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McGrady ME, Ketterl TG, Webster RT, Schwartz LE, Brock MY, Szulczewski L, Burke M, Hommel KA, Pai ALH, Mara CA, Steele AC, Regan GG, Norris RE. Feasibility pilot trial of a tailored medication adherence-promotion intervention for adolescents and young adults with cancer: Study design and protocol. Contemp Clin Trials 2024; 139:107483. [PMID: 38431133 PMCID: PMC10960689 DOI: 10.1016/j.cct.2024.107483] [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] [Received: 12/20/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Medication non-adherence is common among adolescents and young adults (AYAs) with cancer and associated with poor health outcomes. AYAs with cancer endorse multiple barriers to adherence that differ across individuals, suggesting that tailoring intervention content to an AYA's specific barriers may have the potential to improve adherence. The purpose of this manuscript is to report on ORBIT-guided Phase I design efforts to create the first tailored adherence-promotion intervention for AYAs with cancer and the study protocol for the ongoing Phase II pilot feasibility trial. METHODS Phase I design included qualitative interviews (n = 15 AYAs) to understand patient preferences for adherence-promotion care, development and refinement of a best-worst scaling exercise barriers tool (n = 5 AYAs), and development of intervention modules and a tailoring algorithm. In the ongoing Phase II pilot feasibility trial, AYAs (ages 15-24 years) with cancer currently taking oral chemotherapy or prophylactic medication will be recruited from three children's hospitals. Feasibility, acceptability, and usability will be assessed and these outcomes along with data on medication adherence will be used to inform the next phases of intervention development and testing. CONCLUSIONS If promising, this program of research ultimately has the potential to equip clinicians with additional strategies for supporting adherence among AYAs with cancer. NCT05706610.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Tyler G Ketterl
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Rachel Tillery Webster
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Laura E Schwartz
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Margaret Y Brock
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lauren Szulczewski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amii C Steele
- Division of Pediatric Psychology and Neuropsychology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Gillian G Regan
- Division of Pediatric Psychology and Neuropsychology, Levine Children's Hospital at Atrium Health, Charlotte, NC, USA
| | - Robin E Norris
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Aquil A, Mouallif M, Elgot A. Identification and management of mental health distress in Moroccan patients with cancer: Strategies adopted by oncology nurses and barriers to practice. Cancer Rep (Hoboken) 2024; 7:e1985. [PMID: 38627905 PMCID: PMC11021662 DOI: 10.1002/cnr2.1985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Adressing mental distress among cancer patients presents a substantial challenge in the delivery of oncology care. AIMS This present study aims to explore the nursing strategies for identifying and managing distress in cancer patients as well as the concomitant barriers that prevent them from achieving this task. METHODS This qualitative study is based on a semi-structured interview with 25 practicing nurses in oncology. RESULTS Strategies used by nurses to identify mental distress in their patients include: receiving information, mobilizing interpersonal skills, and identifying causes of distress. When asked about the barriers that hinder the practice of identifying and responding to patients' distress, nurses reported facing several barriers that can be classified into three categories: health care system-related barriers, patient-related barriers, and nurse-related barriers. CONCLUSION Oncology nurses should benefit from specific training on the systematic assessment of mental distress in cancer patients, in order to improve the overall management of oncology patients.
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Affiliation(s)
- Amina Aquil
- Laboratory of Health Sciences and TechnologyHigher Institute of Health Sciences, Hassan First University of SettatSettatMorocco
| | - Mustapha Mouallif
- Laboratory of Health Sciences and TechnologyHigher Institute of Health Sciences, Hassan First University of SettatSettatMorocco
| | - Abdeljalil Elgot
- Laboratory of Health Sciences and TechnologyHigher Institute of Health Sciences, Hassan First University of SettatSettatMorocco
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Griesemer I, Gottfredson NC, Thatcher K, Rini C, Birken SA, Kothari A, John R, Guerrab F, Clodfelter T, Lightfoot AF. Intervening in the Cancer Care System: An Analysis of Equity-Focused Nurse Navigation and Patient-Reported Outcomes. Health Promot Pract 2023:15248399231213042. [PMID: 38050901 DOI: 10.1177/15248399231213042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Nurse navigation can improve quality of cancer care and reduce racial disparities in care outcomes. Addressing persistent structurally-rooted disparities requires research on strategies that support patients by prompting structural changes to systems of care. We applied a novel conceptualization of social support to an analysis of racial equity-focused navigation and patient-reported outcomes. METHOD We applied an antiracism lens to create a theory-informed definition of system-facing social support: intervening in a care system on a patient's behalf. Participants were adults with early-stage breast or lung cancer, who racially identified as Black or White, and received specialized nurse navigation (n = 155). We coded navigators' clinical notes (n = 3,251) to identify instances of system-facing support. We then estimated models to examine system-facing support in relation to race, perceived racism in health care settings, and mental health. RESULTS Twelve percent of navigators' clinical notes documented system-facing support. Black participants received more system-facing support than White participants, on average (b = 0.78, 95% confidence interval [CI]: [0.25, 1.31]). The interaction of race*system-facing support was significant in a model predicting perceived racism in health care settings at the end of the study controlling for baseline scores (b = 0.05, 95% CI [0.01, 0.09]). Trends in simple slopes indicated that among Black participants, more system-facing support was associated with slightly more perceived racism; no association among White participants. DISCUSSION The term system-facing support highlights navigators' role in advocating for patients within the care system. More research is needed to validate the construct system-facing support and examine its utility in interventions to advance health care equity.
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Affiliation(s)
- Ida Griesemer
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | | | - Kari Thatcher
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | | | - Sarah A Birken
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Aneri Kothari
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Fatima Guerrab
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- People's Action Institute, Washington, DC, USA
| | | | - Alexandra F Lightfoot
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Betts AC, Murphy CC, Shay LA, Balasubramanian BA, Markham C, Roth ME, Allicock M. Polypharmacy and medication fill nonadherence in a population-based sample of adolescent and young adult cancer survivors, 2008-2017. J Cancer Surviv 2023; 17:1688-1697. [PMID: 36346577 PMCID: PMC10164839 DOI: 10.1007/s11764-022-01274-0] [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] [Received: 06/15/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE We examined the association between polypharmacy-an established risk factor for nonadherence in the elderly-and medication fill nonadherence in a large national sample of adolescent and young adult cancer survivors (AYAs) in the USA. METHODS We pooled data (2008-2017) from the Medical Expenditure Panel Survey. We defined polypharmacy as ≥ 3 unique medications prescribed, based on self-report and pharmacy data, and medication fill nonadherence as self-reported delay or inability to obtain a necessary medication. We estimated prevalence of medication fill nonadherence among AYAs (age 18-39 years with a cancer history). We used logistic regression to estimate the association between (1) polypharmacy and medication fill nonadherence in AYAs, and (2) total number of medications prescribed and medication fill nonadherence, controlling for sex, number of chronic conditions, disability, and survey year. RESULTS AYAs (n = 598) were predominantly female (76.2%), age 30-39 years (64.9%), and non-Hispanic White (72.1%). Nearly half were poor (19.0%) or near-poor/low income (21.6%). One in ten AYAs reported medication fill nonadherence (9.75%). Of these, more than 70% cited cost-related barriers as the reason. AYAs with polypharmacy had 2.49 times higher odds of medication fill nonadherence (95%CI 1.11-5.59), compared to those without polypharmacy. Odds of medication fill nonadherence increased by 16% with each additional medication prescribed (AOR 1.16, 95% CI 1.07-1.25). CONCLUSIONS Polypharmacy may be an important risk factor for medication fill nonadherence in AYAs in the USA. IMPLICATIONS FOR CANCER SURVIVORS Improving AYAs' medication adherence requires eliminating cost-related barriers, particularly for those with polypharmacy.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA.
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, San Antonio, TX, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
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Temple J, Fisher P, Davies C, Millar C, Gemma Cherry M. Psychosocial factors associated with anxiety and depression in adolescents with epilepsy: A systematic review. Epilepsy Behav 2023; 149:109522. [PMID: 38006843 DOI: 10.1016/j.yebeh.2023.109522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/27/2023]
Abstract
Anxiety and depression are common in adolescents with epilepsy. Identifying psychosocial risk factors for anxiety and depression is essential for adolescents with epilepsy to receive appropriate support. This systematic review synthesised findings of studies examining the relationship between psychosocial factors and anxiety and/or depression in adolescents with epilepsy. Outcomes were anxiety, depression, and mixed anxiety & depression. Six electronic databases were searched for studies which: used cross-sectional or prospective designs; quantitatively evaluated the relationship between psychosocial factors and anxiety and/or depression; presented results for adolescents with epilepsy aged 9-18 years; and used validated measures of anxiety and/or depression. Psychosocial factors were categorised as intrapersonal, interpersonal, or parent-specific factors. Sixteen studies (23 articles) were included. All but one were cross-sectional. Regarding intrapersonal factors, alternative mental health difficulties were consistently positively associated with all three outcomes. Negative attitude towards epilepsy, lower seizure self-efficacy, lower self-esteem and stigma were consistently positively associated with depression. Interpersonal factors (i.e., lower family functioning assessed from an adolescent's perspective) and parent-specific factors (i.e., parental stigma, stress, anxiety and psychopathology) were positively associated with at least one outcome. Adolescent epilepsy management should exceed assessment of biological/biomedical factors and incorporate assessment of psychosocial risk factors. Prospective studies examining the interplay between biological/biomedical factors and the psychosocial factors underpinning anxiety and depression in adolescents with epilepsy are needed.
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Affiliation(s)
- James Temple
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK
| | - Cari Davies
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Chris Millar
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK.
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Salvador Á, Mansuklal SA, Moura M, Crespo C, Barros L. Facilitators and barriers to adherence to medical recommendations among adolescents with cancer: A systematic review. J Child Health Care 2023:13674935231208502. [PMID: 37864440 DOI: 10.1177/13674935231208502] [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] [Indexed: 10/22/2023]
Abstract
We aimed to systematically review barriers/facilitators of adherence among adolescents with cancer (aged 10-24 years), following a comprehensive approach to adherence that goes beyond medication-taking. Empirical studies published in English exploring determinants of adherence to medical recommendations among adolescents with cancer were identified in MEDLINE, PsycInfo, and Web of Science, up to October 2021. Records and full-text articles were reviewed by two independent reviewers, and results were classified according to the World Health Organization's (WHO) multidimensional adherence model. Eighteen studies were included. Despite heterogeneity in the definition and measurement of adherence, literature supported barriers/facilitators at patient, treatment, condition, healthcare team/system, and social/economic levels. Specifically, patient-related factors (i.e., psychological functioning and beliefs about disease and treatment) and social-related factors (i.e., family functioning) were major determinants of adolescent adherence. Few studies were conducted, and inconsistent findings were displayed for other dimensions (i.e., healthcare team/system, treatment, and condition-related factors). Adherence is a complex and multidetermined phenomenon. More research is needed to provide critical insights for policymakers and healthcare professionals in planning practices and interventions that effectively address meaningful barriers/facilitators of adolescents' adherence.
