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Amiri S. The prevalence of anxiety symptoms/disorders in cancer patients: a meta-analysis. Front Psychiatry 2024; 15:1422540. [PMID: 39619339 PMCID: PMC11605443 DOI: 10.3389/fpsyt.2024.1422540] [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: 04/30/2024] [Accepted: 10/15/2024] [Indexed: 02/13/2025] Open
Abstract
OBJECTIVE Cancer can have negative effects on mental health. The aim of this study was to investigate the prevalence of anxiety symptoms/disorders in cancer patients' worldwide using meta-analysis. METHODS The study population was cancer patients who had cancer at the time of the study. The outcome studied in this study was anxiety symptoms/disorders. PubMed and Scopus were searched based on the syntax of keywords, this search was limited to articles published in English until September 2021. For this meta-analysis, data on the prevalence of anxiety were first extracted for each of the eligible studies. The random-effects method was used for the pool of all studies. Subgroup analysis was performed based on sex, anxiety disorders, cancer site, and continents. Heterogeneity in the studies was also assessed. RESULT After evaluating and screening the studies, eighty-four studies were included in the meta-analysis. Prevalence of anxiety symptoms/disorders in cancer patients showed that this prevalence is 23% (I2 = 99.59) in the 95% confidence interval between 22-25%. This prevalence was 20% (I 2 = 96.06%) in the 95% confidence interval between 15-24% in men and this prevalence is 31% (I 2 = 99.72%) in the 95% confidence interval between 28-34% in women. The highest prevalence of anxiety was in patients with ovarian, breast, and lung cancers. DISCUSSION It showed a high prevalence of anxiety symptoms/disorders in cancer patients, in addition to therapeutic interventions for cancer, the necessary interventions should be made on the anxiety of these patients. Methodological limitation was the heterogeneity between the studies included in the meta-analysis. Some types of cancer sites could not be studied because the number of studies was small or the site of cancer was not identified.
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Affiliation(s)
- Sohrab Amiri
- Spiritual Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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2
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Solsky I, Patel A, Valenzuela CD, Russell G, Perry K, Duckworth K, Votanopoulos KI, Shen P, Levine EA. Quality-of-Life Outcomes for Patients Taking Opioids and Psychotropic Medications Before Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2024; 31:577-593. [PMID: 37891454 DOI: 10.1245/s10434-023-14215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/09/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) on quality of life (QoL) for patients taking opioids and psychotropic medications preoperatively is unclear. METHODS This study retrospectively reviewed a CRS-HIPEC single-center prospectively maintained database for 2012-2016. Demographics and clinical data on opioids/psychotropic medication use were collected via chart review. The study collected QoL outcomes at baseline, then 3, 6, and 12 months postoperatively via the Center for Epidemiologic Studies Depression Scale (CES-D), Brief Pain Inventory, Functional Assessment of Cancer Therapy, and 36-Item Short-Form Health Survey. Differences in QoL between the groups were calculated using repeated measures analysis of variance regression. Descriptive statistics and Kaplan-Meier analyses were performed. RESULTS Of 388 patients, 44.8% were taking opioids/psychotropic medications preoperatively. At baseline, those taking opioids/psychotropic medications preoperatively versus those not taking these medications had significantly worse QoL. By 1 year postoperatively, the QoL measures did not differ significantly except for emotional functioning (e.g., no medications vs. opioids/psychotropic medications: CES-D, 5.6 vs. 10.1). Median survival did not differ significantly (opioids/psychotropic medications vs. no medications: 52.3 vs. 60.6 months; p = 0.66). At 1 year after surgery, a greater percentage of patients were taking opioids, psychotropic medications, or both than at baseline (63.2% vs. 44.8%; p < 0.001). CONCLUSION Despite worse baseline QoL, patients who took opioids/psychotropic medications had QoL scores 1 year postoperatively similar to the scores of those who did not except in the emotional domains. These data point to the potential utility of a timed psychosocial intervention to enhance emotional adaptation and further support the role of CRS-HIPEC in improving QoL.
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Affiliation(s)
- Ian Solsky
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | - Ana Patel
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | | | - Gregory Russell
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | - Kathleen Perry
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | - Katie Duckworth
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
| | | | - Perry Shen
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Edward A Levine
- Surgical Oncology Service, Wake Forest University, Winston-Salem, NC, USA.
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
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3
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Karveli S, Galanis P, Mitropoulou EM, Karademas E, Markopoulos C. The Role of Attachment Styles on Quality of Life and Distress Among Early-Stage Female Breast Cancer Patients: A Systematic Review. J Clin Psychol Med Settings 2023; 30:724-739. [PMID: 36773123 PMCID: PMC10560157 DOI: 10.1007/s10880-023-09940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
Cancer patients' quality of life (QoL) and distress are affected by dispositional factors such as attachment anxiety or avoidance. In this review, we aimed to provide a thorough overview of the relationship between attachment dimensions and QoL and distress among early-stage breast cancer patients. Following PRISMA guidelines, we conducted a systematic search using PubMed, PsycINFO, Scopus, Cinahl, Google Scholar, and PMC Europe. We reviewed 8 eligible studies describing 1180 patients. Insecure attachment appeared to be related to poorer QoL and higher distress levels. Avoidant attachment was more frequent and was more often associated with more negative outcomes. Healthcare providers should consider investigating modifiable personality traits in the immediate post diagnosis period to identify patients more vulnerable to mental health problems, deliver personalized care, and reduce emotional burden.
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Affiliation(s)
- Spyridoula Karveli
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 11527, Athens, Greece.
| | - Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelos Karademas
- Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymnon, Greece
| | - Christos Markopoulos
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 11527, Athens, Greece
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4
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Rothmund M, Pilz MJ, Egeter N, Lidington E, Piccinin C, Arraras JI, Grønvold M, Holzner B, van Leeuwen M, Petersen MA, Schmidt H, Young T, Giesinger JM. Patient-reported outcome measures for emotional functioning in cancer patients: Content comparison of the EORTC CAT Core, FACT-G, HADS, SF-36, PRO-CTCAE, and PROMIS instruments. Psychooncology 2023; 32:628-639. [PMID: 36707461 DOI: 10.1002/pon.6109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cancer and its treatment can have substantial impact on patients' emotional functioning. Several patient-reported outcome measures (PROMs) assessing emotional functioning are available, but differences in content limit the comparability of results. To better understand conceptual (dis)similarities, we conducted a content comparison of commonly used PROMs. METHODS We included emotional functioning items, scales, and item banks from the EORTC CAT Core, EORTC QLQ-C30, FACT-G, Hospital anxiety and depression scale (HADS), SF-36, PRO-CTCAE, and PROMIS (item banks for anxiety, depression, and anger). Item content was linked to the International Classification of Functioning, Disability, and Health (ICF) and a hierarchical framework established for PROMIS. Single items could be coded with more than one ICF category but were solely assigned to one facet within the PROMIS framework. RESULTS The measures comprise 132 unique items covering the ICF components 'Body functions' (136/153 codings, 88.9%) and 'Activities and participation' (15/153, 9.8%). Most ICF codings (112/153, 73.2%) referred to the third-level category 'b1528 Emotional functions, other specified'. According to the PROMIS framework 48.5% of the items assessed depression (64/132 items), followed by anxiety (41/132, 31.1%) and anger (26/132, 19.7%). The EORTC measures covered depression, anxiety, and anger in a single measure, while the PROMIS inventory provides separate item banks for these concepts. The FACT-G, SF-36, PRO-CTCAE and HADS covered depression and anxiety, but not anger. CONCLUSION Our results provide an in-depth conceptual understanding of selected PROMs and important qualitative information going beyond psychometric evidence. Such information supports the identification of PROMs for which scores can be meaningfully linked with quantitative methods.
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Affiliation(s)
- Maria Rothmund
- University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria.,Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Micha J Pilz
- University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Nathalie Egeter
- University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Emma Lidington
- Cancer Behavioural Science Unit, King's College London, London, UK
| | - Claire Piccinin
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Juan I Arraras
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Mogens Grønvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bernhard Holzner
- University Hospital of Psychiatry I, Innsbruck Medical University, Innsbruck, Austria
| | - Marieke van Leeuwen
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Morten Aa Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Heike Schmidt
- University Clinic and Outpatient Clinic for Radiotherapy and Institute of Health and Nursing Science, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Teresa Young
- Supportive Oncology Research Team, East & North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Johannes M Giesinger
- University Hospital of Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
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5
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Martino ML, Lemmo D, Gargiulo A. A review of psychological impact of breast cancer in women below 50 years old. Health Care Women Int 2021; 42:1066-1085. [PMID: 34357855 DOI: 10.1080/07399332.2021.1901901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.
