Slaaen
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Palliative Team, Department of Internal Medicine, Innlandet Hospital Trust, Hamar Hospital, Hamar, Norway
| |
Collapse
|
7
|
Hatano Y, Morita T, Mori M, Maeda I, Oyamada S, Naito AS, Oya K, Sakashita A, Ito S, Hiratsuka Y, Tsuneto S. Complexity of desire for hastened death in terminally ill cancer patients: A cluster analysis. Palliat Support Care 2021; 19:646-655. [PMID: 33641697 DOI: 10.1017/s1478951521000080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The present study aims were (1) to identify the proportion of terminally ill cancer patients with desire for hastened death (DHD) receiving specialized palliative care, (2) to identify the reasons for DHD, and (3) to classify patients with DHD into some interpretable subgroups. METHODS Advanced cancer patients admitted to 23 inpatients hospices/palliative care units in 2017 were enrolled. Data were prospectively obtained by the primarily responsible physicians. The presence/absence of DHD and reasons for DHD were recorded. A cluster analysis was performed to identify patterns of subgroups in patients with DHD. RESULTS Data from 971 patients, whose Richmond Agitation-Sedation Scale score at admission was zero and who died in palliative care units, were analyzed. The average age was 72 years, common primary cancer sites were the gastrointestinal tract (31%) and the liver/biliary ducts/pancreas (19%). A total of 174 patients (18%: 95% confidence interval, 16-20) expressed DHD. Common reasons for DHD were dependency (45%), burden to others (28%), meaninglessness (24%), and inability to engage in pleasant activities (24%). We identified five clusters of patients with DHD: cluster 1 (35%, 61/173): "physical distress," cluster 2 (21%, 37/173): "dependent and burdensome," cluster 3 (19%, 33/173): "hopelessness," cluster 4 (17%, 30/173): "profound fatigue," and cluster 5 (7%, 12/173): "extensive existential suffering." CONCLUSIONS A considerable number of patients expressed DHD and could be categorized into five subgroups. These findings may contribute to the development of therapeutic strategies.
Collapse
Affiliation(s)
- Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Osaka, Japan
| | | | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Kiyofumi Oya
- Transitional and Palliative Care, Aso Iizuka Hospital, Fukuoka, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Satoko Ito
- Hospice, The Japan Baptist Hospital, Kyoto, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | |
Collapse
|
8
|
Relationship between the depression levels and nutritional statuses of advanced stage cancer patients. Palliat Support Care 2021; 20:654-661. [PMID: 34588082 DOI: 10.1017/s1478951521001516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aimed to determine the depression and nutritional statuses of advanced stage cancer patients and investigate the relationship between depression and malnutrition. METHOD The descriptive, cross-sectional, and correlational study was conducted with 245 patients with advanced cancer. The data were collected by using an Information Form, the Visual Analog Scale, the NRS-2002-Nutritional Risk Score, and the Beck Depression Inventory. RESULTS The mean NRS-2002 score of the patients was 2.22, and when the cutoff value was accepted as 3, it was determined that 39.2% of the patients had malnutrition. The mean Beck Depression Inventory score of the patients was 35.06, and they were found to experience severe depression. There was a positive and significant relationship between the NRS-2002 scores and the Beck Depression Inventory scores (r = 0.409; p < 0.001). SIGNIFICANCE OF RESULTS These results showed that there was a strong relationship between the depression and malnutrition levels of advanced stage cancer patients. Deterioration in the nutritional status of the advanced stage cancer patients was associated with a significant worsening effect in terms of depression and pain.