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Affiliation(s)
- Ágata Salvador
- HEI-Lab, Lusófona University, Lisbon, Portugal
- Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
| | | | - Maria Moura
- Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
- Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - Carla Crespo
- Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
| | - Luísa Barros
- Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
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McGrady ME, Ketterl TG, Norris RE, Perentesis JP, Pettee D, Mara CA, Breen G, Pai ALH. Barriers to medication adherence among adolescents and young adults with cancer. Pediatr Blood Cancer 2023; 70:e30186. [PMID: 36602026 DOI: 10.1002/pbc.30186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Adherence promotion is a critical component of adolescent and young adult (AYA) cancer care, but predictors of nonadherence that could be targeted in intervention efforts remain largely unknown. The purpose of this multi-site longitudinal observational study was to examine the relationship between barriers and medication adherence among AYAs with cancer. PROCEDURE Sixty-five AYAs (ages 15-24 years; mean age = 18.97 years, SD = 2.51; Mmean time since diagnosis = 1.42 years, SD = 1.95) with newly diagnosed or relapsed cancer completed self-report measures of barriers and adherence at quarterly study visits and used an electronic adherence monitoring device for 12 months. Longitudinal mixed effects models were used to examine our primary hypothesis that greater barriers are related to lower adherence over time. Descriptive statistics were used to explore our secondary aim of describing the frequency and patterns of barriers endorsed by AYAs with cancer. RESULTS After controlling for covariates (time, medication type, race, ethnicity, diagnosis, time since diagnosis), a greater number of barriers was associated with lower electronically monitored (β = -5.99, p = .005) and self-reported (β = -1.92, p < .001) adherence. The specific barriers endorsed by AYAs differed across participants, and the majority of AYAs endorsed an entirely different pattern of barriers than any other AYA in the study. CONCLUSION Barriers are associated with nonadherence and may be a promising target for intervention. Individual variability across barriers, however, suggests that tailoring may be necessary, and a promising next step is to explore personalized approaches to adherence promotion.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tyler G Ketterl
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Robin E Norris
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John P Perentesis
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel Pettee
- Division of Pediatric Hematology Oncology, Akron Children's Hospital, Akron, Ohio, USA
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gabriella Breen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Schulze JB, Durante L, Günther MP, Götz A, Curioni-Fontecedro A, Opitz I, von Känel R, Euler S. Clinically Significant Distress and Physical Problems Detected on a Distress Thermometer are Associated With Survival Among Lung Cancer Patients. J Acad Consult Liaison Psychiatry 2023; 64:128-135. [PMID: 36115496 DOI: 10.1016/j.jaclp.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 08/09/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The distress thermometer is a well-established screening tool to detect clinically significant distress in cancer patients. It is often administered in combination with the problem list, differentiating further between various (e.g., physical and emotional) sources of distress. OBJECTIVE The present study aimed to extend previous research on the association between distress and overall survival. A further exploratory analysis aimed to evaluate the predictive value of the problem list for overall survival. METHODS Patients (n = 323) with newly diagnosed lung cancer were recruited from a large cancer center. Patients were split into 2 groups, those with (distress thermometer score ≥5) and those without significant distress. The overall survival time was illustrated by a Kaplan-Meier curve and compared with a log-rank test. Univariable Cox proportional hazard models were built to control the association of distress with overall survival for age, gender, disease stage, comorbidity, and their interaction terms. Multiple linear regression was used to investigate the association of the items from the problem list with survival time. RESULTS Patients with significant distress had a shorter survival time than patients without significant distress (25 vs. 43 months). Regression analysis revealed more problems with both "bathing and dressing" and "eating," as well as absence of "diarrhea" and increased "nervousness," to negatively associated with the overall survival time. CONCLUSIONS Our results show that estimation of the survival function using cancer-related distress is possible. However, when using Cox regression, distress shows no significant value for survival as a predictor. Moreover, our study did not reveal an interaction effect among disease stage, comorbidity, and distress. Overall, results suggest that physical and emotional problems that arise from lung cancer may be useful to identify patients at risk of poor prognosis (on the basis of Kaplan-Meier estimator).
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Affiliation(s)
- Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Larissa Durante
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Götz
- Cancer Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | | | - Isabelle Opitz
- Thoracic Surgery Department, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Reid HW, Selvan B, Montes de Oca MK, Falkovic M, Malone S, Fish LJ, Wheeler S, Davidson BA. "You start feeling comfortable, you just start sharing:" A qualitative study of patient distress screening in Black and White patients with endometrial cancer. Gynecol Oncol 2023; 168:166-175. [PMID: 36502783 PMCID: PMC9884512 DOI: 10.1016/j.ygyno.2022.11.008] [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] [Received: 07/04/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Black patients with endometrial cancer are less likely to express distress and receive referrals for support services compared to White patients. We aim to characterize patient perceptions of the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), a common distress screening tool, among Black and White patients with endometrial cancer and determine strategies to improve equity in referral to appropriate support services. METHODS We conducted semi-structured interviews with 15 Black and 15 White patients with endometrial cancer who reported varying levels of distress on the NCCN DT & PL. Interviews were audio-recorded, transcribed, evaluated through staged content analysis, and salient themes were compared by patient race. RESULTS The NCCN DT & PL was generally considered understandable, however the word "distress" could be alienating to participants who considered their stress to be less "drastic." Black participants mentioned fewer negative emotions such as worry and sadness in describing distress and spoke more often of a positive outlook. Additionally, Black participants emphasized the importance of relationship-building with clinicians for open communication on the NCCN DT & PL and clinical encounter. Finally, participants were divided on whether they would alter the way they completed the NCCN DT & PL given more information on cut off scores for referrals, but generally expressed a desire for more direct offers of support services. CONCLUSIONS Relationship-building, open communication around emotion, and longitudinal direct offers of support emerged as avenues to reduce inequities in referral to supportive services for patients with endometrial cancer.
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Affiliation(s)
- Hadley W Reid
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Bharathi Selvan
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Mary Katherine Montes de Oca
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 2608 Erwin Rd, STE 210, Durham, NC 27710, USA.
| | - Margaret Falkovic
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University School of Medicine, Box 2715, Durham, NC 27710, USA.
| | - Shauna Malone
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701, USA..
| | - Laura J Fish
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University School of Medicine, Box 2715, Durham, NC 27710, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC 2914, Durham, NC 27710, USA.
| | - Sarahn Wheeler
- Division of Maternal Fetal Medicine, Duke University School of Medicine, DUMC 3967, Durham, NC 27710, USA.
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC 27710, USA.
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Reading Wishes from the Lips: Cancer Patients' Need for Psycho-Oncological Support during Inpatient and Outpatient Treatment. Diagnostics (Basel) 2022; 12:diagnostics12102440. [PMID: 36292128 PMCID: PMC9600894 DOI: 10.3390/diagnostics12102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Psycho-oncological support (PO) is an effective measure to reduce distress and improve the quality of life in patients with cancer. Currently, there are only a few studies investigating the (expressed) wish for PO. The aim of this study was to evaluate the number of patients who request PO and to identify predictors for the wish for PO. Methods: Data from 3063 cancer patients who had been diagnosed and treated at a Comprehensive Cancer Center between 2011 and 2019 were analyzed retrospectively. Potential predictors for the wish for PO were identified using logistic regression. As a novelty, a Back Propagation Neural Network (BPNN) was applied to establish a prediction model for the wish for PO. Results: In total, 1752 patients (57.19%) had a distress score above the cut-off and 14.59% expressed the wish for PO. Patients’ requests for pastoral care (OR = 13.1) and social services support (OR = 5.4) were the strongest predictors of the wish for PO. Patients of the female sex or who had a current psychiatric diagnosis, opioid treatment and malignant neoplasms of the skin and the hematopoietic system also predicted the wish for PO, while malignant neoplasms of digestive organs and older age negatively predicted the wish for PO. These nine significant predictors were used as input variables for the BPNN model. BPNN computations indicated that a three-layer network with eight neurons in the hidden layer is the most precise prediction model. Discussion: Our results suggest that the identification of predictors for the wish for PO might foster PO referrals and help cancer patients reduce barriers to expressing their wish for PO. Furthermore, the final BPNN prediction model demonstrates a high level of discrimination and might be easily implemented in the hospital information system.
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11
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Lavan O, Peled O, Avishai-Neumann M, Weizman A, Yahel A, Apter A, Valevski A, Fennig S, Stein J, Benaroya-Milshtein N. Psychopharmacology in the Pediatric Oncology and Bone Marrow Transplant Units: Antidepressant Treatment. J Child Adolesc Psychopharmacol 2022; 32:153-161. [PMID: 35255222 DOI: 10.1089/cap.2021.0083] [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] [Indexed: 11/12/2022]
Abstract
Objectives: The aim of this study was to characterize the clinical profiles, tolerability, and efficacy of two groups of antidepressants, selective serotonin reuptake inhibitors (SSRIs), and the atypical antidepressant, mirtazapine, in children and adolescents treated in a large pediatric Hematology-Oncology center. Methods: A review of computerized medical charts of 32 pediatric patients with cancer, from December 2011 to April 2020, was conducted. Efficacy and tolerability of antidepressant medications were retrospectively analyzed. The Clinical Global Impressions-Severity (CGI-S) and Clinical Global Impressions-Improvement (CGI-I) Scales were used to evaluate psychiatric symptoms severity before and following treatment, while the data on adverse events and drug-drug interactions were retrieved from the computerized medical records. Results: Thirty-two children and adolescents with cancer, 2-21 years of age (mean 14.1 ± 4.6 years), were treated with antidepressants. Fourteen patients (44%) received mirtazapine, whereas 18 patients (56%) received SSRIs: sertraline (25%), escitalopram (25%), or fluoxetine (6%). Treatment choice was dictated either by physician preference or informed by potential drug-drug interactions. The most common psychiatric diagnoses were major depressive disorders (47%), anxiety disorders (19%), and medication-induced psychiatric disorders (19%). The most common psychiatric-medical symptoms were depressed mood (94%) and anxiety (62%). CGI-S improved significantly (p < 0.05) between pretreatment and on-treatment assessments, with no statistically significant difference between SSRI and mirtazapine-treated patients. CGI-I scores at reassessment indicated improvement in most patients (84%). Adverse events of treatment were mild in all patients. Conclusions: The antidepressants used in this study, SSRIs and mirtazapine, were effective and well tolerated in children and adolescents with cancer and psychiatric comorbidities. Given the high rates of depression and anxiety in children with cancer, large-scale, multisite, prospective clinical trials of antidepressants are warranted.