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Affiliation(s)
- Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Anna Gargiulo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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6
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O'Hea E, Kroll-Desrosiers A, Cutillo AS, Michalak HR, Barton BA, Harralson T, Carmack C, McMahon C, Boudreaux ED. Impact of the mental health and dynamic referral for oncology (MHADRO) program on oncology patient outcomes, health care utilization, and health provider behaviors: A multi-site randomized control trial. PATIENT EDUCATION AND COUNSELING 2020; 103:607-616. [PMID: 31753521 PMCID: PMC7061075 DOI: 10.1016/j.pec.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The MHADRO assesses psychosocial and medical needs, provides tailored feedback reports, and connects patients to mental health providers. This study examined the MHADRO's effect on patient outcomes, health care utilization, and oncology provider documentation and behaviors. METHODS 836 patients were part of a multi-site RCT and assessments were conducted at baseline, 2, 6 and 12 months. RESULTS The intervention group engaged in less emergency calls to providers. There were no differences in psychosocial outcomes at follow up assessments. Providers of patients in the intervention group were more likely to: document psychosocial symptoms and history; refer to psychosocial services; encourage support groups; seek psychological evaluations during visits. Patients who agreed to a mental health referral had decreased hospitalizations, increased mental health care interactions, and stronger ratings of counseling potential benefits. This group also reported increased psychosocial distress at all follow-up assessments. CONCLUSION The MHADRO may increase access to mental health care, lessen utilization, and improve providers' management of psychosocial needs, but does not appear to impact overall functioning over time. PRACTICE IMPLICATIONS Providers are encouraged to consider incorporating programs, like the MHADRO, into patient care as they may have the potential to impact screening and management of patients' psychosocial needs.
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Affiliation(s)
- Erin O'Hea
- University of Massachusetts Medical School, Worcester, MA, and Department of Psychology, Stonehill University, Easton, MA, 320 Washington Street, Shields Science Center 212, Easton, MA, USA.
| | - Aimee Kroll-Desrosiers
- Biostatistician, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alexandra S Cutillo
- Medical/Clinical Psychology Doctoral Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hannah R Michalak
- Yale University Alzheimer's Disease Research Unit, One Church Street, Suite 600, New Haven, CT, 06510, United States
| | - Bruce A Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Cori McMahon
- Anderson at Cooper Cancer Center, Camden, NJ, USA
| | - Edwin D Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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7
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How many patients enter endometrial cancer surgery with psychotropic medication prescriptions, and how many receive a new prescription perioperatively? Gynecol Oncol 2019; 152:339-345. [DOI: 10.1016/j.ygyno.2018.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022]
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8
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Anxiety and Depression Disorders in Relation to the Quality of Life of Breast Cancer Patients with Locally Advanced or Disseminated Stage. ACTA ACUST UNITED AC 2018; 47:211-220. [PMID: 30286843 DOI: 10.1016/j.rcp.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 03/21/2017] [Accepted: 04/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate patterns of association between anxiety and depression and the different elements of the construct of quality of life, in patients with locally advanced breast cancer or disseminated stages METHODS: With a single measure over time, HADS and FACIT-B scales were applied in 107 women histologically confirmed to have breast cancer, in stages IIB, IIIA, IIIB, IIIC and IV. Factor analysis and multidimensional scaling methods were used to analyze patterns of association RESULTS: In 84.1% of the patients clinical anxiety was found (95%CI, 75.8-90.5%) and clinical depression in 25.2% (95%CI, 17.3-34.6%). Factor analysis groups items of the two scales in 4 domains which accounted for 59% of the total variance, where 2 items (H11 and B8) showed high values of uniqueness and low factor loadings. Multidimensional scaling suggests five groups, showing proximity between depressive symptoms and physical symptoms, as well as between anxious symptoms and related to functionality and social and family environment CONCLUSIONS: The HADS in patients with neoplastic disease detects a high frequency of depressive and especially anxious symptoms, which makes it advisable to reevaluate their psychometric properties in patients with cancer. The association between depressive symptoms of HADS and physical symptoms of quality of life construct is in favor of the difficulty of diagnosing depressive disorder in patients with cancer, so it may be necessary to develop instruments that allow locating symptoms or clinical characteristics that facilitate this diagnosis.
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9
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Gerbi GB, Ivory S, Archie-Booker E, Claridy MD, Miles-Richardson S. Factors associated with self-reported history of depression diagnosis among cancer survivors aged 18 years and over in the United States. Psychooncology 2018; 27:2039-2044. [PMID: 29776008 DOI: 10.1002/pon.4770] [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] [Received: 02/15/2018] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE According to the American Cancer Society, 25% of cancer survivors in the United States develop depression. The objective of this study is to assess factors associated with self-reported history of depression diagnosis among cancer survivors aged ≥18 years in the United States. METHODS Data were analyzed from the 2014 Behavioral Risk Factor Surveillance System (N = 6079). The Behavioral Risk Factor Surveillance System collects data about US residents regarding their health-related risk behaviors and events, chronic health conditions, and use of preventive services. Respondents were considered to have a history of depression diagnosis if they answered yes to the question "Has a doctor or other health care provider EVER told you that you have a depressive disorder, including depression, major depression, dysthymia, or minor depression?" Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with depression in cancer survivors. Analyses were conducted using SAS 9.4. RESULTS After adjusting for demographic and socioeconomic factors, females (AOR: 1.70; 95% CI, 1.50-1.97); those with an annual household income of $24 999 or less (AOR: 2.48; 95% CI, 1.95-3.16); $25 000 to $49 999 (AOR: 1.62; 95% CI, 1.31-2.02), and $50 000 to $74 999 (AOR: 1.35; 95% CI, 1.10-1.71); those who were not married (AOR = 1.37; 95% CI, 1.17-1.60); and those who perceived their health as poor (AOR = 2.33; 95% CI, 2.01-2.70), were significantly more likely to report a diagnosis of depression. CONCLUSIONS The results indicate that gender, income, marital status, and perceived health status were associated with self-reported depression among cancer survivors aged ≥18 years in the United States.
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Affiliation(s)
- Gemechu B Gerbi
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Stranjae Ivory
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elaine Archie-Booker
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Mechelle D Claridy
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA
| | - Stephanie Miles-Richardson
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA.,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
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10
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Loth FL, Meraner V, Holzner B, Singer S, Virgolini I, Gamper EM. Following patient pathways to psycho-oncological treatment: Identification of treatment needs by clinical staff and electronic screening. Psychooncology 2018; 27:1312-1319. [PMID: 29462499 PMCID: PMC6001788 DOI: 10.1002/pon.4675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In this retrospective investigation of patient pathways to psycho-oncological treatment (POT), we compared the number of POT referrals before and after implementation of electronic screening for POT needs and investigated psychosocial predictors for POT wish at a nuclear medicine department. METHODS We extracted medical chart information about number of referrals and extent of follow-up contacts. During standard referral (November 2014 to October 2015), POT needs were identified by clinical staff only. In the screening-assisted referral period (November 2015 to October 2016), identification was supported by electronic screening for POT needs. Psychosocial predictors for POT wish were examined using logistic regression. RESULTS We analysed data from 487 patients during standard referral (mean age 56.4 years; 60.2% female, 88.7% thyroid carcinoma or neuroendocrine tumours) of which 28 patients (5.7%) were referred for POT. Of 502 patients in the screening-assisted referral period (mean age 57.0 years; 55.8% female, 86.6% thyroid carcinoma or neuroendocrine tumours), 69 (13.7%) were referred for POT. Of these, 36 were identified by psycho-oncological (PO) screening and 33 by clinical staff. After PO-screening implementation, referrals increased by a factor of 2.4. The strongest predictor of POT wish was depressive mood (P < .001). During both referral periods, about 15% of patients visited the PO outpatient unit additionally to inpatient PO consultations. CONCLUSIONS Our results provide evidence from a real-life setting that PO screening can foster POT referrals, reduce barriers to express the POT wish, and hence help to meet psychosocial needs of this specific patient group. Differences between patients' needs, wish, and POT uptake should be further investigated.