Collapse
|
9
|
Elliesen R, Glaesmer H, Koranyi S, Mehnert-Theuerkauf A. [Death Wishes in Patients with Advanced Cancer: An Explorative Analysis of Psychotherapeutic Treatment Transcripts]. Psychother Psychosom Med Psychol 2021; 72:18-25. [PMID: 34311486 DOI: 10.1055/a-1499-8082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Todeswünsche bei Patienten mit einer fortgeschrittenen Krebserkrankung sind bereits seit längerem Gegenstand der psychoonkologischen Forschung. Auch wenn es inzwischen einige Ansätze gibt, die sich mit der Konzeptualisierung und Beschreibung von Todeswünschen befassen, fehlt es bislang an einem in der klinischen Praxis gut anwendbaren Konzept und dazugehörigen Erhebungsinstrumenten. Ziel der Studie ist deshalb die phänomenologische Beschreibung von Todeswünschen bei Patienten mit fortgeschrittenem Krebs. Dafür wurden N=228 transkribierte Psychotherapiegespräche von 76 Patienten im Rahmen der randomisiert-kontrollierten Psychotherapiestudie Managing Cancer and Living Meaningfully (CALM) hinsichtlich des Themas Todeswunsch explorativ analysiert. Von den untersuchten 76 Patienten berichteten 16 (21%) explizit von Todeswünschen. Mithilfe ihrer Beschreibungen konnten zwei Dimensionen identifiziert werden: (1) Gründe für Todeswünsche mit sieben Unterkategorien (Vermeidung von Schmerz und Leid, Kontrolle und Selbstbestimmung erhalten, körperlicher Abbau und Begrenzungen im Alltag, Angst vor Siechtum, Leben nicht mehr lebenswert, Gefühl der Lebensvollendung und alles getan zu haben, fehlende Zukunftsperspektiven) sowie (2) der Grad des mit dem Todeswunsch verbundenen Handlungsdrucks. Die Ergebnisse stimmen mit existierenden Theorien zu Todeswünschen bei Patienten mit einer fortgeschrittenen Krebserkrankung größtenteils überein. Als zusammengehörige Dimensionen des Phänomens Todeswunsch wurden sie jedoch bisher noch nicht beschrieben. Vor allem für die klinische Praxis scheint dies sehr sinnvoll zu sein, da die Gründe in der Therapie größtenteils bearbeitbar sein dürften und der Grad des Handlungsdrucks Aufschluss über die Notwendigkeit einer Intervention geben kann.Death wishes in patients with advanced cancer is a research topic of high interest in psycho-oncologic research. Despite existing concepts describing death wishes, there is a lack of clinically applicable concepts and appropriate instruments. The objective of this study was the phenomenological description of death wishes in patients with advanced cancer. For this purpose, we qualitatively explored N=228 transcribed psychotherapeutic treatment sessions of 76 patients derived from an RCT evaluating the efficacy of Managing Cancer and Living Meaningfully (CALM) psychotherapeutic intervention. Sixteen out of the 76 patients explicitly reported death wishes (21%). Two dimensions were identified: (1) reasons for a death wish with seven subcategories (avoidance of pain and suffering, maintaining control and self-determination, physical deterioration and limitations in everyday life, fear of infirmity, life not longer worth living, feeling of life completion and having done everything, lack of future perspectives) and (2) the degree of pressure to act associated with the death wish. These results are consistent with existing theories regarding death wishes in patients with advanced cancer. However, they have not yet been described as interrelated dimensions of the phenomenon of the death wish.
Collapse
Affiliation(s)
- Ruth Elliesen
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig, Deutschland
| | - Heide Glaesmer
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig, Deutschland
| | - Susan Koranyi
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig, Deutschland
| | - Anja Mehnert-Theuerkauf
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig, Deutschland
| |
Collapse
|
10
|
Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective. Palliat Support Care 2021; 18:486-494. [PMID: 31551106 DOI: 10.1017/s1478951519000816] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Since February 2016, French Claeys-Leonetti law has recognized patients' right to confront incurable diseases with short-term prognosis and refractory physical or psychological or existential symptoms by requesting continuous deep sedation until death (CDSUD). Determining when psychological or existential distress is refractory and unbearable remains complex and controversial.This review provides a comprehensive thought on CDSUD for advanced incurable patients with refractory psychological and/or existential distress in palliative care settings. It offers guidance on psychiatric or psychological diagnosis for explaining patients' requests for CDSUD. METHOD A narrative literature review (2000-2019) was conducted on the MedLine search about the use of palliative sedation in cases of refractory psychological and/or existential distress. RESULTS (1) Definitions of "refractory symptom," "refractory psychological distress," and "refractory existential distress" are inconsistent; (2) alternative diagnoses might obscure or be obscured by psycho-existential distress; and (3) criteria on meanings, reasons for requests, decision-making processes, and functions are evolving in practice. SIGNIFICANCE OF RESULTS Before implementing CDSUD, palliative healthcare professionals should seek input from psycho-oncologists in palliative care. Mental health professionals should analyze and assess the reasons for psychological and/or existential distress, consider the intentionality processes of requests, and explore alternative diagnoses, such as depressive or adjustment disorders, demoralization syndrome, desire to hasten death, and desire for euthanasia. Therapeutic responses (e.g., pharmacological and psychotherapeutic) should be implemented before deciding that psycho-existential distress is refractory.