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Affiliation(s)
- Orly Lavan
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Peled
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pharmacy, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Meital Avishai-Neumann
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Geha Mental Health Center, Petah Tikva, Israel
| | - Anat Yahel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Alan Apter
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Valevski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Geha Mental Health Center, Petah Tikva, Israel
| | - Silvana Fennig
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jerry Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Noa Benaroya-Milshtein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pharmacy, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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12
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Günther MP, Schulze JB, Kirchebner J, Jordan KD, von Känel R, Euler S. Severe mental illness in cancer is associated with disparities in psycho-oncological support. Curr Probl Cancer 2022; 46:100849. [DOI: 10.1016/j.currproblcancer.2022.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/03/2022]
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13
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Reid HW, Broadwater G, Montes de Oca MK, Selvan B, Fayanju O, Havrilesky LJ, Davidson BA. Distress screening in endometrial cancer leads to disparity in referral to support services. Gynecol Oncol 2022; 164:622-627. [PMID: 35016785 PMCID: PMC8891066 DOI: 10.1016/j.ygyno.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/01/2021] [Accepted: 01/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Racial disparities in survival from endometrial cancer (EC) are well known. Cancer distress has also been associated with worse clinical outcomes. We characterized the association between race/ethnicity, patient distress reported on the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), referral to support services, time to surgery, and acceptance of adjuvant therapy in patients with EC. METHODS We included patients presenting at an academic gynecologic oncology practice from 1/2013-6/2020 who had not received prior EC-directed treatment. Demographics, NCCN DT scores, and treatment details were abstracted from the electronic medical record. Difference in initial DT scores by race/ethnicity and treatment type was tested using general linear modeling. The significance of interaction effects was tested using linear mixed models and logistic regression. RESULTS 393 non-Hispanic White (NHW) and 134 non-Hispanic Black (NHB) patients were included. Median distress scores were higher in NHW patients compared to NHB patients (4 vs. 2, p < 0.001); 51% of NHW patients qualified for referral to support services compared to 40% of NHB patients (p = 0.03). Distress scores were highest at initial appointment and declined over time in NHW patients regardless of treatment, but were initially low and remained low over time in NHB patients. There was no association of initial distress score with time to surgery or acceptance of adjuvant treatment (p-values >0.25). CONCLUSIONS An observed difference in NCCN DT leads to racial disparities in referral to support services. The NCCN DT may not adequately measure distress in NHB women with EC.
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Affiliation(s)
- Hadley W Reid
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Gloria Broadwater
- Duke Cancer Institute Biostatistics, Duke University Medical Center, DUMC Box 2717, Durham, NC, USA.
| | - Mary Katherine Montes de Oca
- Department of Obstetrics and Gynecology, Duke University School of Medicine, 2608 Erwin Rd, STE 210, Durham, NC 27710, USA.
| | - Bharathi Selvan
- Duke University School of Medicine, DUMC 3710, Durham, NC 27710, USA.
| | - Oluwadamilola Fayanju
- Department of Surgery, Duke University School of Medicine, DUMC 3513, Durham, NC 27710, USA.
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC, 27710, USA.
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Duke University School of Medicine, DUMC Box 3079, Durham, NC, 27710, USA.
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14
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Günther MP, Kirchebner J, Schulze JB, von Känel R, Euler S. Towards identifying cancer patients at risk to miss out on psycho-oncological treatment via machine learning. Eur J Cancer Care (Engl) 2022; 31:e13555. [PMID: 35137480 PMCID: PMC9286797 DOI: 10.1111/ecc.13555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/14/2021] [Accepted: 01/24/2022] [Indexed: 12/23/2022]
Abstract
Objective In routine oncological treatment settings, psychological distress, including mental disorders, is overlooked in 30% to 50% of patients. High workload and a constant need to optimise time and costs require a quick and easy method to identify patients likely to miss out on psychological support. Methods Using machine learning, factors associated with no consultation with a clinical psychologist or psychiatrist were identified between 2011 and 2019 in 7,318 oncological patients in a large cancer treatment centre. Parameters were hierarchically ordered based on statistical relevance. Nested resampling and cross validation were performed to avoid overfitting. Results Patients were least likely to receive psycho‐oncological (i.e., psychiatric/psychotherapeutic) treatment when they were not formally screened for distress, had inpatient treatment for less than 28 days, had no psychiatric diagnosis, were aged 65 or older, had skin cancer or were not being discussed in a tumour board. The final validated model was optimised to maximise sensitivity at 85.9% and achieved an area under the curve (AUC) of 0.75, a balanced accuracy of 68.5% and specificity of 51.2%. Conclusion Beyond conventional screening tools, results might contribute to identify patients at risk to be neglected in terms of referral to psycho‐oncology within routine oncological care.
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Affiliation(s)
- Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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15
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Psychosocial risk, symptom burden, and concerns in families affected by childhood cancer. Support Care Cancer 2021; 30:2283-2292. [PMID: 34719739 DOI: 10.1007/s00520-021-06646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The revised Psychosocial Assessment Tool (PATrev) is a common family-level risk-based screening tool for pediatric oncology that has gained support for its ability to predict, at diagnosis, the degree of psychosocial support a family may require throughout the treatment trajectory. However, ongoing screening for symptoms and concerns (e.g., feeling alone, understanding treatment) remains underutilized. Resource limitations necessitate triaging and intervention based on need and risk. Given the widespread use of the PATrev, we sought to explore the association between family psychosocial risk, symptom burden (as measured by the revised Edmonton Symptom Assessment System (ESAS-r)), and concerns (as measured by the Canadian Problem Checklist (CPC)). METHODS Families (n = 87) with children ≤ 18 years of age (M = 11.72, male: 62.1%) on or off treatment for cancer were recruited from the Alberta Children's Hospital. One parent from each family completed the PATrev and the CPC. Participants 8-18 years of age completed the ESAS-r. RESULTS Risk category (universal/low risk = 67.8%, targeted/intermediate risk = 26.4%, clinical/high risk = 5.7%) predicted symptom burden (F[2, 63.07] = 4.57, p = .014) and concerns (F[2, 82.06] = 16.79, p < .001), such that universal risk was associated with significantly lower symptom burden and fewer concerns. CONCLUSION Family psychosocial risk is associated with cross-sectionally identified concerns and symptom burden, suggesting that resources might be prioritized for families with the greatest predicted need. Future research should evaluate the predictive validity of the PATrev to identify longitudinal concerns and symptom burden throughout the cancer trajectory.
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16
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Psihogios AM, Rabbi M, Ahmed A, McKelvey ER, Li Y, Laurenceau JP, Hunger SP, Fleisher L, Pai AL, Schwartz LA, Murphy SA, Barakat LP. Understanding Adolescent and Young Adult 6-Mercaptopurine Adherence and mHealth Engagement During Cancer Treatment: Protocol for Ecological Momentary Assessment. JMIR Res Protoc 2021; 10:e32789. [PMID: 34677129 PMCID: PMC8571686 DOI: 10.2196/32789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer demonstrate suboptimal oral chemotherapy adherence, increasing their risk of cancer relapse. It is unclear how everyday time-varying contextual factors (eg, mood) affect their adherence, stalling the development of personalized mobile health (mHealth) interventions. Poor engagement is also a challenge across mHealth trials; an effective adherence intervention must be engaging to promote uptake. OBJECTIVE This protocol aims to determine the temporal associations between daily contextual factors and 6-mercaptopurine (6-MP) adherence and explore the proximal impact of various engagement strategies on ecological momentary assessment survey completion. METHODS At the Children's Hospital of Philadelphia, AYAs with acute lymphoblastic leukemia or lymphoma who are prescribed prolonged maintenance chemotherapy that includes daily oral 6-MP are eligible, along with their matched caregivers. Participants will use an ecological momentary assessment app called ADAPTS (Adherence Assessments and Personalized Timely Support)-a version of an open-source app that was modified for AYAs with cancer through a user-centered process-and complete surveys in bursts over 6 months. Theory-informed engagement strategies will be microrandomized to estimate the causal effects on proximal survey completion. RESULTS With funding from the National Cancer Institute and institutional review board approval, of the proposed 30 AYA-caregiver dyads, 60% (18/30) have been enrolled; of the 18 enrolled, 15 (83%) have completed the study so far. CONCLUSIONS This protocol represents an important first step toward prescreening tailoring variables and engagement components for a just-in-time adaptive intervention designed to promote both 6-MP adherence and mHealth engagement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32789.
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Affiliation(s)
- Alexandra M Psihogios
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Mashfiqui Rabbi
- Department of Statistics, Harvard University, Boston, MA, United States
| | - Annisa Ahmed
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Elise R McKelvey
- Children's Hospital of Philadelphia, La Salle University, Philadelphia, PA, United States
| | - Yimei Li
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Stephen P Hunger
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Linda Fleisher
- Health Communications and Health Disparities, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Ahna Lh Pai
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lisa A Schwartz
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Susan A Murphy
- Department of Statistics, Harvard University, Boston, MA, United States
| | - Lamia P Barakat
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
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17
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Nguyen TQ, Do TM, Pham TA. Screening for Psychological Distress in Vietnamese Cancer Patients: An Evaluation of the Distress Thermometer. Cancer Med 2021; 10:7793-7803. [PMID: 34559957 PMCID: PMC8559463 DOI: 10.1002/cam4.4298] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Background Psychological distress is prevalent in patients with cancer, negatively affecting their treatment and quality of life. Clinical guidelines recommended screening all cancer patients routinely for psychological problems using simple measures such as the Distress Thermometer (DT) and Problem List (PL). This study is the first research in Vietnam to identify the optimal DT cutoff point to screen distress and the relationship with PL items among cancer patients. Methods 300 cancer patients were recruited from 10 departments at Vietnam National Cancer Hospital (K hospital) and completed the DT and PL. Participants also completed the Patient Health Questionnaire‐9 (PHQ‐9) and the Generalized Anxiety Disorder‐7 (GAD‐7) with standard cutoff scores for identifying significant depression and anxiety. Results Receiver operating characteristic (ROC) curve analyses showed that a DT cutoff score of 4 had an area under the ROC curve of 0.81 and 0.82 using the PHQ‐9 and GAD‐7 cutoff scores of 10 as the criterion, respectively. This indicated good overall accuracy. This cutoff also showed a sensitivity of 0.87 and 0.92 for PHQ‐9 and GAD‐7 total score defined cases, respectively. Both specificity values were 0.58. In terms of the PL, 164 distressed patients (54.7%) reported significantly more emotional problems, family issues, and practical and physical problem, implying various causes contribute to psychological distress among cancer patients. Conclusions The study showed that the DT with a cutoff of 4 accompanied with PL is a simple and effective instrument compared to previous, longer measures commonly used to detect psychosocial distress in Vietnamese cancer patients. This cutoff point also identified patients with problems contributing towards distress.