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Affiliation(s)
- Fanny L Loth
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.,Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Verena Meraner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany.,University Cancer Centre Mainz, Mainz, Germany
| | - Irene Virgolini
- Department for Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva M Gamper
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.,Innsbruck Institute of Patient-centered Outcome Research, Innsbruck, Austria
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11
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Workforce design in primary care-mental health integration: a case study at one veterans affairs medical center. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2015.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Kagee A, Roomaney R, Knoll N. Psychosocial predictors of distress and depression among South African breast cancer patients. Psychooncology 2017; 27:908-914. [DOI: 10.1002/pon.4589] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/25/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ashraf Kagee
- Department of Psychology; Stellenbosch University; Matieland South Africa
| | - Rizwana Roomaney
- Department of Psychology; Stellenbosch University; Matieland South Africa
| | - Nina Knoll
- Free University of Berlin; Berlin Germany
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13
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Thompson LMA, Bobonis Babilonia M. Distinguishing Depressive Symptoms From Similar Cancer-Related Somatic Symptoms: Implications for Assessment and Management of Major Depression after Breast Cancer. South Med J 2017; 110:667-672. [PMID: 28973709 DOI: 10.14423/smj.0000000000000705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prevalence rates of major depressive disorder (MDD) following breast cancer diagnosis are estimated to be ~5% to >20%, and these rates range from slightly below to somewhat above the expected prevalence rate for MDD in the general population of women in the United States. Women with a history of MDD are at increased risk for recurrence of MDD after breast cancer and need to be monitored closely. To properly diagnose and treat MDD, healthcare providers must be able to recognize depressive symptoms and distinguish them from similar somatic symptoms that are associated with breast cancer and breast cancer treatment. The National Comprehensive Cancer Network and the American Society of Clinical Oncology have published guidelines for the screening, assessment, and care of adult cancer patients with depressive symptoms. Use of a standardized and validated screening measure may help healthcare providers identify patients in need of further assessment or treatment. Evidence-based nonpharmacological interventions such as cognitive behavioral therapy and antidepressant medications are recommended treatment options.
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Affiliation(s)
- Lora M A Thompson
- From the Supportive Care Medicine Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Margarita Bobonis Babilonia
- From the Supportive Care Medicine Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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14
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Kaidar-Person O, Meattini I, Deal AM, Francolini G, Carta G, Terzo L, Camporeale J, Muss H, Marks LB, Livi L, Mayer DK, Zagar TM. The use of psychological supportive care services and psychotropic drugs in patients with early-stage breast cancer: a comparison between two institutions on two continents. Med Oncol 2017; 34:144. [PMID: 28726045 DOI: 10.1007/s12032-017-1003-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/14/2017] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the mental health consumption among patients with early-stage breast cancer in two radiation oncology departments in two countries (USA and Italy). Data were extracted from the medical records of consecutive patients treated between 2014 and 2015 in two centers. Extracted data included patient's demographics, treatment, referral to psychological supportive care programs, and prescribed psychotropic drugs. Data from the two centers were compared using Student's t, Wilcoxon, Fisher's exact, and Jonckheere-Terpstra tests. Adjusted relative risks (RR) were estimated using Poisson regression. A total of 231 (Italy = 110, USA = 121) patients were included, with a mean age of 60 years. The crude rate of psychological supportive care visits was similar in the US versus the Italian cohort (28.9 vs. 21.8%, p = 0.23). The crude rate of prescribed psychotropic drug was higher in the US cohort versus Italian cohort (43.8 vs. 18.2%, p < 0.0001). These differences remained significant after adjusting for breast cancer subtype, stage, and treatment (RR 1.8, 95 CI 1.17-2.76). Between 20 and 30% of patients receive psychological supportive care during treatment for breast cancer. The use of psychotropic medication was higher in the US cohort than the cohort from Italy. The reasons for these differences might be related to social and cultural differences and the method of prescribing medication.
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Affiliation(s)
- Orit Kaidar-Person
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA. .,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero, Universitaria Careggi - University of Florence, Florence, Italy
| | - Allison M Deal
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero, Universitaria Careggi - University of Florence, Florence, Italy
| | - Giulio Carta
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero, Universitaria Careggi - University of Florence, Florence, Italy
| | - Lauren Terzo
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA
| | - Jayne Camporeale
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Hyman Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.,Department of Medicine, Division of Medical Oncology, UNC Hospital, Chapel Hill, NC, USA
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero, Universitaria Careggi - University of Florence, Florence, Italy
| | - Deborah K Mayer
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Timothy M Zagar
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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15
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Shinn EH, Valentine A, Baum G, Carmack C, Kilgore K, Bodurka D, Basen-Engquist K. Comparison of four brief depression screening instruments in ovarian cancer patients: Diagnostic accuracy using traditional versus alternative cutpoints. Gynecol Oncol 2017; 145:562-568. [PMID: 28400146 DOI: 10.1016/j.ygyno.2017.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We compared the diagnostic accuracy of 4 depression screening scales, using traditional and alternative scoring methods, to the gold standard Structured Clinical Interview-DSM IV major depressive episode (MDE) in ovarian cancer patients on active treatment. METHODS At the beginning of a new chemotherapy regimen, ovarian cancer patients completed the following surveys on the same day: the Center for Epidemiological Studies Depression Scale (CES-D), the Beck Depression Inventory Fast-Screen for Primary Care (BDI-FastScreen), the Patient Health Questionnaire-9 (PHQ-9), and a 1-item screener ("Are you depressed?"). Each instrument's sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated with respect to major depression. To control for antidepressant use, the analyses were re-run for a subsample of patients who were not on antidepressants. RESULTS One hundred fifty-three ovarian cancer patients were enrolled into the study. Only fourteen participants met SCID criteria for current MDE (9%). When evaluating all patients regardless of whether they were already being treated with antidepressants, the two-phase scoring approach with an alternate cutpoint of 6 on the PHQ-9 had the best positive predictive value (PPV=32%). Using a traditional cutpoint of 16 on the CES-D resulted in the lowest PPV (5%); using a more stringent cutpoint of 22 resulted in a slightly improved but still poor PPV, 7%. CONCLUSIONS Screening with a two-phase PHQ-9 proved best overall, and its accuracy was improved when used with patients who were not already being treated with antidepressants.
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Affiliation(s)
- Eileen H Shinn
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA.
| | - Alan Valentine
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1454, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - George Baum
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA.
| | - Cindy Carmack
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Kelly Kilgore
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Diane Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center: Mid Campus Building 1 - Unit 1727, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA.
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16
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Favez N, Cairo Notari S, Charvoz L, Notari L, Ghisletta P, Panes Ruedin B, Delaloye JF. Distress and body image disturbances in women with breast cancer in the immediate postsurgical period: The influence of attachment insecurity. J Health Psychol 2016; 21:2994-3003. [DOI: 10.1177/1359105315589802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The aim of this study was to assess, in the immediate postsurgical period, the influence of attachment avoidance and anxiety on distress and body image disturbances in women facing breast cancer. Seventy-five women participated in the study 3 weeks after surgery. Questionnaires were used to assess study variables. To predict distress and body image disturbances, we controlled for several variables known to influence adjustment to the stress of breast cancer. The results of hierarchical regression analyses show that attachment explains the outcomes above and beyond other influential variables. Insecurely attached women are especially vulnerable to the stress of the disease.
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Affiliation(s)
- Nicolas Favez
- University of Geneva, Switzerland
- Distance Learning University, Switzerland
| | | | | | | | - Paolo Ghisletta
- University of Geneva, Switzerland
- Distance Learning University, Switzerland
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17
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İzci F, İlgün AS, Fındıklı E, Özmen V. Psychiatric Symptoms and Psychosocial Problems in Patients with Breast Cancer. THE JOURNAL OF BREAST HEALTH 2016; 12:94-101. [PMID: 28331743 PMCID: PMC5351486 DOI: 10.5152/tjbh.2016.3041] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/18/2016] [Indexed: 01/01/2023]
Abstract
Cancer is a physical disease and also one of the leading clinical manifestations where psychosocial problems are prevalent. Psychosocial problems that these patients may have in the long run include anxiety, uneasiness, mourning, helplessness, fatigue, impairment of concentration, sleep disorders, mental and cognitive reservation, sexual dysfunction, infertility, psychological distress, and psychiatric disorders. Psychosocial problems have a nature of underpinning the emergence of psychological troubles. The prevalence of psychological disorders in patients with cancer range from 29% to 47%. Psychiatric disorders that are likely to be seen are severe stress disorder, adjustment disorder, depressive disorder, and other neurotic disorders. It is considered by the present author that in the event of breast cancer, potential psychiatric disorders may affect prognosis of the disease, adherance to and success of therapy, social and societal functioning, and survival rate. This paper aims to review the psychiatric symptoms and diseases that may develop in patients with breast cancer, which is one of the most frequent types of a globally common disease; i.e., cancer, as well as the impact of psychiatric symptoms on the treatment of disease.
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Affiliation(s)
- Filiz İzci
- Department of Psychiatry, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Ahmet Serkan İlgün
- Clinic of General Surgery, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Ebru Fındıklı
- Department of Psychiatry, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Vahit Özmen
- Clinic of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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18
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Herr MM, Mohile NA, van Wijngaarden E, Brown EB, Rich DQ. Antidepressant use and risk of central nervous system metastasis. J Neurooncol 2016; 129:179-87. [PMID: 27289477 DOI: 10.1007/s11060-016-2165-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/01/2016] [Indexed: 01/21/2023]
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19
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Saboonchi F, Petersson LM, Wennman-Larsen A, Alexanderson K, Vaez M. Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship. J Psychosoc Oncol 2016; 33:603-19. [PMID: 26315500 DOI: 10.1080/07347332.2015.1082165] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.
