Anxiety and depression among cancer survivors: the role of engagement with sources of emotional support information

Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority

PURPOSE

This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors.

METHODS

Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann-Whitney U test and Kruskal-Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score.

RESULTS

One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z =  - 15.939, P < 0.001) and EQ-VAS scores (Z =  - 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z =  - 1.610, P = 0.107), but the difference was not statistically significant.

CONCLUSION

Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.

"I Want to Be Alone, but I Don't Want to Be Lonely": Uncertainty Management Regarding Social Situations among College Students with Social Anxiety Disorder

Individuals with social anxiety disorder (iSAD) experience adverse outcomes in daily life due to the disorder (e.g., lower educational and work achievement compared to their healthy counterparts). They are prone to social isolation, even though they desire intimate interpersonal relationships. Yet, little research on iSAD is devoted to understanding in detail a) when they interpret social situations as social-anxiety-provoking, b) how this interpretation motivates their assessments of their efficacy and likely interaction outcomes, and c) how they choose specific information-seeking strategies in uncertain social situations. Leveraging the theory of motivated information management (TMIM) and the emotional systems (ES) model, we explored the lived experiences of iSAD. We conducted in-depth interviews (N = 27) and analyzed them using thematic analysis. iSAD perceived discrepancies in a) mutual goals, b) common ground, and c) self-image as social-anxiety-provoking. These interpretations motivated their assessments of a) socializing benefits, b) communication competency, and c) interactant partner's amiability, which led to a mix of information-seeking decisions in social situations. Practical and theoretical implications for future research are discussed.

The relationship between personality traits of cancer patients and their preferences when receiving bad news

OBJECTIVE

This study aimed to determine the relationship between the personality traits of cancer patients and their preferences when receiving bad news.

METHODS

In this descriptive correlational study, 200 cancer patients who were selected by the continuous sampling method participated. Patients self-reportedly completed the demographic and medical information questionnaire, the Measure of Patients' Preference (MPP) scale, and the short form of the Eysenck Personality Inventory (EPI).

RESULTS

The majority of participants were female (73%), 42.5% had higher education, and 47.5% suffered from breast cancer. In this study, the mean scores of extraversion and neuroticism in patients were 14.59 ± 2.47 and 15.17 ± 3.43, respectively. Regarding patients' preferences for receiving bad news, the score obtained by them in the content category was greater compared to two categories of context and support. This study showed a significant and negative correlation between neuroticism and patients' preferences in the support category (P < 0.001 and r =  - 0.265). Regarding the categories of the MPP, there was a significant relationship between gender (P = 0.018) and marital status (P = 0.049) with context category, education (P = 0.011) with content category, and marital status (P = 0.003) and employment (P = 0.009) with support category.

CONCLUSION

Personality traits and demographic characteristics of cancer patients can influence their preferences for receiving bad news. Therefore, the consideration of these traits by health care team members is of particular importance to communicate with and deliver bad news to patients.

The mediating role of unmet needs in the relationship between displacement and psychological adjustment: A study of cancer survivors from a Portuguese island region

PURPOSE

The present study aims to explore whether the association between previous displacement to mainland Portugal to perform cancer therapy and current psychological adaptation is mediated by cancer survivors' unmet needs in terms of their emotional experience, financial concerns, access and continuity of care, and relations with others.

METHOD

This cross-sectional study included a sample of 173 cancer survivors from the Azores archipelago (Portugal) recruited from a local oncological health unit. Participants completed a sociodemographic and clinical questionnaire and self-report measures assessing their unmet needs and psychological adaptation. Two parallel multiple mediation models were tested.

RESULTS

Azorean cancer survivors live with unmet needs, especially emotional needs (M = 16.68, SD = 10.78). Displacement was indirectly associated with both anxious (indirect effect = 0.58, SE = 0.27, 95% Bias Corrected and accelerated Confidence Interval = [0.05, 1.15]) and depressive symptomatology (indirect effect = 0.36, SE = 0.17, 95% Bias Corrected and accelerated Confidence Interval = [0.03, 0.84]) through unmet emotional needs.

CONCLUSION

Previous displacements seem to play an important role in the way cancer survivors adapt to survivorship by contributing to higher levels of unmet emotional needs. These findings can provide a scientific and clinical contribution to other isolated or island regions in the world where survivors face similar constraints.

A smartphone-based support group for alcoholism: Effects of giving and receiving emotional support on coping self-efficacy and risky drinking

The purpose of this study was to investigate the nature and effects of exchanging emotional support via a smartphone-based support group for patients with alcohol dependence. Of the 349 patients who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for alcohol dependence, 153 patients participated in the discussion group within the Addiction-Comprehensive Health Enhancement Support System, a smartphone application aimed at reducing relapse. This was developed to prevent problem drinking by offering individuals in recovery for alcohol dependence automated 24/7 recovery support services and frequent assessment of their symptom status as part of their addiction care. The results showed that receiving emotional support from health care providers improved coping self-efficacy. Giving emotional support and receiving emotional support from health care providers acted as a buffer, protecting patients from the harmful effects of emotional distress on risky drinking. Clinicians and researchers should use the features of smartphone-based support groups to reach out to alcoholic patients in need and encourage them to participate in the exchange of emotional support with others.