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Affiliation(s)
| | - Tuyet Mai Do
- Vietnam National Cancer Hospital, Hanoi, Vietnam
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18
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One-minute time interval estimation as a novel potent indicator of emotional concerns in cancer patients prior to starting chemotherapy. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Meggiolaro E, De Padova S, Ruffilli F, Bertelli T, Bragagni M, Prati S, Pisotti L, Massa I, Foca F, Tamberi S, De Giorgi U, Zerbinati L, Tiberto E, Grassi L. From Distress Screening to Uptake: An Italian Multicenter Study of Cancer Patients. Cancers (Basel) 2021; 13:cancers13153761. [PMID: 34359662 PMCID: PMC8345103 DOI: 10.3390/cancers13153761] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Little consideration is given to the referral and uptake of available supportive services after distress screening. However, identifying the reasons for accepting or refusing help is mandatory for implementing a screening policy. The present study explored the practical usefulness of and potential barriers to the application of distress management. METHODS 406 cancer patients were consecutively selected and asked to complete the Distress Thermometer (DT) and Problem Check List (PL). All patients with a DT score ≥6 were invited for a post-DT telephone interview with a trained psychologist. RESULTS The 112 patients who refused to take part were more often older, retired, at a more advanced stage of illness, and with no previous experience of psychological intervention with respect to those who accepted. Of the 78 patients with a score ≥6 who were referred to the Psycho-Oncology Service, 65.4% accepted the telephone interview. Twenty-two patients rejected the initial invitation immediately for various reasons including logistic difficulties, physical problems, and feeling embarrassed about opening up to a psychologist. CONCLUSIONS Our study confirms that screening per sé is insufficient to deal with the problem of distress and that more emphasis should be placed on implementing referral and treatment.
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Affiliation(s)
- Elena Meggiolaro
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (S.D.P.); (F.R.); (T.B.)
- Correspondence: ; Tel.: +39-0543-739260; Fax: +39-0543-739151
| | - Silvia De Padova
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (S.D.P.); (F.R.); (T.B.)
| | - Federica Ruffilli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (S.D.P.); (F.R.); (T.B.)
| | - Tatiana Bertelli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (S.D.P.); (F.R.); (T.B.)
| | - Marina Bragagni
- Nursing and Technical Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.B.); (S.P.); (L.P.)
| | - Sabrina Prati
- Nursing and Technical Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.B.); (S.P.); (L.P.)
| | - Lidia Pisotti
- Nursing and Technical Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (M.B.); (S.P.); (L.P.)
| | - Ilaria Massa
- Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Stefano Tamberi
- Medical Oncology Unit, Ospedale degli Infermi, 48018 Faenza, Italy;
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44121 Ferrara, Italy; (L.Z.); (E.T.); (L.G.)
| | - Elisa Tiberto
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44121 Ferrara, Italy; (L.Z.); (E.T.); (L.G.)
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44121 Ferrara, Italy; (L.Z.); (E.T.); (L.G.)
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Günther MP, Schulze JB, Jellestad L, Mehnert-Theuerkauf A, von Känel R, Euler S. Mental disorders, length of hospitalization, and psychopharmacy-New approaches to identify barriers to psychological support for patients with cancer. Psychooncology 2021; 30:1773-1781. [PMID: 34089283 DOI: 10.1002/pon.5743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/04/2021] [Accepted: 06/01/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite abundant evidence that emotional distress is frequent in cancer patients and associated with adverse health outcomes, distress screening rates and adequate referrals to psychological support programs among those in need are insufficient in many cancer centers. We therefore aimed to analyze patient- and treatment-related barriers to distress screening and referrals to psychological support as a mandatory component of best-practice cancer care. METHOD In the present explorative study, latent class analysis was used to identify homogeneous subgroups among 4837 patients diagnosed with cancer between 2011 and 2019. RESULTS Four subgroups were identified. Patients with a mental disorder and psychopharmacology were least probable to be screened for distress. Together with patients aged 65 or older and male patients, they were also less likely to receive psychological support. Patients hospitalized for 28 days or longer were most likely to be both screened and to receive psychological support. CONCLUSIONS Clinicians and researchers are recommended not neglect patients with mental disorders and psychopharmacological treatment as well as male and elderly patients when screening for distress and providing access to psychological support.
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Affiliation(s)
- Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lena Jellestad
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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21
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Klages KL, Berlin KS, Cook JL, Keenan ME, Semenkovich K, Banks GG, Rybak TM, Ankney RL, Decker KM, Whitworth JR, Corkins MR. Examining Risk Factors of Health-Related Quality of Life Impairments Among Adolescents with Inflammatory Bowel Disease. Behav Med 2021; 47:140-150. [PMID: 34048329 DOI: 10.1080/08964289.2019.1676193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Inflammatory Bowel Disease (IBD) is a chronic, costly, and burdensome disease that is typically diagnosed during adolescence. Despite the use of effective treatments, rates of relapse and intestinal inflammation remain high and put patients at risk for long term physical and psychosocial health complications. Given the costs associated with IBD, it is critical to examine potential risk factors of poor health-related quality of life (HRQoL) among patients for the enhancement and further development of interventions. As such, the aim of the current study was to examine how sociodemographic and disease characteristics, psychosocial problems, and adherence behaviors impact HRQoL among a sample of youth with IBD. 107 adolescents with IBD and their caregiver completed self- and parent-report measures as part of a psychosocial screening service. Medical records were reviewed to obtain information regarding diagnosis, insurance, medication use, illness severity, and disease activity. Results revealed lower HRQoL scores among adolescents with more psychosocial problems (Est. = -3.08; p < .001), greater disease severity (Est. = -.40; p = .001), and those who identified as Black (Est. = -.38; p < .05). Greater disease severity (Est. = .13 p = .004), use of nonpublic insurance (Est. = .32 p = .004), and fewer psychosocial problems (Est. = -.13 p = .04) were associated with greater adherence behaviors. These findings suggest that implementing individually tailored, evidence-based psychological interventions focused on coping with psychosocial problems and symptoms may be important in enhancing adherence behaviors and HRQoL among adolescents with IBD.
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Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Sciences Center
| | | | | | | | | | | | | | | | - John R Whitworth
- Department of Pediatrics, University of Tennessee Health Sciences Center
| | - Mark R Corkins
- Department of Pediatrics, University of Tennessee Health Sciences Center
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22
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Carr E, Rosengarten L. Teenagers and Young Adults with Cancer: An Exploration of Factors Contributing to Treatment Adherence. J Pediatr Oncol Nurs 2021; 38:190-204. [PMID: 33769898 PMCID: PMC8172305 DOI: 10.1177/1043454221992302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
This systematic appraisal explores the literature surrounding treatment adherence in teenagers and young adults (TYAs) with cancer, with the aim of identifying influential factors that could affect adherence rates. This area is particularly important due to the increased risk of relapse and death associated with nonadherent behavior. In addition, TYAs are found to be the age group least likely to adhere to medical regimes. A comprehensive review of the literature was conducted and seven studies met the inclusion criteria, the articles were then critiqued using a data extraction form and eight themes were generated and discussed. This review highlights the complexities and difficulties in measuring adherence, as well as the key factors affecting adherence, before identifying implications for practice. Good communication and relationships are crucial between all parties involved in TYAs’ care including the patients, professionals, parents, and peers. A model of adherence was adapted on the basis of the result of the systematic review, other literature pertaining to adherence in TYAs, and the clinical experience of the authors. Personal factors and external factors, along with treatment factors and interactions with the system all have an effect on the patient's response or ability to adhere. It is apparent that there is a need for more high-quality qualitative and quantitative research in this area, with an emphasis on finding interventions that directly improve adherence specific to this age group.
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Affiliation(s)
- Elizabeth Carr
- Safari Day Unit, 156793Lincoln County Hospital, Lincoln, UK
| | - Leah Rosengarten
- Faculty of Health and Life Sciences, 5995Northumbria University, Newcastle upon Tyne, UK
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23
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Associated factors of distress in patients with advanced cancer: A retrospective study. Palliat Support Care 2020; 19:447-456. [PMID: 33222720 DOI: 10.1017/s1478951520001066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to assess the psychosocial distress and associated factors in advanced cancer patients consulting at the outpatient Palliative Care Unit at the National Cancer Institute in Mexico City. DESIGN A retrospective study was conducted using electronic records (June 2015 to December 2016). SAMPLE A total of 646 patients with advanced cancer during their first visit to the outpatient palliative care unit at the National Cancer Institute in Mexico were evaluated using the Distress Thermometer (DT) and ECOG performance status scores. FINDINGS Overall, 62% were women, with a median age of 57 years, and married (54.8%). The most frequent diagnosis was gastrointestinal cancer (28.6%), and 38.9% had a functional performance status of ECOG 2. The median DT score was 4.0 (IQR = 2-6), with 56% reporting DT scores ≥4. The three most frequent problems ≥4 were sadness (82.6%), feeling weak (81.2%), worry (79.6%), and <4 were feeling weak (57.7%), fatigue (55.6%), and financial security (52.1%). The variables associated with distress according to the multiple logistic regression analysis were problems with housing (OR = 2.661, 95% CI = 1.538-4.602), sadness (OR = 2.533, 95% CI = 1.615-3.973), transportation (OR = 1.732, 95% CI = 1.157-2.591), eating (OR = 1.626, 95% CI = 1.093-2.417), nervousness (OR = 1.547, 95% CI = 1.014-2.360), and sleep (OR = 1.469, 95% CI = 1.980-2.203). CONCLUSION The principal factors were related to distress levels, housing problems, transportation issues, and emotional problems such as sadness, nervousness, lower functionality, and younger age. Therefore, psychosocial support is of considerable relevance in palliative care. These findings will help clinicians understand the distress of patients with advanced cancer in palliative care in Latin American countries.