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Affiliation(s)
- Fredrik Saboonchi
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,b Department of Medicine and Public Health , Red Cross University College , Stockholm , Sweden
| | - Lena-Marie Petersson
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Agneta Wennman-Larsen
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,c Sophiahemmet University, Stockholm , Sweden
| | - Kristina Alexanderson
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Marjan Vaez
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,d Centre for Occupational and Environmental Medicine , Stockholm County Council , Stockholm , Sweden
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20
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Rice DB, Thombs BD. Risk of Bias from Inclusion of Currently Diagnosed or Treated Patients in Studies of Depression Screening Tool Accuracy: A Cross-Sectional Analysis of Recently Published Primary Studies and Meta-Analyses. PLoS One 2016; 11:e0150067. [PMID: 26919313 PMCID: PMC4769287 DOI: 10.1371/journal.pone.0150067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/08/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depression screening can improve upon usual care only if screening tools accurately identify depressed patients who would not otherwise be recognized by healthcare providers. Inclusion of patients already being treated for depression in studies of screening tool accuracy would inflate estimates of screening accuracy and yield. The present study investigated (1) the proportion of primary studies of depression screening tool accuracy that were recently published in journals listed in MEDLINE, which appropriately excluded currently diagnosed or treated patients; and (2) whether recently published meta-analyses identified the inclusion of currently diagnosed or treated patients as a potential source of bias. METHODS MEDLINE was searched from January 1, 2013 through March 27, 2015 for primary studies and meta-analyses on depression screening tool accuracy. RESULTS Only 5 of 89 (5.6%) primary studies excluded currently diagnosed or treated patients from any analyses and only 3 (3.4%) from main analyses. In 3 studies that reported the number of patients excluded due to current treatment, the number of excluded patients was more than twice the number of newly identified depression cases. None of 5 meta-analyses identified the inclusion of currently diagnosed and treated patients as a potential source of bias. CONCLUSIONS The inclusion of currently diagnosed and treated patients in studies of depression screening tool accuracy is a problem that limits the applicability of research findings for actual clinical practice. Studies are needed that evaluate the diagnostic accuracy of depression screening tools among only untreated patients who would potentially be screened in practice.
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Affiliation(s)
- Danielle B. Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
- School of Nursing, McGill University, Montréal, Québec, Canada
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21
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Sanjida S, Janda M, Kissane D, Shaw J, Pearson SA, DiSipio T, Couper J. A systematic review and meta-analysis of prescribing practices of antidepressants in cancer patients. Psychooncology 2016; 25:1002-16. [PMID: 26775715 DOI: 10.1002/pon.4048] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/19/2015] [Accepted: 11/12/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics. METHODS PubMed, Embase, Web of Science, Scopus and psychINFO were searched using keywords 'psychotropic', 'antidepressants', 'prescription' and 'cancer'. Prevalence of antidepressants, type, dose and follow-up of antidepressants and prescriber details were extracted. RESULTS Overall, 1537 articles between 1979 and February 2015 were found, 38 met the inclusion criteria and were reviewed according to PRISMA guidelines. The prevalence rate of prescribing antidepressants to cancer patients was 15.6% (95% CI = 13.3-18.3). Prescription was significantly less common in studies from Asia (7.4%; 95% CI = 4.3-12.5), more common in female (22.6%; 95% CI = 16.0-31.0) or breast cancer patients (22.6%; 95% CI = 16.0-30.9). Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressants. General practitioners and psychiatrists, followed by oncologists, were identified as the major providers of antidepressant prescriptions to cancer patients. Few studies reported the exact dose, length of time drugs were prescribed for or follow-up regimens. CONCLUSIONS There is considerable variation in the prescribing patterns of antidepressants across the world, with few studies reporting robust data on exact dose or follow-up regimens. Prospective studies that monitor antidepressant prescribing, including details of reasons for prescribing and the healthcare providers involved, dose, change in dose or type of medication and follow-up are needed to ascertain whether patients are being treated optimally and if side effects or drug-drug interactions are identified and managed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Saira Sanjida
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - David Kissane
- Department of Psychiatry, Monash University, Melbourne, Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | | | - Tracey DiSipio
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Jeremy Couper
- Department of Psychiatry, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
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22
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Gonzalez P, Nuñez A, Wang-Letzkus M, Lim JW, Flores K, Nápoles AM. Coping with breast cancer: Reflections from Chinese American, Korean American, and Mexican American women. Health Psychol 2016; 35:19-28. [PMID: 26389720 PMCID: PMC4695243 DOI: 10.1037/hea0000263] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The present study identified and compared the coping strategies of Chinese American, Korean American, and Mexican American breast cancer survivors (BCS). METHODS Six focus groups were conducted with Chinese American (n = 21), Korean American (n = 11), and Mexican American (n = 9) BCS. Interviews were audio-recorded, transcribed, and translated for thematic content analysis of coping experiences and strategies. RESULTS Women reported the use of 8 coping strategies (religious/spiritual, benefit finding, fatalism, optimism, fighting spirit, information seeking, denial, and self-distraction). Among Chinese American BCS, benefit finding was the most referenced coping strategy, whereas religious/spiritual coping was most frequently reported among Korean American and Mexican American BCS. Denial and self-distraction were the least cited strategies. CONCLUSIONS Survivors draw upon new found inner strength to successfully integrate their cancer experience into their lives. Coping models must consider the diversity of cancer survivors and the variability in coping strategies among cultural ethnic minority BCS.
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Affiliation(s)
| | - Alicia Nuñez
- Graduate School of Public Health, San Diego State University
| | | | | | - Katrina Flores
- Eunice Kennedy Shriver National Institute of Child Health & Human Development
| | - Anna María Nápoles
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
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23
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Tojal C, Costa R. Depressive symptoms and mental adjustment in women with breast cancer. Psychooncology 2015; 24:1060-5. [PMID: 25645194 DOI: 10.1002/pon.3765] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/19/2014] [Accepted: 01/03/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Depression is the most common psychological disorder observed in breast cancer patients. The purposes of this study were: to determine the prevalence of depressive symptoms among women with breast cancer; and examine the association of depressive symptoms and demographic and clinical variables as well as the association between mental adjustment to cancer and level of depressive symptoms. METHODS A total of 150 breast-cancer-diagnosed women were recruited in an Oncology Hospital. The Beck Depression Inventory and The Mini Mental Adjustment to Cancer Scale were administered. RESULTS Most of the patients had clinically significant symptoms of depression (56.5%), and there were few women without clinically significant depressive symptoms (18.4%). Both educational level (p < .001) and marital status (p = .041) are associated with depression symptoms. More depression was associated with more helplessness/hopelessness and anxious preoccupation and less fighting spirit and cognitive avoidance. CONCLUSIONS Specific interventions for women with breast cancer should be carried out in order to enhance the mental health and resilience behaviors.
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Affiliation(s)
- Catarina Tojal
- Psychology, Universidade Europeia
- Laureate International Universities, Lisboa, Portugal
| | - Raquel Costa
- Universidade Europeia
- Laureate International Universities, Lisboa, Portugal
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24
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Braun IM, Rao SR, Meyer FL, Fedele G. Patterns of psychiatric medication use among nationally representative long-term cancer survivors and controls. Cancer 2014; 121:132-8. [PMID: 25208515 DOI: 10.1002/cncr.29014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 05/30/2014] [Accepted: 06/23/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Investigations of long-term cancer survivors (LTCS) indicate that this population is not appreciably different from cancer-naive peers with respect to several neuropsychiatric domains. The current study sought to determine whether differences in psychiatric medication use might help to explain the negative findings. METHODS In a nationally representative sample, 5692 subjects were queried for cancer history, psychiatric diagnoses, and psychotropic medication use. The LTCS were defined as those individuals who were ≥5 years from diagnosis and whose cancer was in remission or cured. Odds ratios and 95% confidence intervals were obtained from multivariable logistic regression models evaluating the relationship between cancer status and use of psychiatric medications. The interaction between case/control status and psychiatric diagnoses was also tested in a logistic regression model to predict psychotropic medication use. RESULTS A total of 225 participants met the criteria for LTCS and 3953 met the criteria for cancer-naive controls (CNC). The LTCS were no more likely than CNC to carry a psychiatric diagnosis. Despite the LTCS reporting somewhat greater psychotropic medication use compared with the CNC (28.8% vs 22.3%), unadjusted and adjusted differences did not reach statistical significance, possibly due to sample size. The interaction between case/control status and carrying a psychiatric diagnosis was not found to be significantly associated with receiving a psychiatric medication. CONCLUSIONS LTCS and CNC demonstrated comparable rates of psychiatric prescription medication use. The relationship between taking a psychiatric medication and carrying a psychiatric diagnosis was not found to be significantly different between the case and control groups. These findings contribute to an emerging hypothesis that in general LTCS are not a particularly psychiatrically vulnerable group.