Collapse
|
11
|
Ross S, Agin-Liebes G, Lo S, Zeifman RJ, Ghazal L, Benville J, Franco Corso S, Bjerre Real C, Guss J, Bossis A, Mennenga SE. Acute and Sustained Reductions in Loss of Meaning and Suicidal Ideation Following Psilocybin-Assisted Psychotherapy for Psychiatric and Existential Distress in Life-Threatening Cancer. ACS Pharmacol Transl Sci 2021; 4:553-562. [PMID: 33860185 PMCID: PMC8033770 DOI: 10.1021/acsptsci.1c00020] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 12/13/2022]
Abstract
People with advanced cancer are at heightened risk of desire for hastened death (DHD), suicidal ideation (SI), and completed suicide. Loss of Meaning (LoM), a component of demoralization, can be elevated by a cancer diagnosis and predicts DHD and SI in this population. We completed a randomized controlled trial in which psilocybin-assisted psychotherapy (PAP) produced rapid and sustained improvements in depression, demoralization, and hopelessness in people with cancer. Converging epidemiologic and clinical trial findings suggests a potential antisuicidal effect of this treatment. To probe our hypothesis that PAP relieves SI through its beneficial impacts on depression and demoralization (LoM in particular), we performed secondary analyses assessing within- and between-group differences with regard to LoM and an SI composite score. Among participants with elevated SI at baseline, PAP was associated with within-group reductions in SI that were apparent as early as 8 h and persisted for 6.5 months postdosing. PAP also produced large reductions in LoM from baseline that were apparent 2 weeks after treatment and remained significant and robust at the 6.5 month and 3.2 and 4.5 year follow-ups. Exploratory analyses support our hypothesis and suggest that PAP may be an effective antisuicidal intervention following a cancer diagnosis due to its positive impact on hopelessness and demoralization and its effects on meaning-making in particular. These preliminary results implicate psilocybin treatment as a potentially effective alternative to existing antidepressant medications in patients with cancer that are also suicidal, and warrant further investigation in participants with elevated levels of depression and suicidality.
Collapse
Affiliation(s)
- Stephen Ross
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Gabrielle Agin-Liebes
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, San Francisco, California, 94110, United States.,Zuckerberg San Francisco General Hospital, San Francisco, California, 94110, United States
| | - Sharon Lo
- Pacific University College of Health Professions, Hillsboro, Oregon 97123-4218, United States
| | | | - Leila Ghazal
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
| | - Julia Benville
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
| | - Silvia Franco Corso
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, New York, 10032-3784, United States
| | - Christian Bjerre Real
- Memorial Sloan Kettering Cancer Center, New York, New York, 10065-6007, United States
| | - Jeffrey Guss
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Anthony Bossis
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Sarah E Mennenga
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
| |
Collapse
|
12
|
Escala de Desesperanza de Beck (BHS): ventajas de una administración adaptativa. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2020. [DOI: 10.33881/2027-1786.rip.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
La escala de Desesperanza de Beck (BHS) es usada con frecuencia como screening para la detección de riesgo suicida y/o depresión aun cuando, por su extensión de 20 ítems, resulta poco eficiente. En este trabajo se analiza si una estrategia de administración adaptativa podría abreviar el tiempo de aplicación de la BHS. Participaron 783 individuos de población general (50.9% mujeres). Se seleccionó aleatoriamente un 70% de los casos para calibrar los ítems con el Modelo Logístico de 2 parámetros de la Teoría de Respuesta al Ítem. Se eliminaron dos elementos que presentaron funcionamiento inadecuado. El 30% restante de la muestra se utilizó para simular una administración adaptativa de los 18 ítems calibrados. Se compararon dos modalidades de interrupción: a) al administrar 9 ítems y b) al alcanzar un error de estimación ≤ 0.35 o administrar 9 ítems (criterio mixto). Bajo ambas condiciones se registraron correlaciones de .95 con el nivel de Desesperanza estimado a partir de los 18 ítems. No obstante, la interrupción basada en el criterio mixto no mostró un impacto adicional en la eficiencia de la medida. Al igual que la versión de 18 ítems, las aplicaciones adaptativas estimaron con más precisión los niveles elevados del rasgo. La medición adaptativa no afectó las evidencias de validez al estudiar la asociación del rasgo con facetas del Neuroticismo y dimensiones sintomatológicas. Se concluye que una administración adaptativa de 9 ítems puede abreviar considerablemente la BHS sin perjudicar la validez y confiabilidad de la medida.