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24
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Peled O, Lavan O, Stein J, Vinograd I, Yahel A, Valevski A, Weizman A, Kimmel-Tamir E, Apter A, Fennig S, Yaniv I, Bernfeld Y, Benaroya-Milshtein N. Psychopharmacology in the Pediatric Oncology and Bone Marrow Transplant Units: Antipsychotic Medications Palliate Symptoms in Children with Cancer. J Child Adolesc Psychopharmacol 2020; 30:486-494. [PMID: 32845729 DOI: 10.1089/cap.2019.0164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives: The present study characterized the psychiatric diagnoses and symptoms that led to the administration of antipsychotic medications in children and adolescents with cancer, and to evaluate the benefits and tolerability of these drugs in a large hospital-based pediatric hematology-oncology practice. Methods: Efficacy and adverse effects of two second-generation antipsychotics were retrospectively analyzed in 43 patients 2.9-19.6 (mean 12.1) years of age. The Clinical Global Impression-Severity (CGI-S) Scale and Improvement (CGI-I) Scale were used to evaluate psychiatric symptom severity before and following treatment, while the incidence of side effects and drug-drug interactions were collected from medical records. Results: Olanzapine was administered to 58% of patients and risperidone to 42%; the choice of drug was at the discretion of the treating psychiatrist. The common psychiatric diagnoses among these patients included adjustment disorder (37%) and medication-induced psychiatric disorders (23%). The most common psychiatric-medical symptoms included irritability/agitation (79%) and depressed mood (74%). CGI-S improved significantly (p < 0.001) between assessments, with no statistically significant difference between olanzapine- and risperidone-treated patients. CGI-I scores at reassessment indicated superiority of olanzapine as compared with risperidone. Adverse effects of treatment were mild. Conclusions: Olanzapine and risperidone can be well tolerated and ameliorate severe psychiatric-medical symptoms in children and adolescents with cancer. The potential palliative benefits of these second-generation antipsychotics (e.g., rapid onset of action, antiemesis, sedation, and appetite stimulation) increase the utility of their use in children treated in oncology and bone marrow transplant units.
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Affiliation(s)
- Orit Peled
- Department of Pharmacy, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Lavan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Jerry Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Inbal Vinograd
- Department of Pharmacy, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yahel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Avi Valevski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Research Unit, Geha Mental Health Center, and Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Research Unit, Geha Mental Health Center, and Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Ella Kimmel-Tamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Alan Apter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Silvana Fennig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Isaac Yaniv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yael Bernfeld
- Department of Pharmacy, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Benaroya-Milshtein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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25
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Warembourg M, Lonca N, Filleron A, Tran TA, Knight M, Janes A, Soulairol I, Leguelinel-Blache G. Assessment of anti-infective medication adherence in pediatric outpatients. Eur J Pediatr 2020; 179:1343-1351. [PMID: 32140853 DOI: 10.1007/s00431-020-03605-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Abstract
The objective of this pilot study was to assess the overall adherence rate of the pediatric population to anti-infective drugs prescribed for acute infection at hospital discharge and to identify risk factors for non-adherence behavior. Pediatric patients discharged from a French university hospital with at least one oral drug prescription for acute infection were included for 3 months. Medication adherence and antibiotic knowledge were assessed through data collected by calling the parents. Overall adherence was assessed according to seven items: medication order filling, administered dose, time of intake, frequency of doses, medication omission, dose modification, and length of treatment. Seventy-five patients were included, and 63 interviews were exploited. The median age was 1.4 years, IQR = [0.7; 3.3]. Overall adherence to anti-infective agents concerned 34.9% of patients. The most frequently prescribed antibiotics were amoxicillin (29.3%), amoxicillin associated with clavulanic acid (25.3%), cotrimoxazole (18.7%), and cefixime (12.0%). A lack of parents' anti-infective knowledge was associated with non-adherence to anti-infective drugs.Conclusion: Two-thirds of outpatients were non-adherent to anti-infectives in acute infectious diseases. The misunderstanding of anti-infective treatment could be a risk factor for non-adherence. Implementation of preventive actions such as therapeutic education or pharmaceutical counseling at hospital discharge could improve adherence to anti-infective agents. What Is Known: • Non-adherence to anti-infective drugs involves the emergence and spread of antibiotic resistance. • Very few studies have assessed medication adherence in acute infectious diseases in pediatrics after hospital discharge. What Is New: • Only 35% of children were overall adherent to anti-infective drugs in acute infectious disease after hospital discharge. • Most patients (89%) had a good primary adherence but very few (40%) had good secondary adherence mainly due to dose omission and dose modification.
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Affiliation(s)
- Marion Warembourg
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Nelly Lonca
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Anne Filleron
- Department of Pediatrics, Nimes University Hospital, University of Montpellier, Nimes, France.,INSERM U 1183, Team 3, Immune Regulation and Microbiota, University of Montpellier, Montpellier, France
| | - Tu Anh Tran
- Department of Pediatrics, Nimes University Hospital, University of Montpellier, Nimes, France.,INSERM U 1183, Team 3, Immune Regulation and Microbiota, University of Montpellier, Montpellier, France
| | - Michèle Knight
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Alexia Janes
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Ian Soulairol
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France.,UMR 5253, MACS Team, ICGM, University of Montpellier, Montpellier, France
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France. .,Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, UPRES, EA 2415, University of Montpellier, Montpellier, France.
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26
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Yardeni M, Abebe Campino G, Bursztyn S, Shamir A, Mekori-Domachevsky E, Toren A, Gothelf D. A three-tier process for screening depression and anxiety among children and adolescents with cancer. Psychooncology 2020; 29:2019-2027. [PMID: 32691478 DOI: 10.1002/pon.5494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/03/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To establish and to evaluate the effectiveness of a three-tier screening process of depressive and anxiety disorders among children and adolescents with cancer based on questionnaires (first tier), semistructured psychiatric interviews (second tier), and referral for psychiatric assessment and recommendations for treatment (third tier). We also aimed to determine the rates of depressive and anxiety disorders among participants. METHODS Participants and their parents completed the Patient Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety modules. Then, they were interviewed separately using the semistructured Affective and Anxiety Modules of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). PROMIS cutoff values for diagnosing depressive and anxiety disorders, based on the K-SADS, were calculated by receiver-operating characteristics (ROCs). RESULTS Of 91 participants 34 (37.4%) aged 7 to 21 years with cancer met the K-SADS criteria for depressive and/or anxiety disorders. The results of the ROC analyses were stronger for depressive disorders than for anxiety disorders and for more severe cases. The cutoff of 13 on the child-reported PROMIS for a major depressive episode had a sensitivity of 0.80 and a specificity of 0.82, and a cutoff of 14 on the parent-reported PROMIS for generalized anxiety disorder had a sensitivity of 0.78 and a specificity of 0.79. CONCLUSIONS Using the K-SADS, we found that anxiety and depressive disorders are very common in youngsters with cancer. The three-tier screening process we developed for depression and anxiety in this population provides practical cutoff values for identifying depressive and anxiety disorders in children with cancer.
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Affiliation(s)
- Maya Yardeni
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel
| | - Gadi Abebe Campino
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Bursztyn
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Shamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Mekori-Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Amos Toren
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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27
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Admiraal JM, Hoekstra-Weebers JEHM, Schröder CP, Tuinier W, Hospers GAP, Reyners AKL. Distress, problems, referral wish, and supportive health care use in breast cancer survivors beyond the first year after chemotherapy completion. Support Care Cancer 2020; 28:3023-3032. [PMID: 31511981 PMCID: PMC7256025 DOI: 10.1007/s00520-019-05030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/06/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE We examined distress levels, problems, referral wish, and supportive health care use in a cross-sectional group of breast cancer survivors at two-time points with a 1-year time interval. Also, factors related to continuing elevated distress were explored. METHODS Breast cancer survivors, 1-5 years after chemotherapy completion, filled in the Dutch Distress Thermometer/Problem List (DT/PL) and questions on background characteristics at study inclusion (T1). DT/PL responses and health care use were discussed during semi-structured interviews. One year later, re-assessment took place (T2). The data were analyzed by descriptive and univariate analyses. Continuing elevated distress was defined as a DT score ≥ 5 at T1 and T2. RESULTS Seventy-three survivors completed all questionnaires (response = 84.6%). Eighteen (25%) experienced continuing elevated distress. Fatigue (T1 N = 48 (66%); T2 N = 41 (56%)) and lack of physical fitness (T1 N = 44 (60%); T2 N = 36 (49%)) were most often reported. Time since diagnosis, health care use, and practical, social, emotional and physical problems were significantly associated with continuing elevated distress. Between diagnosis and T1, N = 49(67%) used supportive healthcare services, mostly a psychologist and/or a physical/lymphedema therapist, and between T1 and T2, 39 (53%) did. At T1, 8 (11%) expressed a referral wish and at T2, 11 (16%) did. CONCLUSIONS Screening and management of distress, problems, and referral wish are important, even years after chemotherapy completion as a substantial proportion of breast cancer survivors continue to report elevated distress and problems. Special attention should be paid to survivors reporting physical problems, especially fatigue and lack of physical fitness, since these problems are most strongly related to continuing elevated distress.
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Affiliation(s)
- J M Admiraal
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, The Netherlands
| | - C P Schröder
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - W Tuinier
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - G A P Hospers
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - Anna K L Reyners
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands.
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28
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Psihogios AM, Schwartz LA, Ewing KB, Czerniecki B, Kersun LS, Pai ALH, Deatrick JA, Barakat LP. Adherence to Multiple Treatment Recommendations in Adolescents and Young Adults with Cancer: A Mixed Methods, Multi-Informant Investigation. J Adolesc Young Adult Oncol 2020; 9:651-661. [PMID: 32392434 DOI: 10.1089/jayao.2020.0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This mixed methods study sought to assess adolescent and young adult (AYA) adherence to three cancer treatment recommendations (medications, diet, physical activity), and determine the individual, family, and health system factors associated with suboptimal adherence. Methods: In Stage 1, 72 AYA-caregiver dyads completed a validated adherence interview and surveys about individual and family functioning. Matched providers (n = 34 who reported on 61 AYAs) completed global adherence ratings through survey. In Stage 2, a subset (n = 31) completed qualitative interviews. Results: Medication adherence was higher (M = 94.8%) than diet (M = 73.9%) and physical activity (M = 55.4%), although ≥50% demonstrated "Imperfect Adherence" for each subtask. Univariately, AYAs who missed a medication had more depressive symptoms, worse health-related quality of life (HRQOL), and more medication barriers; their families had more financial stress, worse family functioning, and lower self-efficacy. The odds of adhering to medications were lower with worse HRQOL (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.02-1.15) and family functioning (OR = 0.18; 95% CI, 0.04-0.91). The odds of adhering to physical activity and diet were lower with worse family functioning (OR = 0.09; 95% CI, 0.01-0.91) and more barriers (OR = 0.24, CI: 0.10-0.61), respectively. Qualitative themes further supported multilevel influences on AYA adherence. Conclusions: Adherence challenges were identified across medications, diet, and physical activity. Multilevel contextual factors were associated with suboptimal adherence, including poorer HRQOL and family functioning. Findings support the need to improve clinical adherence assessment and develop contextually tailored interventions.