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Affiliation(s)
- Ilana M Braun
- Division of Adult Psychosocial Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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25
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Shapovalov Y, Zettel M, Spielman SC, Amico-Ruvio SA, Kelly EA, Sipe GO, Dickerson IM, Majewska AK, Brown EB. Fluoxetine modulates breast cancer metastasis to the brain in a murine model. BMC Cancer 2014; 14:598. [PMID: 25129445 PMCID: PMC4242485 DOI: 10.1186/1471-2407-14-598] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/06/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite advances in the treatment of primary breast tumors, the outcome of metastatic breast cancer remains dismal. Brain metastases present a particularly difficult therapeutic target due to the "sanctuary" status of the brain, with resulting inability of most chemotherapeutic agents to effectively eliminate cancer cells in the brain parenchyma. A large number of breast cancer patients receive various neuroactive drugs to combat complications of systemic anti-tumor therapies and to treat concomitant diseases. One of the most prescribed groups of neuroactive medications is anti-depressants, in particular selective serotonin reuptake inhibitors (SSRIs). Since SSRIs have profound effects on the brain, it is possible that their use in breast cancer patients could affect the development of brain metastases. This would provide important insight into the mechanisms underlying brain metastasis. Surprisingly, this possibility has been poorly explored. METHODS We studied the effect of fluoxetine, an SSRI, on the development of brain metastatic breast cancer using MDA-MB-231BR cells in a mouse model. RESULTS The data demonstrate that fluoxetine treatment increases the number of brain metastases, an effect accompanied by elevated permeability of the blood-brain barrier, pro-inflammatory changes in the brain, and glial activation. This suggests a possible role of brain-resident immune cells and glia in promoting increased development of brain metastases. CONCLUSION Our results offer experimental evidence that neuroactive substances may influence the pathogenesis of brain metastatic disease. This provides a starting point for further investigations into possible mechanisms of interaction between various neuroactive drugs, tumor cells, and the brain microenvironment, which may lead to the discovery of compounds that inhibit metastasis to the brain.
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Affiliation(s)
- Yuriy Shapovalov
- />Department of Neurobiology and Anatomy, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 603, Rochester, NY 14642 USA
- />Department of Biomedical Engineering, University of Rochester, Box 270168, Rochester, NY 14627 USA
| | - Martha Zettel
- />Department of Neurobiology and Anatomy, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 603, Rochester, NY 14642 USA
| | - Sara C Spielman
- />Department of Neurobiology and Anatomy, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 603, Rochester, NY 14642 USA
| | - Stacy A Amico-Ruvio
- />Department of Neurobiology and Anatomy, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 603, Rochester, NY 14642 USA
| | - Emily A Kelly
- />Department of Neurobiology and Anatomy, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 603, Rochester, NY 14642 USA
| | - Grayson O Sipe
- />Department of Neurobiology and Anatomy, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 603, Rochester, NY 14642 USA
| | - Ian M Dickerson
- />Department of Neurobiology and Anatomy, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 603, Rochester, NY 14642 USA
| | - Ania K Majewska
- />Department of Neurobiology and Anatomy, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 603, Rochester, NY 14642 USA
| | - Edward B Brown
- />Department of Biomedical Engineering, University of Rochester, Box 270168, Rochester, NY 14627 USA
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26
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Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: patterns of transiency and severity of the distress response. Eur J Oncol Nurs 2014; 18:598-604. [PMID: 24997517 DOI: 10.1016/j.ejon.2014.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/09/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress. AIM To examine the transiency of distress response in breast cancer patients by investigating the changes in clinical caseness of depression and anxiety during one year following surgery. METHODS Data on the Hospital Anxiety and Depression Scale from a cohort of 715 women with breast cancer on three assessments within one year following breast surgery were subjected to Generalized Estimation Equation Analysis, McNemar's test, and logistic regression. RESULTS There was a significant decrease in the proportions of anxiety cases from baseline (37.7%) to 4 months (26.7%) but no significant change from 4 to 12 months. Caseness in depression significantly increased from baseline (18.5%) to 4 months (21.5%) but decreased to 15.3% at 12 months. Only experience of major adverse life events contributed to 12 months caseness of anxiety and depression beyond baseline caseness. DISCUSSION The average decrease in caseness of anxiety and depression a year following surgery lends support to the view of distress as a transient non-pathological response. A subgroup of patients, however, displayed enduring or recurrent severe distress indicating the presence of potential disorder. The findings emphasize the importance of screening and follow up monitoring of distress.
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27
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Janberidze E, Hjermstad MJ, Brunelli C, Loge JH, Lie HC, Kaasa S, Knudsen AK. The use of antidepressants in patients with advanced cancer-results from an international multicentre study. Psychooncology 2014; 23:1096-102. [DOI: 10.1002/pon.3541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Elene Janberidze
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Oncology, St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Regional Centre for Excellence in Palliative Care, Department of Oncology; Oslo University Hospital; Oslo Norway
| | - Cinzia Brunelli
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Palliative Care, Pain Therapy and Rehabilitation Unit; Fondazione IRCCS Istituto Nazionale Tumori Milano; Milano Italy
| | - Jon Håvard Loge
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- National Resource Centre for Late Effects After Cancer Treatment; Oslo University Hospital; Oslo Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine; University of Oslo; Oslo Norway
| | - Hanne Cathrine Lie
- National Resource Centre for Late Effects After Cancer Treatment; Oslo University Hospital; Oslo Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine; University of Oslo; Oslo Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Oncology, St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Oncology, St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
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Yoo GJ, Levine EG, Pasick R. Breast cancer and coping among women of color: a systematic review of the literature. Support Care Cancer 2014; 22:811-24. [PMID: 24389825 DOI: 10.1007/s00520-013-2057-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 11/12/2013] [Indexed: 10/25/2022]
Abstract
Breast cancer is the most commonly diagnosed form of cancer for women regardless of race/ethnicity. Women of color are diagnosed at later stages and experience greater mortality than their White counterparts. However, there has been comparatively little research on coping with breast among racial/ethnic minorities at time of diagnosis, during treatment, or in the course of survivorship. This is despite the fact that research has repeatedly shown that distress can impact disease progression and survival. The questions asked of this systematic literature review include: (1) What is known about coping with breast cancer among major racial/ethnic groups? (2) What are the strengths and gaps in research to date? Over 120 peer-reviewed published studies (1980-2012) were reviewed. A total of 33 met criteria for inclusion including 15 quantitative, 17 qualitative, and 1 mixed methods study. The majority of studies were small sample cross-sectional studies. Only five studies were longitudinal, and two randomized-controlled intervention trials sought to improve coping among survivors. The most common topic in both quantitative and qualitative studies was spirituality and coping among African American breast cancer patients. Thirteen studies included Latinas only or in combination with other groups. Only one quantitative and one qualitative study solely addressed the Asian American population exploring coping and adjustment. In the course of this systematic literature review, we elucidate what is known about coping with breast cancer among racial/ethnic minority women and identify priorities for future research.
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Affiliation(s)
- Grace J Yoo
- Asian American Studies Department, Cancer Disparities Research Group, San Francisco State University, 1600 Holloway, EP 103, San Francisco, CA, 94132, USA,
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29
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Davis C, Rust C, Choi S. A pilot randomized study of skills training for African American cancer survivors. SOCIAL WORK IN PUBLIC HEALTH 2014; 29:549-560. [PMID: 25144697 DOI: 10.1080/19371918.2014.892865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/06/2014] [Indexed: 06/03/2023]
Abstract
This study tested the efficacy of a psychosocial group intervention for African American breast cancer survivors based on the Cancer Survival Toolbox with the specific aim of decreasing distress and improving aspects of psychosocial functioning and quality of life. This pilot study utilized a randomized, repeated measures, experimental design. The study sample (N = 71) consisted of an intervention group (n = 23) of cancer survival skills training for 6 weeks and a control group (n = 48). The study could not confirm that cancer skills training in a psychoeducational group setting had a positive effect on decreasing stress or improving aspects of psychosocial functioning and quality of life.