Collapse
|
13
|
Psychological Strain and Suicidal Ideation in Athletes: The Multiple Mediating Effects of Hopelessness and Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218087. [PMID: 33147888 PMCID: PMC7662376 DOI: 10.3390/ijerph17218087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/30/2022]
Abstract
The present study aims to examine the relationship between psychological strain, suicidal ideation, hopelessness, and depression among Chinese athletes. Participants were 774 Chinese athletes (454 men and 320 women), with a range of ages from 12 to 35 (M = 18.47, SD = 3.39). The structural equation modeling method was used to examine the multiple mediating effects of hopelessness and depression between psychological strain and suicidal ideation. As expected, a positive correlation between psychological strain, suicidal ideation, hopelessness, and depression was found. Additionally, results seem to indicate that psychological strain directly and positively influenced suicidal ideation, and that hopelessness and depression played a serial mediating role in the relationship between psychological strain and suicidal ideation. To conclude, the psychological strain theory is applicable for explaining suicidal ideation in athletes. In athletes, psychological strain is sequentially associated first with a sense of hopelessness and then depression, which is in turn related to suicidal ideation. The present study makes a significant contribution to the literature because we provide a new theoretical basis and new methods for preventing mental disorder and suicidality in athletes.
Collapse
|
14
|
Caruso R, Nanni MG, Rodin G, Hales S, Malfitano C, De Padova S, Bertelli T, Murri MB, Bovero A, Miniotti M, Leombruni P, Zerbinati L, Sabato S, Grassi L. Effectiveness of a brief manualized intervention, Managing Cancer and Living Meaningfully (CALM), adapted to the Italian cancer care setting: Study protocol for a single-blinded randomized controlled trial. Contemp Clin Trials Commun 2020; 20:100661. [PMID: 33089003 PMCID: PMC7566943 DOI: 10.1016/j.conctc.2020.100661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/29/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022] Open
Abstract
Patients with advanced cancer suffer from psychosocial distress that may impair quality of life and that may be ameliorated by psychotherapeutic treatment. We describe here the methodology of a randomized controlled trial (RCT) to assess the effectiveness of a novel, brief, semi-structured psychotherapeutic intervention to reduce distress and increase well-being in patients with advanced or metastatic cancer. The intervention, called Managing Cancer and Living Meaningfully (CALM), was originally developed in Canada and we are now testing its Italian adaptation (CALM-IT). The study is a single-blinded phase III RCT with assessment at baseline, 3 and 6 months with two conditions: CALM-IT versus a nonspecific supportive intervention (SPI). Eligibility criteria include: ≥ 18 years of age; fluency in the Italian language; no cognitive deficit, and diagnosis of advanced or metastatic cancer with an expected survival of 12–18 months. CALM-IT includes up to 12 sessions, delivered over 6 months and covers 4 domains: i) Symptom Management and Communication with Health Care Providers; ii) Changes in Self and Relations with Close Others; iii) Sense of Meaning and Purpose; and iv) the Future and Mortality. The primary outcome is difference in severity of depressive symptoms between treatment arm and the primary endpoint is 6 months. The secondary endpoint is 3 months and secondary outcomes are: generalized anxiety, distress about dying and death, demoralization, spiritual well-being, attachment security, posttraumatic growth, communication with partners, quality of life, and satisfaction with clinical care. If shown to be effective, CALM-IT can be implemented nationally to relieve distress and to promote psychological well-being in patients with advanced cancer.