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Affiliation(s)
- Alexandra M Psihogios
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry and Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kylie B Ewing
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryn Czerniecki
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie S Kersun
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ahna L H Pai
- Center for the Promotion of Adherence and Self-Management, Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Janet A Deatrick
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry and Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelmen School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Granek L, Nakash O, Ariad S, Shapira S, Ben-David M. Strategies and Barriers in Addressing Mental Health and Suicidality in Patients With Cancer. Oncol Nurs Forum 2020; 46:561-571. [PMID: 31424452 DOI: 10.1188/19.onf.561-571] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify how oncology nurses address mental health distress and suicidality in patients, what strategies they employ in treating this distress, and the barriers they face in addressing distress and suicidality in patients with cancer. PARTICIPANTS & SETTING 20 oncology nurses at two cancer centers in Israel were interviewed. METHODOLOGIC APPROACH The grounded theory method of data collection and analysis was employed. FINDINGS Strategies used in addressing patients' mental health distress were being emotionally available, providing practical support, treating physical symptoms, and referring to counseling. Strategies in addressing suicidality were assessing the situation, offering end-of-life or palliative care, treating physical symptoms, and referring for assessment. Barriers to addressing distress were lack of training, stigma, workload or lack of time, and limited availability and accessibility of mental health resources. Barriers in addressing suicidality were lack of knowledge and training, patient reluctance to receive care, and lack of protocol. IMPLICATIONS FOR NURSING Developing guidelines for addressing and responding to mental health distress and suicidality is essential to improving patients' quality of life and reducing disease-related morbidity and mortality. Reducing mental healthcare stigma for patients is critical.
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30
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Vandermorris A, Sampson L, Korenblum C. Promoting adherence in adolescents and young adults with cancer to optimize outcomes: A developmentally oriented narrative review. Pediatr Blood Cancer 2020; 67:e28128. [PMID: 31886630 DOI: 10.1002/pbc.28128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/10/2019] [Accepted: 11/25/2019] [Indexed: 01/03/2023]
Abstract
Adherence is a critical consideration in ongoing efforts to improve outcomes among adolescents and young adults (AYAs) with cancer. In this narrative review, we embed existing conceptualizations of adherence within a developmental context to provide a novel vantage point from which to examine this important issue. Applying this developmentally oriented framework, we summarize the most current literature on strategies to enhance adherence in the AYA population. A developmentally informed approach to working with AYAs can elucidate unique strengths and vulnerabilities of this population and offer a new perspective on opportunities to respond to biopsychosocial barriers to adherence in a strengths-based, collaborative manner.
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Affiliation(s)
- Ashley Vandermorris
- Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
| | - Lorna Sampson
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Chana Korenblum
- Princess Margaret Cancer Centre, University Health Network, Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
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31
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The Relationship between Health Disparities, Psychosocial Functioning and Health Outcomes in Pediatric Hematology-Oncology and Stem Cell Transplant Populations: Recommendations for Clinical Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072218. [PMID: 32224963 PMCID: PMC7178256 DOI: 10.3390/ijerph17072218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/09/2023]
Abstract
Not only do racial and ethnic minority children and adolescents with chronic illness experience disparities in health status and health outcomes, they also experience significant healthcare disparities, including differences in healthcare coverage, access to care, and quality of care. It is well known that the interaction between psychosocial functioning, health behaviors and ethnic and racial disparities, ultimately leads to worse health and psychosocial outcomes in pediatric and AYA chronic illness patient populations, including increased rates of morbidity and mortality. Investigating the impact of racial and ethnic factors on health outcomes, and strategies for reducing these disparities, is of the utmost importance, specifically in life-threatening conditions like cancer and sickle cell disease. This commentary underscores the relative importance of identifying factors that could reduce disparities between minority and non-minority populations. This present paper will focus on the dynamic relationships between health disparities, psychosocial factors and health outcomes within pediatric cancer, sickle cell disease and bone marrow transplant populations, and will offer recommendations for healthcare professionals working with these vulnerable patient populations. The primary goal of this commentary is to provide recommendations for enhancing cultural competency and humility for those working with highly vulnerable patient populations.
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32
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When Multiple Objective Measures of Medication Adherence Indicate Incongruent Adherence Results: An Example with Pediatric Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061956. [PMID: 32192028 PMCID: PMC7142654 DOI: 10.3390/ijerph17061956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/14/2020] [Indexed: 12/18/2022]
Abstract
Previous research suggests that children and adolescents with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) often have difficulty adhering to complex treatment regimens during the maintenance phase of therapy. Measurement of treatment adherence can be done via objective (e.g., electronic monitoring (EM), pharmacological assays) or subjective methods (patient, parent, or physician reports). This paper provides an illustration of recommended strategies for comparing discrepancies between two objective measures of medication adherence (e.g., behavioral adherence using electronic monitoring versus pharmacological adherence using 6-mercaptopurine (6MP) metabolite data) within a relatively large cohort of pediatric patients with ALL or LBL (N = 139) who had longitudinal data for both measures of medication adherence over a 15-month period. Additionally, individual- and family-level factors such as gender, socioeconomic status, household environment, and dose intensity will be examined to identify possible sources of discrepancies between adherence measures. This information will provide practical advice for physicians, healthcare providers, and psychologists in identifying nonadherence and the caveats therein so patients achieve the best possible health outcomes.
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33
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Longitudinal Patterns of Social Problem-Solving Skills in an Ethnically Diverse Sample of Pediatric Patients with Cancer and their Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051581. [PMID: 32121378 PMCID: PMC7084745 DOI: 10.3390/ijerph17051581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/16/2022]
Abstract
Pediatric patients with acute lymphoblastic leukemia and lymphoblastic lymphoma are prescribed a daily oral chemotherapy medication named 6-mercaptopurine. Adherence to this medication is vital for survival and decreased risk for disease relapse. Adaptive problem-solving strategies are important for adhering to this complex regimen. This manuscript examined ethnic and racial differences in social problem-solving domains (Social Problem-Solving Inventory) among patients aged 7–19 years old who were diagnosed with cancer; and, their caregivers (N = 139). This was a 15-month longitudinal study. We also examined differences in medication adherence based on behavioral adherence measures. Our study found significant differences between minority and non-minority reporters across multiple social problem-solving domains (p < 0.05). However, there were no significant differences observed for medication adherence. Our findings underscore the importance of implementing culturally sensitive interventions in clinical care that could ultimately positively impact health behaviors, interactions with healthcare providers, and long-term health outcomes.
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McGrady ME, Prosser LA, Thompson AN, Pai ALH. Application of a Discrete Choice Experiment to Assess Adherence-Related Motivation Among Adolescents and Young Adults With Cancer. J Pediatr Psychol 2019; 43:172-184. [PMID: 29049671 DOI: 10.1093/jpepsy/jsx104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/07/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To develop and pilot test a discrete choice experiment (DCE) to assess the specific factors likely to motivate a given adolescent or young adult with cancer to adhere to medications included in treatment protocols. Methods A multimethod and iterative approach was used. Twenty adolescents and young adults with cancer participated in DCE pilot testing and refinement. Hierarchical Bayes was used to estimate attribute and attribute-level preference scores for each participant. Results The final DCE included nine choice sets composed of four attributes. The resulting DCE was modified with feedback from 20 adolescents and young adults (M[SD] age = 18.66 [2.95]) with cancer. The DCE was understandable and relevant. The factors likely to motivate adolescents and young adults with cancer to be adherent differed across individuals. Conclusions DCEs including the measure developed in this manuscript offer a novel approach to understanding individual-level differences critical for informing adherence-promotion efforts.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Lisa A Prosser
- Department of Pediatrics, Child Health Evaluation and Research Center, University of Michigan
| | - Aimee N Thompson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center
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Jammu A, Chasen M, van Heest R, Hollingshead S, Kaushik D, Gill H, Bhargava R. Effects of a Cancer Survivorship Clinic-preliminary results. Support Care Cancer 2019; 28:2381-2388. [PMID: 31489511 DOI: 10.1007/s00520-019-05067-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/28/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Initial investigation of the impact of a Cancer Survivorship Clinic following its introduction in February 2017. METHODS A systematic chart review of 176 patients enrolled in the Cancer Survivorship Clinic (CSC) who completed a minimum of one follow-up visit after the initial baseline visit. This was assessed using three screening tools: distress thermometer (DT), Canadian Problem Checklist (CPC), and Edmonton Symptom Assessment Scale (ESAS). Descriptive statistics and t tests were utilized to assess the impact of the CSC. RESULTS Distress thermometer: Statistically significant decline in scores from the baseline visit to the follow-up visit among the study population (p < 0.05). There was a significant decline in score among high-risk patients with an initial DT≥4 (p < 0.0001). Canadian Problem Checklist: Based on the initial baseline visit, the top five reported causes of distress among the study population include pain, anxiety, fatigue, tingling in hands and feet, sleep. Edmonton Symptom Assessment Scale: Statistically significant decline in reported pain, tiredness, nausea, depression, anxiety, drowsiness, and shortness of breath scores (p < 0.05). CONCLUSIONS Overall, patients had a significant reduction in distress from the baseline visit to the follow-up visit. High-risk patients experienced a more significant reduction in distress. Reduction in patient distress was independent of the number of visits to the clinic. Reported symptom severity for pain, tiredness, depression, anxiety, drowsiness, and shortness of breath also declined significantly following clinic intervention. Further qualitative studies required to establish the clinical significance of study findings. IMPLICATIONS FOR CANCER SURVIVORS Continued active clinical support and education for cancer survivors should be considered a potentially essential element in the cancer treatment trajectory to address patient well-being and distress.