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Affiliation(s)
- Cindy Davis
- a College of Social Work, University of Tennessee , Nashville , Tennessee , USA
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Cohen M. The association of cancer patients' emotional suppression and their self-rating of psychological distress on short screening tools. Behav Med 2013; 39:29-35. [PMID: 23668909 DOI: 10.1080/08964289.2012.731440] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Emotional suppression of negative emotions was previously reported to be related to higher psychological distress in cancer patients. The possible effect of elevated levels of emotional suppression on the use of instruments for screening for distress in cancer patients has not been studied. To assess the relation of cancer patients' emotional suppression to their self-rating on the Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS). Two hundred forty one cancer patients, aged 21-87 years, completed the DT, the HADS and the Courtauld Emotional Control scale (CEC). Participants reported moderated levels of psychological distress but high mean levels of emotional suppression. Older age and higher levels of education and income predicted lower score on the DT and the HADS. Higher emotional suppression predicted lower self-reported psychological distress on the DT, the total HADS score and the HADS depression subscale, but not on the anxiety subscale. Emotion-regulation style may affect cancer patients' self-rating on the screening instruments, hence, reduce their accurate identification of distressed patients.
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Affiliation(s)
- Miri Cohen
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 31905, Israel.
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31
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Gamper EM, Groenvold M, Petersen MA, Young T, Costantini A, Aaronson N, Giesinger JM, Meraner V, Kemmler G, Holzner B. The EORTC emotional functioning computerized adaptive test: phases I-III of a cross-cultural item bank development. Psychooncology 2013; 23:397-403. [PMID: 24217943 PMCID: PMC3974657 DOI: 10.1002/pon.3427] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/27/2013] [Accepted: 09/12/2013] [Indexed: 11/29/2022]
Abstract
Background The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group is currently developing computerized adaptive testing measures for the Quality of Life Questionnaire Core-30 (QLQ-C30) scales. The work presented here describes the development of an EORTC item bank for emotional functioning (EF), which is one of the core domains of the QLQ-C30. Methods According to the EORTC guidelines on module development, the development of the EF item bank comprised four phases, of which the phases I–III are reported in the present paper. Phase I involved defining the theoretical framework for the EF item bank and a literature search. Phase II included pre-defined item selection steps and a multi-stage expert review process. In phase III, feedback from cancer patients from different countries was obtained. Results On the basis of literature search in phase I, a list of 1750 items was generated. These were reviewed and further developed in phase II with a focus on relevance, redundancy, clarity, and difficulty. The development and selection steps led to a preliminary list of 41 items. In phase III, patient interviews (N = 41; Austria, Denmark, Italy, and the UK) were conducted with the preliminary item list, resulting in some minor changes to item wording. The final list comprised 38 items. Discussion The phases I–III of the developmental process have resulted in an EF item list that was well accepted by patients in several countries. The items will be subjected to larger-scale field testing in order to establish their psychometric characteristics and their fit to an item response theory model.
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Affiliation(s)
- Eva-Maria Gamper
- Department for Psychiatry and Psychotherapy, University Clinic for Biological Psychiatry, Anichstraße 35, Innsbruck, Austria
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Mols F, Husson O, Roukema JA, van de Poll-Franse LV. Depressive symptoms are a risk factor for all-cause mortality: results from a prospective population-based study among 3,080 cancer survivors from the PROFILES registry. J Cancer Surviv 2013; 7:484-92. [PMID: 23677523 DOI: 10.1007/s11764-013-0286-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/11/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND The goal of this large prospective population-based study was to examine the association between depressive symptoms and all-cause mortality among cancer survivors up to 10 years post-diagnosis. METHODS All currently alive individuals diagnosed with endometrial or colorectal cancer (CRC) between 1998 and 2007 or with lymphoma or multiple myeloma between 1999 and 2008, as registered in the Eindhoven Cancer Registry, received a questionnaire on depressive symptoms (Hospital Anxiety and Depression Scale (HADS)) in 2008 or 2009, respectively; 69 % (n = 3,080) responded. Survival status was obtained from the Central Bureau for Genealogy. RESULTS Clinically elevated levels of depressive symptoms (HADS cutoff value ≥8) were more prevalent in those who died compared to those who survived (38 vs. 19 %, respectively; p < 0.0001). This was also evident across different types of cancer. After adjustment for independent predictors of all-cause mortality, 1-10-year survivors with depressive symptoms had an increased risk of death (hazard ratio (HR) 2.07; 95 % confidence interval (CI) 1.56-2.74; p < 0.0001), and this was also found among 1-2-year survivors (HR, 2.20; 95 % CI, 1.41-3.43; p < 0.001). Sub-analyses among CRC survivors gave the opportunity to adjust for metastasis and showed that depressive symptoms among 1-10-year CRC survivors and 1-2-year CRC survivors increased the risk of death (HR, 1.88; 95 % CI, 1.24-2.83; p < 0.01 and HR, 2.55; 95 % CI, 1.44-4.51; p < 0.001, respectively). CONCLUSIONS This study showed that patients with depressive symptoms had twofold risk for all-cause mortality, even after adjustment for major clinical predictors. IMPLICATIONS FOR CANCER SURVIVORS Paying more attention to the recognition and treatment of depressive symptoms seems warranted since depressive symptoms are often underdiagnosed and undertreated in cancer patients.
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Affiliation(s)
- Floortje Mols
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands.
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33
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Saboonchi F, Wennman-Larsen A, Alexanderson K, Petersson LM. Examination of the construct validity of the Swedish version of Hospital Anxiety and Depression Scale in breast cancer patients. Qual Life Res 2013; 22:2849-56. [DOI: 10.1007/s11136-013-0407-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2013] [Indexed: 01/06/2023]
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Caccia S, Pasina L, Nobili A. How pre-marketing data can be used for predicting the weight of drug interactions in clinical practice. Eur J Intern Med 2013; 24:217-21. [PMID: 23279878 DOI: 10.1016/j.ejim.2012.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 12/06/2012] [Indexed: 11/15/2022]
Abstract
Unexpected drug interactions have led to the withdrawal of many drugs, raising concern about the gap between what is known at the time of approval and the risk of serious effects in the longer term, particularly in high-risk populations generally excluded from drug development. This is because the majority of drug interaction studies are done using in vitro methods, or in healthy young volunteers who may not reflect the complexity of patients, and the settings in which the drug will be used in clinical practice. Pre-marketing interaction studies should therefore be designed to make information easily accessible and clinically transferable. They should be adequate in terms of sample size, population, comorbidity, phenotyping and/or genotyping, end-points and outcome measures, and conducted in conditions of dose, route and timing of co-administration that reproduce the proposed therapeutic indications of the new drug. Although young volunteers have the advantage of minimizing some confounding effects introduced by diseases or polypharmacy, patients drawn from populations for whom the drug is intended would be more relevant and accurate, providing the studies are feasible and safe.
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Affiliation(s)
- Silvio Caccia
- Laboratory for Quality Assessment of Geriatric Therapies Services, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Walker J, Holm Hansen C, Martin P, Sawhney A, Thekkumpurath P, Beale C, Symeonides S, Wall L, Murray G, Sharpe M. Prevalence of depression in adults with cancer: a systematic review. Ann Oncol 2013; 24:895-900. [PMID: 23175625 DOI: 10.1093/annonc/mds575] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Walker
- Psychological Medicine Research Department of Psychiatry, University of Oxford, Oxford, UK.
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Goldsbury D, Harris M, Pascoe S, Barton M, Olver I, Spigelman A, Beilby J, Veitch C, Weller D, O'Connell DL. The varying role of the GP in the pathway between colonoscopy and surgery for colorectal cancer: a retrospective cohort study. BMJ Open 2013; 3:bmjopen-2012-002325. [PMID: 23471608 PMCID: PMC3612745 DOI: 10.1136/bmjopen-2012-002325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To describe general practitioner (GP) involvement in the treatment referral pathway for colorectal cancer (CRC) patients. DESIGN A retrospective cohort analysis of linked data. SETTING A population-based sample of CRC patients diagnosed from August 2004 to December 2007 in New South Wales, Australia, using the 45 and Up Study, cancer registry diagnosis records, inpatient hospital records and Medicare claims records. PARTICIPANTS 407 CRC patients who had a colonoscopy followed by surgery. PRIMARY OUTCOME MEASURES Patterns of GP consultations between colonoscopy and surgery (ie, between diagnosis and treatment). We investigated whether consulting a GP presurgery was associated with time to surgery, postsurgical GP consultations or rectal cancer cases having surgery in a centre with radiotherapy facilities. RESULTS Of the 407 patients, 43% (n=175) had at least one GP consultation between colonoscopy and surgery. The median time from colonoscopy to surgery was 27 days for those with an intervening GP consultation and 15 days for those without the consultation. 55% (n=223) had a GP consultation up to 30 days postsurgery; it was more common in cases of patients who consulted a GP presurgery than for those who did not (65% and 47%, respectively, adjusted OR 2.71, 95% CI 1.50 to 4.89, p=0.001). Of the 142 rectal cancer cases, 23% (n=33) had their surgery in a centre with radiotherapy facilities, with no difference between those who did and did not consult a GP presurgery (21% and 25% respectively, adjusted OR 0.84, 95% CI 0.27 to 2.63, p=0.76). CONCLUSIONS Consulting a GP between colonoscopy and surgery was associated with a longer interval between diagnosis and treatment, and with further GP consultations postsurgery, but for rectal cancer cases it was not associated with treatment in a centre with radiotherapy facilities. GPs might require a more defined and systematic approach to CRC management.