Collapse
Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON M5G 2M9, Canada.,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON M5G 2M9, Canada.,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON M5G 2M9, Canada.,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Silvia De Padova
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Tatiana Bertelli
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per Lo Studio e La Cura Dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy
| | - Andrea Bovero
- Clinical Psychology Unit, Department of Neuroscience, University of Turin, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
| | - Marco Miniotti
- Clinical Psychology Unit, Department of Neuroscience, University of Turin, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
| | - Paolo Leombruni
- Clinical Psychology Unit, Department of Neuroscience, University of Turin, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Silvana Sabato
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy
| | | |
Collapse
|
15
|
Kremeike K, Frerich G, Romotzky V, Boström K, Dojan T, Galushko M, Shah-Hosseini K, Jünger S, Rodin G, Pfaff H, Perrar KM, Voltz R. The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach. BMC Palliat Care 2020; 19:49. [PMID: 32299415 PMCID: PMC7164236 DOI: 10.1186/s12904-020-00548-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress. METHODS Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. RESULTS 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was "proactively addressing desire to die". CONCLUSIONS We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically - based on evidence, patients' views and consensus among professional experts. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).
Collapse
Affiliation(s)
- Kerstin Kremeike
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Gerrit Frerich
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Vanessa Romotzky
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kathleen Boström
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thomas Dojan
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maren Galushko
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Medical Faculty, Cologne, Germany
| | - Klaus Maria Perrar
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS), University of Cologne, Cologne, Germany
| |
Collapse
|
16
|
Andersen BL, Valentine TR, Lo SB, Carbone DP, Presley CJ, Shields PG. Newly diagnosed patients with advanced non-small cell lung cancer: A clinical description of those with moderate to severe depressive symptoms. Lung Cancer 2019; 145:195-204. [PMID: 31806360 DOI: 10.1016/j.lungcan.2019.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aims of this observational study were to 1) accrue newly diagnosed patients with advanced-stage non-small cell lung cancer (NSCLC) awaiting the start of first-line treatment and identify those with moderate to severe depressive symptoms and, 2) provide a clinical description of the multiple, co-occurring psychological and behavioral difficulties and physical symptoms that potentially exacerbate and maintain depressive symptoms. MATERIALS AND METHODS Patients with stage IV NSCLC (N = 186) were enrolled in an observational study (ClinicalTrials.gov Identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended screening measure for depression (Patient Health Questionnaire-9 [PHQ-9]). Individuals with none/mild (n = 119; 64 %), moderate (n = 52; 28 %), and severe (n = 15; 8 %) depressive symptoms were identified. Patients also completed measures of hopelessness, generalized anxiety disorder (GAD) symptoms, stress, illness perceptions, functional status, and symptoms. RESULTS Patients with severe depressive symptoms reported concomitant feelings of hopelessness (elevating risk for suicidal behavior), anxiety symptoms suggestive of GAD, and traumatic, cancer-specific stress. They perceived lung cancer as consequential for their lives and not controllable with treatment. Pain and multiple severe symptoms were present along with substantial functional impairment. Patients with moderate depressive symptoms had generally lower levels of disturbance, though still substantial. The most salient differences were low GAD symptom severity and fewer functional impairments for those with moderate symptoms. CONCLUSIONS Depressive symptoms of moderate to severe levels co-occur in a matrix of clinical levels of anxiety symptoms, traumatic stress, impaired functional status, and pain and other physical symptoms. All of the latter factors have been shown, individually and collectively, to contribute to the maintenance or exacerbation of depressive symptoms. As life-extending targeted and immunotherapy use expands, prompt identification of patients with moderate to severe depressive symptoms, referral for evaluation, and psychological/behavioral treatment are key to maximizing treatment outcomes and quality of life for individuals with advanced NSCLC.
Collapse
Affiliation(s)
- B L Andersen
- Department of Psychology, The Ohio State University, United States.
| | - T R Valentine
- Department of Psychology, The Ohio State University, United States
| | - S B Lo
- Department of Psychology, The Ohio State University, United States
| | - D P Carbone
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
| | - C J Presley
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
| | - P G Shields
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center and The James Cancer Hospital/Solove Research Institute, United States
| |
Collapse
|