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Affiliation(s)
- Anish Jammu
- Department of Corporate Research, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada
| | - Martin Chasen
- Division of Palliative Care, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada. .,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Family Medicine, McMaster University, Hamilton, ON, Canada. .,The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, Ontario, Canada.
| | - Rardi van Heest
- Division of Palliative Care, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada
| | - Sean Hollingshead
- Division of Palliative Care, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada
| | - Deepanjali Kaushik
- Department of Corporate Research, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada.,Division of Palliative Care, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada
| | - Harprit Gill
- Division of Palliative Care, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada
| | - Ravi Bhargava
- Department of Corporate Research, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada.,Division of Palliative Care, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada.,The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, Ontario, Canada
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Validity and Reliability of the Persian Version of Emotion Thermometers in Iranian Advanced Cancer Patients. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.90504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ham K, Chin S, Suh YJ, Rhee M, Yu ES, Lee HJ, Kim JH, Kim SW, Koh SJ, Chung KM. Preliminary Results From a Randomized Controlled Study for an App-Based Cognitive Behavioral Therapy Program for Depression and Anxiety in Cancer Patients. Front Psychol 2019; 10:1592. [PMID: 31402881 PMCID: PMC6669916 DOI: 10.3389/fpsyg.2019.01592] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/25/2019] [Indexed: 01/02/2023] Open
Abstract
Cancer patients experience various psychological and social difficulties, the most common being depression and anxiety. The purpose of this study was to develop and evaluate the effectiveness of an app-based cognitive behavioral therapy program for depression and anxiety in cancer patients. For this purpose, 63 participants who met the inclusion criteria were randomly assigned to either a mobile-application-based cognitive behavioral therapy program (HARUToday), a simple information-provision mobile-application-based program (HARUCard), or a waitlist control group. Self-report questionnaires including the Beck Depression Inventory, State-Trait Anxiety Inventory, Health-Related Quality of Life Scale, Dysfunctional Attitude Scale, and two computer tasks including the dot-probe task and the Implicit Association Test, were administered before and after 66 days of intervention. The results showed that the Beck Depression Inventory and State-Trait Anxiety Inventory scores of the cognitive behavioral therapy program (HARUToday) group decreased significantly after the intervention compared to the attention control (HARUCard) and waitlist control groups. However, there were no significant changes in scores of the Health-Related Quality of Life Scale and Dysfunctional Attitude Scale, and the two computer tasks. Such results suggest that a mobile-application-based cognitive behavioral therapy program may be an effective intervention for alleviating depression and anxiety, but not the general quality of life of cancer patients. Taking into consideration that psychosocial problems may not the topmost priority for cancer patients who are facing a chronic and possibly mortal disease, a mobile-application cognitive behavioral therapy program may be a possible solution for the alleviation of depression and anxiety in cancer patients who have many restraints in terms of time and space.
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Affiliation(s)
- Kyunghee Ham
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Siyung Chin
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Yung Jae Suh
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Myungah Rhee
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Eun-Seung Yu
- Department of Psychiatry, National Cancer Center, Goyang-si, South Korea
| | - Hyun Jeong Lee
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang-si, South Korea
| | - Jong-Heun Kim
- Department of Psychiatry, National Cancer Center, Goyang-si, South Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Women's Cancer Clinic, Yonsei University College of Medicine, Seoul, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Kyong-Mee Chung
- Department of Psychology, Yonsei University, Seoul, South Korea
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McGrady ME, Pai ALH. A Systematic Review of Rates, Outcomes, and Predictors of Medication Non-Adherence Among Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:485-494. [PMID: 31038372 DOI: 10.1089/jayao.2018.0160] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Nonadherence to medications in cancer treatment protocols may be a particular concern among adolescents and young adults (AYAs) with cancer and predictive of poor health outcomes, but data supporting this claim remain limited. The purpose of this article was to systematically review the rates, outcomes, and predictors of oral medication nonadherence among AYAs with cancer. PubMed (i.e., MEDLINE), CINAHL, and PsycINFO databases were searched in 2018 using terms related to medication adherence and cancer. A total of 37,884 records representing 34,006 unique articles were identified and reviewed. Thirteen articles representing 12 studies met inclusion criteria and examined medication adherence among AYAs with cancer. Results of these studies suggest that 21%-60% of AYAs are nonadherent to oral medications, likely placing them at increased risk for poor health outcomes (i.e., relapse, infection/fever, and death). Psychosocial factors (i.e., knowledge, beliefs about capabilities, beliefs about consequences, environmental context and resources, and emotion) were related to nonadherence and warrant future study. Of note, demographic, disease, and family composition variables did not predict nonadherence. Clinical implications as well as limitations and resulting future directions are discussed.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Linder LA, Wu YP, Macpherson CF, Fowler B, Wilson A, Jo Y, Jung SH, Parsons B, Johnson R. Oral Medication Adherence Among Adolescents and Young Adults with Cancer Before and Following Use of a Smartphone-Based Medication Reminder App. J Adolesc Young Adult Oncol 2018; 8:122-130. [PMID: 30307778 DOI: 10.1089/jayao.2018.0072] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE This study evaluated oral medication adherence among adolescents and young adults (AYAs) with cancer during a trial of a smartphone-based medication reminder application (app). METHODS Twenty-three AYAs receiving at least one prescribed, scheduled oral medication related to their outpatient cancer treatment participated in this 12-week single-group interrupted time series longitudinal design study. Baseline oral medication adherence was monitored using electronic monitoring caps for 4 weeks. Participants then used a medication reminder app and continued to have their oral medication adherence monitored for 8 weeks. Participants completed an electronically administered weekly survey addressing perceived adherence and reasons for nonadherence. RESULTS Four adherence phenotypes were identified using visual graphical analysis of individual participants' weekly adherence: (1) high adherence during the preintervention and intervention periods (n = 13), (2) low preintervention adherence and improved adherence during the intervention period (n = 3), (3) low adherence during both periods (n = 6), and (4) high preintervention adherence and low adherence during the intervention period (n = 1). Growth curve models did not show significant changes in adherence by preintervention versus intervention trajectories (p > 0.05); however, the variance in adherence during the intervention narrowed for more highly adherent AYAs. "Forgetfulness" was the most frequently reported reason for nonadherence. CONCLUSION Although overall adherence did not improve following use of the app, the variance decreased for more highly adherent participants. Additional or alternative interventions are needed for AYAs with persistently poor adherence. Assessment of adherence patterns may support individualized recommendation of tailored interventions.
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Affiliation(s)
- Lauri A Linder
- 1 College of Nursing, University of Utah , Salt Lake City, Utah.,2 Cancer Blood and Transplant Service, Primary Children's Hospital , Salt Lake City, Utah.,3 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah , Salt Lake City, Utah
| | - Yelena P Wu
- 3 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah , Salt Lake City, Utah.,4 Department of Dermatology, University of Utah , Salt Lake City, Utah
| | | | - Brynn Fowler
- 6 Comer Children's Hospital, University of Chicago , Chicago, Illinois
| | - Andrew Wilson
- 1 College of Nursing, University of Utah , Salt Lake City, Utah.,7 Department of Family & Preventive Medicine, University of Utah , Salt Lake City, Utah.,8 Real World Data Services, PAREXEL International Corporation , Waltham, Massachusetts
| | - Yeonjung Jo
- 1 College of Nursing, University of Utah , Salt Lake City, Utah
| | - Se-Hee Jung
- 1 College of Nursing, University of Utah , Salt Lake City, Utah
| | - Bridget Parsons
- 3 Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah , Salt Lake City, Utah
| | - Rebecca Johnson
- 9 Multicare Health System, Mary Bridge Children's Hospital , Tacoma, Washington
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One-minute time interval estimation as a novel ultrashort tool for distress screening. Support Care Cancer 2018; 27:2031-2037. [PMID: 30218189 DOI: 10.1007/s00520-018-4461-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Our study explores the potential relationship between time estimation and level of distress in cancer patients prior to starting chemotherapy. METHODS Time estimation was assessed in 262 chemonaïve patients with solid tumors by evaluating each subject's prospective estimation of how fast 1 min passed compared to the actual time. The median value (40 s) of time estimation was used to stratify the patients into two categories of fast and slow time estimation. The National Comprehensive Cancer Network Distress Thermometer was used at the beginning of treatment to evaluate levels of distress. Patients scoring 4 or above (51.9%) were regarded as having high levels of distress. RESULTS The pattern of the time estimation distributions significantly changed according to the level of distress. Patients with a fast time estimation had significantly higher levels of distress (4.55 ± 3.1) than patients with a slow time estimation (3.3 ± 2.9) (p = 0.001). ROC analysis revealed that at the optimal cutoff value of time estimation, patients with low and high distress levels can be discriminated with an AUC = 0.60 (95% CI: 0.53-0.67, p = 0.005) and with a sensitivity of 62.5% and specificity of 53.2%. Moreover, in a multivariate logistic regression model, fast time estimation was an independent predictor of high levels of distress. CONCLUSION Time estimation is a novel potent indicator of high levels of distress in cancer patients. This test is an easily performed, time-saving, and nonintrusive ultrashort screening tool that is even suitable for patients who are not willing to reveal their level of distress via direct questionnaires.
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Granek L, Nakash O, Ben-David M, Shapira S, Ariad S. Oncologists' Treatment Responses to Mental Health Distress in Their Cancer Patients. QUALITATIVE HEALTH RESEARCH 2018; 28:1735-1745. [PMID: 29973126 DOI: 10.1177/1049732318786479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objectives of this study were to identify how oncologists respond to mental health distress in their patients, what specific strategies they use in treating this distress, and what barriers they report responding to their patients' emotional distress. Twenty-three oncologists at two cancer centers were interviewed. The grounded theory method of data collection and analysis was used. Oncologists varied in their response to patients' emotional distress. Strategies used in responding to patients' distress included creating supportive relationships and prescribing medications, while barriers included patient reluctance, a lack of protocol on how to respond to patients, limited psychosocial resources, and a lack of time. Developing and adopting clear guidelines to addressing mental health distress among cancer patients is critical in assuring quality care for the whole patient and reduce the risk for poor quality of life and potential disease-related morbidity and mortality.
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Affiliation(s)
- Leeat Granek
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ora Nakash
- 2 Smith College, Northampton, Massachusetts, USA
- 3 Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Merav Ben-David
- 4 Tel Aviv University, Tel Aviv, Israel
- 5 Sheba Medical Center, Ramat-Gan, Israel
| | - Shahar Shapira
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Samuel Ariad
- 1 Ben-Gurion University of the Negev, Beer-Sheva, Israel
- 6 Soroka University Medical Center, Beer-Sheva, Israel
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Bail JR, Traeger L, Pirl WF, Bakitas MA. Psychological Symptoms in Advanced Cancer. Semin Oncol Nurs 2018; 34:241-251. [DOI: 10.1016/j.soncn.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Draeger DL, Sievert KD, Hakenberg OW. Analysis of psychosocial stress factors in patients with renal cancer. Ther Adv Urol 2018; 10:175-182. [PMID: 29899758 PMCID: PMC5993071 DOI: 10.1177/1756287218754766] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/31/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The experience of stress in patients with cancer through helplessness and the suppression of emotions correlates with unfavorable disease prognosis. Significant distress can reduce survival probability as well as subjectively perceived poor quality of life. Currently, there are few data on psychological stress in patients with renal cancer and most studies focus on survival time. The aim of the study was to evaluate the psychosocial stress of patients with renal cancer with screening questionnaires for an inpatient psychosocial treatment program. METHODS Patients undergoing inpatient surgical or medical treatment for renal cancer were prospectively assessed for psychosocial stress with two standardized stress screening questionnaires used for the identification of the need for psychosocial care [NCCN Distress Thermometer (NCCN-DT), Hornheider Screening Instrument (HSI)]. RESULTS Seventy-four patients with a mean age of 65 years were assessed. The average NCCN-DT score was 4.8 (scale of 0-10) and did not correlate with tumor stage, sex or prognosis. According to the DT results, 27% of patients were in need of psychosocial care which was significantly higher than the self-reported need. The main stressors were anxiety (32%), pain (27%), nervousness (26%), sadness, worry and sleeping difficulties (20%). CONCLUSIONS There is a significant number of patients with renal cancer with increased psychological distress and a consecutive need for psychosocial care. This is underreported and largely unrecognized by patients as well as physicians and nurses. Easy-to-use assessment tools can be very helpful in identifying patients in need and this information can be used to implement psychological support and thus improve patient care.