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Affiliation(s)
- David Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Mark Harris
- UNSW Research Centre for Primary Health Care and Equity, Sydney, New South Wales, Australia
| | - Shane Pascoe
- UNSW Research Centre for Primary Health Care and Equity, Sydney, New South Wales, Australia
| | - Michael Barton
- Liverpool Health Service, Collaboration for Cancer Outcomes Research & Evaluation, Sydney, New South Wales, Australia
| | - Ian Olver
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Allan Spigelman
- UNSW St Vincent's Clinical School, Sydney, New South Wales, Australia
| | - Justin Beilby
- Faculty of Health Sciences, University of Adelaide, Adelaide, New South Wales, Australia
| | - Craig Veitch
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - David Weller
- Centre for Population Health Services, University of Edinburgh,Edinburgh, Scotland
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
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Davis C, Rust C, Darby K. Coping skills among African-American breast cancer survivors. SOCIAL WORK IN HEALTH CARE 2013; 52:434-448. [PMID: 23701577 DOI: 10.1080/00981389.2012.742482] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Women with a diagnosis of breast cancer, particularly African-American women, face multiple barriers to survival. Although research exists regarding the unique barriers faced by African-American breast cancer survivors, there has been little research into the various coping needs or coping strategies used among African-American women. The purpose of this article is to provide information from an exploratory study of data investigating the coping skills of 30 African-American women diagnosed and treated for breast cancer. Quantitative data was collected via a self-report questionnaire based on the pretest of the Breast Cancer Survivors Toolbox. The study sample was evaluated to determine overall coping skills followed by an analysis of individual categories of coping skills (e.g., communication, information seeking, negotiating, social support systems, cultural norms). Although limited by the non-random sampling technique and self-report, the results of the study support the need for further research regarding the use of interventions and strategies tailored to improve coping skills used by this population.
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Affiliation(s)
- Cindy Davis
- College of Social Work, University of Tennessee, Knoxville, Tennessee, USA.
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38
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Clinical variables correlated with coping patterns in a sample of Egyptian female patients with breast cancer. MIDDLE EAST CURRENT PSYCHIATRY 2012. [DOI: 10.1097/01.xme.0000415418.77067.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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39
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Antidepressants to cancer patients during the last year of life-a population-based study. Psychooncology 2012; 22:506-14. [DOI: 10.1002/pon.3059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/31/2012] [Accepted: 02/06/2012] [Indexed: 11/07/2022]
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40
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Pinto AC, de Azambuja E. Improving quality of life after breast cancer: Dealing with symptoms. Maturitas 2011; 70:343-8. [DOI: 10.1016/j.maturitas.2011.09.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 09/22/2011] [Indexed: 11/16/2022]
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Meijer A, Roseman M, Milette K, Coyne JC, Stefanek ME, Ziegelstein RC, Arthurs E, Leavens A, Palmer SC, Stewart DE, de Jonge P, Thombs BD. Depression screening and patient outcomes in cancer: a systematic review. PLoS One 2011; 6:e27181. [PMID: 22110613 PMCID: PMC3215716 DOI: 10.1371/journal.pone.0027181] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/12/2011] [Indexed: 01/10/2023] Open
Abstract
Background Several practice guidelines recommend screening for depression in cancer care, but no systematic reviews have examined whether there is evidence that depression screening benefits cancer patients. The objective was to evaluate the potential benefits of depression screening in cancer patients by assessing the (1) accuracy of depression screening tools; (2) effectiveness of depression treatment; and (3) effect of depression screening, either alone or in the context of comprehensive depression care, on depression outcomes. Methods Data sources were CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO and SCOPUS databases through January 24, 2011; manual journal searches; reference lists; citation tracking; trial registry reviews. Articles on cancer patients were included if they (1) compared a depression screening instrument to a valid criterion for major depressive disorder (MDD); (2) compared depression treatment with placebo or usual care in a randomized controlled trial (RCT); (3) assessed the effect of screening on depression outcomes in a RCT. Results There were 19 studies of screening accuracy, 1 MDD treatment RCT, but no RCTs that investigated effects of screening on depression outcomes. Screening accuracy studies generally had small sample sizes (median = 17 depression cases) and used exploratory methods to set sample-specific cutoff scores that varied substantially across studies. A nurse-delivered intervention for MDD reduced depressive symptoms moderately (effect size = 0.37). Conclusions The one treatment study reviewed reported modest improvement in depressive symptoms, but no evidence was found on whether or not depression screening in cancer patients, either alone or in the context of optimal depression care, improves depression outcomes compared to usual care. Depression screening in cancer should be evaluated in a RCT in which all patients identified as depressed, either through screening or via physician recognition and referral in a control group, have access to comprehensive depression care.
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Affiliation(s)
- Anna Meijer
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michelle Roseman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Quebéc, Canada
| | - Katherine Milette
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebéc, Canada
| | - James C. Coyne
- Behavioral Oncology Program, Abramson Cancer Center and Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
- Health Psychology Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michael E. Stefanek
- Office of Research Administration, Indiana University, Bloomington, Indiana, United States of America
| | - Roy C. Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Erin Arthurs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Allison Leavens
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Steven C. Palmer
- LIVESTRONG Survivorship Center of Excellence, Cancer Control, and Outcomes, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Donna E. Stewart
- Women's Health Program, University Health Network, Toronto, Ontario, Canada
- Departments of Psychiatry, Obstetrics and Gynaecology, Family and Community Medicine, Medicine, Surgery and Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Peter de Jonge
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Quebéc, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Quebéc, Canada
- Department of Medicine, McGill University, Montréal, Quebéc, Canada
- * E-mail:
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Palmer SC, Taggi A, Demichele A, Coyne JC. Is screening effective in detecting untreated psychiatric disorders among newly diagnosed breast cancer patients? Cancer 2011; 118:2735-43. [PMID: 21989608 DOI: 10.1002/cncr.26603] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 07/25/2011] [Accepted: 07/27/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND A key purpose of routine distress screening is to ensure that cancer patients receive appropriate mental health care. Most studies validating screening instruments overestimate the effectiveness of screening by not differentiating between patients with untreated disorders and patients who are already being treated. This study adopts the novel strategy of evaluating the effectiveness of screening after correcting for disorder for which treatment is already being provided. METHODS A total of 437 recently diagnosed breast cancer patients received in-clinic distress screening and telephone-based psychiatric interviews. Analyses were conducted using receipt of psychotropic medication for mental health difficulties in the context of a psychiatric disorder as a proxy for identification and treatment. RESULTS Rates of elevated distress (33%), major depressive disorder (8%), minor depression (6%), dysthymia (2%), or generalized anxiety disorder (3%) were similar to those in other samples. Thirty-six percent of patients received psychotropic medication around the time of cancer diagnosis, including 64% of those with a current psychiatric diagnosis. Although 39% of patients with elevated distress had a psychiatric disorder, the positive predictive value of screening fell to 15% for an untreated psychiatric disorder and 6% had untreated depression. CONCLUSION Given the high rates of existing treatment, screening may not be efficient for identifying untreated disorder. Almost two-thirds of patients with treated disorders remain symptomatic. Use of symptom scales might reasonably be expanded to surveillance of treatment response or ruling out disorder. Substantial resources would likely be required to coordinate or manage psychiatric care among patients, as would a willingness to intervene in existing relationships with other providers.
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Affiliation(s)
- Steven C Palmer
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Qiu J, Yang M, Chen W, Gao X, Liu S, Shi S, Xie B. Prevalence and correlates of major depressive disorder in breast cancer survivors in Shanghai, China. Psychooncology 2011; 21:1331-7. [PMID: 21983854 DOI: 10.1002/pon.2075] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our objective is to measure the prevalence and correlates of major depressive disorder (MDD) among Chinese breast cancer patients after surgery, which is essential for analyzing the service needs and allocating mental health resources. METHODS A total of 505 patients were randomly recruited from 1580 post-surgery breast cancer outpatients from one tertiary hospital in Shanghai, and the Mini International Neuropsychiatric Interview was used to assess 1-month prevalence of MDD according to the Diagnostic and Statistical Manual Fourth Edition (DSM-IV) in a two-phase design. RESULTS The adjusted 1-month prevalence of MDD was 20.59% (95% CI 17.06-23.82). The risk for depression within the first year was two times as higher as that in more than 1 year. Patients within 1 year after surgery, with lower income, disrupted marriage or being single, recurrent breast cancer and psychiatric history were more likely to have MDD. There was no significant association between depression and disease stage, type of surgery, receptor status and cancer treatment. CONCLUSIONS Depression is quite common in Chinese breast cancer patients and survivors. A more sensitive and responsive mental health service is recommended for this population.
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Affiliation(s)
- Jianyin Qiu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Henderson VP, Clemow L, Massion AO, Hurley TG, Druker S, Hébert JR. The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial. Breast Cancer Res Treat 2011; 131:99-109. [PMID: 21901389 DOI: 10.1007/s10549-011-1738-1] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 08/09/2011] [Indexed: 11/29/2022]
Abstract
The aim of this study was determine the effectiveness of a mindfulness-based stress-reduction (MBSR) program on quality of life (QOL) and psychosocial outcomes in women with early-stage breast cancer, using a three-arm randomized controlled clinical trial (RCT). This RCT consisting of 172 women, aged 20-65 with stage I or II breast cancer consisted of the 8-week MBSR, which was compared to a nutrition education program (NEP) and usual supportive care (UC). Follow-up was performed at three post-intervention points: 4 months, 1, and 2 years. Standardized, validated self-administered questionnaires were adopted to assess psychosocial variables. Statistical analysis included descriptive and regression analyses incorporating both intention-to-treat and post hoc multivariable approaches of the 163 women with complete data at baseline, those who were randomized to MBSR experienced a significant improvement in the primary measures of QOL and coping outcomes compared to the NEP, UC, or both, including the spirituality subscale of the FACT-B as well as dealing with illness scale increases in active behavioral coping and active cognitive coping. Secondary outcome improvements resulting in significant between-group contrasts favoring the MBSR group at 4 months included meaningfulness, depression, paranoid ideation, hostility, anxiety, unhappiness, and emotional control. Results tended to decline at 12 months and even more at 24 months, though at all times, they were as robust in women with lower expectation of effect as in those with higher expectation. The MBSR intervention appears to benefit psychosocial adjustment in cancer patients, over and above the effects of usual care or a credible control condition. The universality of effects across levels of expectation indicates a potential to utilize this stress reduction approach as complementary therapy in oncologic practice.
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Affiliation(s)
- Virginia P Henderson
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, 3209 Colonial Drive, Columbia, SC 29203, USA
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Thombs BD, Arthurs E, El-Baalbaki G, Meijer A, Ziegelstein RC, Steele RJ. Risk of bias from inclusion of patients who already have diagnosis of or are undergoing treatment for depression in diagnostic accuracy studies of screening tools for depression: systematic review. BMJ 2011; 343:d4825. [PMID: 21852353 PMCID: PMC3191850 DOI: 10.1136/bmj.d4825] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2011] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate the proportion of original studies included in systematic reviews and meta-analyses on the diagnostic accuracy of screening tools for depression that appropriately exclude patients who already have a diagnosis of or are receiving treatment for depression and to determine whether these systematic reviews and meta-analyses evaluate possible bias from the inclusion of such patients. DESIGN Systematic review. DATA SOURCES Medline, PsycINFO, CINAHL, Embase, ISI, SCOPUS, and Cochrane databases were searched from 1 January 2005 to 29 October 2009. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews and meta-analyses in any language that reported on the diagnostic accuracy of screening tools for depression. RESULTS Only eight of 197 (4%) unique publications from 17 systematic reviews and meta-analyses specifically excluded patients who already had a diagnosis of or were receiving treatment for depression. No systematic reviews or meta-analyses commented on possible bias from the inclusion of such patients, even though 10 reviews used quality assessment tools with items to rate risk of bias from composition of the sample of patients. CONCLUSIONS Studies of the accuracy of screening tools for depression rarely exclude patients who already have a diagnosis of or are receiving treatment for depression, a potential bias that is not evaluated in systematic reviews and meta-analyses. This could result in inflated estimates of accuracy on which clinical practice and preventive care guidelines are often based, a problem that takes on greater importance as the rate of diagnosed and treated depression in the population increases.
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Affiliation(s)
- Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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Palmer SC, van Scheppingen C, Coyne JC. Clinical Trial Did Not Demonstrate Benefits of Screening Patients With Cancer for Distress. J Clin Oncol 2011; 29:e277-8; author reply e279-80. [PMID: 21300932 DOI: 10.1200/jco.2010.34.1206] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Luutonen S, Vahlberg T, Eloranta S, Hyväri H, Salminen E. Breast cancer patients receiving postoperative radiotherapy: distress, depressive symptoms and unmet needs of psychosocial support. Radiother Oncol 2011; 100:299-303. [PMID: 21316782 DOI: 10.1016/j.radonc.2011.01.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 01/14/2011] [Accepted: 01/14/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The diagnosis and treatment of breast cancer can cause considerable psychological consequences, which may remain unrecognized and untreated. In this study, the prevalence of depressive symptoms and distress, and unmet needs for psychosocial support were assessed among breast cancer patients receiving postoperative radiotherapy. MATERIAL AND METHODS Out of 389 consecutive patients, 276 responded and comprised the final study group. Depressive symptoms were assessed with the Beck Depression Inventory. Distress was measured with the Distress Thermometer. Hospital records of the patients were examined for additional information. RESULTS Nearly one third of patients (32.1%) displayed depressive symptoms, and more than a quarter of patients (28.4%) experienced distress. Younger age (p=0.001) and negative hormone receptor status (p=0.008) were independent factors associated with distress. One quarter of the patients expressed an unmet need for psychosocial support, which was independently associated with depressive symptoms and/or distress (p=0.001) and younger age (p=0.006). CONCLUSIONS During radiotherapy for breast cancer, the staff should have awareness of the higher risk of depression and distress in their patients and should consider screening tools to recognise distress and depressive symptoms. Special attention should be paid to younger patients.
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Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 2011; 12:160-74. [PMID: 21251875 DOI: 10.1016/s1470-2045(11)70002-x] [Citation(s) in RCA: 1504] [Impact Index Per Article: 107.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Substantial uncertainty exists about prevalence of mood disorders in patients with cancer, including those in oncological, haematological, and palliative-care settings. We aimed to quantitatively summarise the prevalence of depression, anxiety, and adjustments disorders in these settings. METHODS We searched Medline, PsycINFO, Embase, and Web of Knowledge for studies that examined well-defined depression, anxiety, and adjustment disorder in adults with cancer in oncological, haematological, and palliative-care settings. We restricted studies to those using psychiatric interviews. Studies were reviewed in accordance with PRISMA guidelines and a proportion meta-analysis was done. FINDINGS We identified 24 studies with 4007 individuals across seven countries in palliative-care settings. Meta-analytical pooled prevalence of depression defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria was 16·5% (95% CI 13·1-20·3), 14·3% (11·1-17·9) for DSM-defined major depression, and 9·6% (3·6-18·1) for DSM-defined minor depression. Prevalence of adjustment disorder alone was 15·4% (10·1-21·6) and of anxiety disorders 9·8% (6·8-13·2). Prevalence of all types of depression combined was of 24·6% (17·5-32·4), depression or adjustment disorder 24·7% (20·8-28·8), and all types of mood disorder 29·0% (10·1-52·9). We identified 70 studies with 10,071 individuals across 14 countries in oncological and haematological settings. Prevalence of depression by DSM or ICD criteria was 16·3% (13·4-19·5); for DSM-defined major depression it was 14·9% (12·2-17·7) and for DSM-defined minor depression 19·2% (9·1-31·9). Prevalence of adjustment disorder was 19·4% (14·5-24·8), anxiety 10·3% (5·1-17·0), and dysthymia 2·7% (1·7-4·0). Combination diagnoses were common; all types of depression occurred in 20·7% (12·9-29·8) of patients, depression or adjustment disorder in 31·6% (25·0-38·7), and any mood disorder in 38·2% (28·4-48·6). There were few consistent correlates of depression: there was no effect of age, sex, or clinical setting and inadequate data to examine cancer type and illness duration. INTERPRETATION Interview-defined depression and anxiety is less common in patients with cancer than previously thought, although some combination of mood disorders occurs in 30-40% of patients in hospital settings without a significant difference between palliative-care and non-palliative-care settings. Clinicians should remain vigilant for mood complications, not just depression. FUNDING None.
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Affiliation(s)
- Alex J Mitchell
- Leicester General Hospital, Leicester Partnership Trust, Leicester, UK.
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Ezquiaga Terrazas E, García López A, Huerta Ramírez R, Pico Rada A. [Prevalence of depression in primary care according to the methodology of the studies]. Med Clin (Barc) 2010; 137:612-5. [PMID: 20934195 DOI: 10.1016/j.medcli.2010.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 05/21/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
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Munir F, Burrows J, Yarker J, Kalawsky K, Bains M. Women’s perceptions of chemotherapy-induced cognitive side affects on work ability: a focus group study. J Clin Nurs 2010; 19:1362-70. [DOI: 10.1111/j.1365-2702.2009.03006.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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