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Affiliation(s)
- Désirée Louise Draeger
- Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, Schillingallee 35, 18057 Rostock, Germany
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Psihogios AM, Murray C, Zebracki K, Acevedo L, Holmbeck GN. Testing the Utility of a Bio-Neuropsychosocial Model for Predicting Medical Adherence and Responsibility During Early Adolescence in Youth With Spina Bifida. J Pediatr Psychol 2018; 42:910-921. [PMID: 27831479 DOI: 10.1093/jpepsy/jsw092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/05/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives The present longitudinal, multi-method, and multi-informant study examined biological, neuropsychological, and social predictors of medical adherence and responsibility among early adolescents with spina bifida (SB). Methods Youth with SB (M age = 11.40 at Time 1) and their parents and teachers completed surveys, and families and peers completed observational assessments, at two biennial data collection time points (n = 112 for both time points). Multinomial logistic regressions tested predictors of group membership (adherent vs. nonadherent and child responsible vs. not responsible with SB medical tasks). Results Consistent with the bio-neuropsychosocial model, several risk factors emerged for SB management. Impaired gross motor classification and low IQ were barriers to obtaining medical responsibility, and high family stress and executive dysfunction were barriers to adherence and responsibility. Conclusions This study offered intervention targets to promote self-management and adherence for youth with SB and their families, including parent stress-management and family problem-solving.
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Affiliation(s)
| | | | - Kathy Zebracki
- Shriners Hospitals for Children.,Northwestern University Feinberg School of Medicine
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Hisamura K, Matsushima E, Tsukayama S, Murakami S, Motoo Y. An exploratory study of social problems experienced by ambulatory cancer patients in Japan: Frequency and association with perceived need for help. Psychooncology 2018. [PMID: 29528536 DOI: 10.1002/pon.4703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Little is known about the social problems experienced by cancer patients in non-Western countries. The aims of this study were (1) to explore the characteristics and frequencies of social problems in cancer outpatients, as well as their associations with the need for help, and (2) to take the initial steps to develop an instrument for the assessment of cancer-related social problems in Japan. METHODS A cross-sectional group of 109 patients completed the Social Problem Checklist and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. Participants rated the levels of the problem severity and the need for help on each item. Factor structure, internal consistency, and construct validity were also assessed. RESULTS In total, 72.5% of the participants encountered ≥1 problem, and 33% experienced ≥1 serious problem. The amount of help needed tended to be lower than problem severity, especially for family and social life issues. The most common reason for not needing help, as reported by approximately 40% of patients who experienced problems, was the preference for self-management. A 3-factor model was extracted that included financial matters, medical information, and family and social life. Excellent internal consistencies for each factor and convergent correlations between the relevant subscales of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Social Problem Checklist were confirmed. CONCLUSIONS A substantial proportion of participants had cancer-related social problems, but they had ambivalent help-related needs. Interventions that enhance the patient's abilities for self-care could be essential to help cancer outpatients manage social problems in Japan.
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Affiliation(s)
- Kazuho Hisamura
- Department of Medical Oncology, Kanazawa Medical University, Ishikawa, Japan
| | - Eisuke Matsushima
- Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Shinya Murakami
- Department of Surgery, Komatsu Municipal Hospital, Komatsu, Japan
| | - Yoshiharu Motoo
- Department of Medical Oncology, Kanazawa Medical University, Ishikawa, Japan
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Cancer patients' wish for psychological support during outpatient radiation therapy : Findings from a psychooncological monitoring program in clinical routine. Strahlenther Onkol 2018. [PMID: 29532098 PMCID: PMC6008369 DOI: 10.1007/s00066-018-1288-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer patients frequently suffer from physical and psychosocial impairments due to their disease and its treatment. Psychooncology (PO) can help to cope with stress resulting from outpatient radiotherapy (RT) treatment. There are currently few data regarding patients' wishes for PO support. The aim of this study was to investigate the number of patients with a wish for PO, treatment paths, and predictors of the wish for PO among cancer patients at the beginning of RT. METHODS The results of routine psychological stress screening (Hornheide screening instrument; cut-off ≥ 4) of 944 cancer patients between 2015 and 2017 were analyzed in a retrospective cross-sectional study. Predictors for a wish for PO support were identified by stepwise binary logistic regression, in which sociodemographic and treatment data were included in addition to the screening items. RESULTS Around 20% of patients had above-average stress levels and 13% expressed a wish for PO support (participation rate was approximately 55%). Low emotional wellbeing (OR = 11.3) and lack of social support (OR = 9.4) were strong predictors for this treatment wish. Among patients with pancreatic cancer, head and neck tumors, and hematologic disease, there was a substantial difference between the degree of psychological stress and the wish for treatment. Patients with urological (23.5%) and lung tumors (20.9%) most frequently expressed a wish for PO support. CONCLUSION Patient-reported psychosocial problems were better predictors of a wish for PO support than sociodemographic or clinical data. Stress screening should thus be implemented in clinical routine.
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Granek L, Nakash O, Ariad S, Shapira S, Ben-David M. Oncologists' identification of mental health distress in cancer patients: Strategies and barriers. Eur J Cancer Care (Engl) 2018; 27:e12835. [PMID: 29508452 DOI: 10.1111/ecc.12835] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 11/30/2022]
Abstract
The purpose of this research was to examine oncologists' perspectives on indicators of mental health distress in patients: what strategies they use to identify these indicators, and what barriers they face in this task. Twenty-three oncologists were interviewed, and the grounded theory method of data collection and analysis was used. Oncologists perceived distress to be a normative part of having cancer and looked for affective, physical, verbal and behavioural indicators using a number of strategies. Barriers to identification of mental health distress included difficulty in differentiating between mental health distress and symptoms of the disease, and lack of training. A systematic, time-efficient assessment of symptoms of emotional distress is critical for identification of psychiatric disorders among patients and differentiating normative emotional responses from psychopathology. Clinical bias and misdiagnosis can be a consequence of an ad hoc, intuitive approach to assessment, which can have consequences for patients and their families. Once elevated risk is identified for mental health distress, the patient can be referred to specialised care that can offer evidence-based treatments.
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Affiliation(s)
- L Granek
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - O Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzilya, Israel
| | - S Ariad
- Department of Oncology, Soroka University Medical Center, Ben- Gurion University of the Negev, Beer Sheva, Israel
| | - S Shapira
- Department of Gender Studies, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - M Ben-David
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Radiation Oncology Department, Sheba Medical Center, Ramat-Gan, Israel
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48
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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: 1.0] [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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49
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Tonsing KN, Vungkhanching M. Assessing psychological distress in cancer patients: The use of distress thermometer in an outpatient cancer/hematology treatment center. SOCIAL WORK IN HEALTH CARE 2018; 57:126-136. [PMID: 29135393 DOI: 10.1080/00981389.2017.1402844] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study is to assess the feasibility of the distress thermometer (DT) and the accompanying problem checklist (PC) as a screening tool for psychological distress and the sources of those distress at an outpatient cancer treatment center in Central California. Forty-three patients completed the DT and the PC. Based on a recommended DT cutoff score of 4, patients were classified as "distressed" (>4) and "not-distressed" (<4). Respondents ranged in age from 34 to 87 years (mean = 60.44, SD = 12.05), the majority of whom were female (55.8%). The most common types of cancer diagnosis were breast cancer, followed by blood abnormality (i.e., blood disorders), lung, and bladder cancer. Based on the recommended DT cutoff score, 51% of patients were identified as significantly distressed. Results showed significant difference on DT score between the distressed and not-distressed groups, t(41) = -4.25, p < .001. The most commonly reported sources of distress were in the practical, emotional, and physical domains of the PC list. Routine distress screening can significantly help improve identification of distress and the sources of the distress in cancer patients and enable healthcare professionals to facilitate appropriate psychosocial support and referrals. Implications for practice and research are discussed.
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Affiliation(s)
- Kareen N Tonsing
- a Sociology, Anthropology, Social Work & Criminal Justice , Oakland University , Rochester , MI , USA
| | - Martha Vungkhanching
- b Department of Social Work Education, College of Health and Human Services , California State University , Fresno , CA , USA
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50
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Ohnhäuser S, Wüller J, Foldenauer AC, Pastrana T. Changes in Distress Measured by the Distress Thermometer as Reported by Patients in Home Palliative Care in Germany. J Palliat Care 2018; 33:39-46. [PMID: 29332504 DOI: 10.1177/0825859717751932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To identify changes in distress as reported by patients in a home palliative care program over a 2-week period. METHODS Prospective study in West Germany with consecutive patients cared for at home by a palliative care specialty team. Exclusion criteria were patients under 18 years of age, mentally or physically not able to complete the assessment questionnaires, or unable to comprehend German language. Distress was measured using the distress thermometer (DT); sociodemographic and medical data were collected from the patients' records. RESULTS One hundred three participated in the study (response rate of 69%) and 39 participants completed DT at 2-week follow-up (T1; response rate = 38%; mean age = 67; female = 54.4%; married = 67%; living home with relatives = 60.2%; oncological condition = 91.3%; Karnofsky performance status [KPS] 0-40 = 18.9%, KPS 50-70 = 70.3%, KPS >80 = 10.8%). The mean DT score at the first visit (T0) was 5.9 (2.3), with 82.1% of the participants scoring DT ≥5. At the 2-week follow-up (T1), mean DT score was 5.0 (2.0), with 64.1% scoring DT ≥5, showing a statistically significant difference between T0 and T1. Comparing the single scores at T0 and T1 of each participant, the difference in DT scores was -0.9 (2.27). CONCLUSION The DT is a useful tool for screening severity and changes in psychological distress as well as sources of distress. The DT detected change in self-reported distress within a short treatment period, indicating success or failure of the palliative care treatment approaches.
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Affiliation(s)
- Stefanie Ohnhäuser
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | | | - Tania Pastrana
- 4 Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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