Coping in Patients With Incurable Lung and Gastrointestinal Cancers: A Validation Study of the Brief COPE

CONTEXT

Patients with incurable cancer engage in several coping styles to manage the impact of cancer and its treatment. The Brief COPE is a widely used measure intended to capture multiple and distinct types of coping. The Brief COPE has not been validated among patients with incurable cancer.

OBJECTIVES

We sought to validate seven subscales of the Brief COPE in a large sample of patients newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers (N = 350).

METHODS

Participants completed the Brief COPE and measures assessing quality of life (QOL) (Functional Assessment of Cancer Therapy-General) and psychological distress (Hospital Anxiety and Depression Scale) within eight weeks of diagnosis of incurable cancer. We evaluated the psychometric properties of the Brief COPE using a confirmatory factor analysis and tests of correlation with the QOL and distress scales.

RESULTS

The Brief COPE factors were consistent with the original subscales, although the Behavioral Disengagement Scale had low internal consistency. Factors showed anticipated relationships with QOL and distress measures, except emotional support coping, which was correlated with increased depression and anxiety. We also conducted an exploratory high-order factor analysis to determine if subscales' score variances grouped together. The high-order factor analysis resulted in two factors, with active, emotional support, positive reframing, and acceptance loading onto one factor and denial and self-blame loading onto the second.

CONCLUSION

The selected subscales of the Brief COPE are appropriate measures of coping among individuals newly diagnosed with incurable lung and gastrointestinal cancers.

Effects of occupational therapy on quality of life of patients with metastatic prostate cancer. A randomized controlled study

OBJECTIVES

To evaluate the efficiency of occupational therapy relative to a home program in improving quality of life (QoL) among men who were treated for metastatic prostate cancer (MPC).

METHODS

Fifty-five men were assigned randomly to either the 12-week cognitive behavioral therapy based occupational therapy (OT-CBSM) intervention (treatment group) or a home program (control group) between March 2012 and August 2014 in the Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey. The Canadian Occupational Performance Measure (COPM) was used to measure the occupational performance and identify difficulties in daily living activities. The QoL and symptom status were measured by The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 and its Prostate Cancer Module. A 12-week OT-CBSM intervention including client-centered training of daily living activities, recreational group activities, and cognitive behavioral stress management intervention were applied.

RESULTS

The COPM performance and satisfaction scores, which indicate occupational participation and QoL increased statistically in the treatment group in relation to men who were included in the home-program (p less than or equal to 0.05).

CONCLUSION

A 12-week OT-CBSM intervention was effective in improving QoL in men treated for MPC, and these changes were associated significantly with occupational performance.

Exploring views on what is important for patient-centred care in end-stage renal disease using Q methodology

BACKGROUND

This study aimed to explore views on what is considered important for Patient-Centred Care (PCC) among patients and the healthcare professionals treating them in a haemodialysis department.

METHODS

Interviews were conducted among 14 patients with end-stage renal disease receiving dialysis and 12 healthcare professionals (i.e. 2 doctors, 4 staff members, and 6 nurses) working at a haemodialysis department. Participants were asked to rank-order 35 statements representing eight dimensions of PCC previously discussed in the literature. Views on PCC, and communalities and differences between them, were explored using by-person factor analysis.

RESULTS

Four views on what is important for PCC in end-stage renal disease were identified. In viewpoint 1, listening to patients and taking account of their preferences in treatment decisions is considered central to PCC. In viewpoint 2, providing comprehensible information and education to patients so that they can take charge of their own care is considered important. In viewpoint 3, several aspects related to the atmosphere at the department were put forward as important for PCC. In viewpoint 4, having a professional or acquaintance that acts as care coordinator, making treatment decisions with or for them, was considered particularly beneficial. All views agreed about the relative importance of certain PCC dimensions; the patient preferences and information and education dimensions were generally considered most important, while the family and friends and the access to care dimensions were considered least important.

CONCLUSIONS

The four views on PCC among patients in a haemodialysis department and the professionals treating them suggest that there is no one size fits all strategy for providing PCC to patients with end-stage renal disease. Some patients may benefit from educational interventions to improve their self-management skills and place them in charge of their own care, whereas other patients may benefit more from the availability of a care coordinator to make decisions for them, or with them. Furthermore, our results suggest that not all eight dimensions of PCC need to be given equal consideration in the care for patients with end-stage renal disease in order to improve patient outcomes.

Psychosocial issues in colorectal cancer survivorship: the top ten questions patients may not be asking

Advances in colorectal cancer screening and treatment have increased survivorship significantly in recent years. This has led to an increased emphasis on the need for continuing patient care long after cancer treatment is completed. Colorectal cancer survivors may face a number of psychosocial issues following treatment, including cancer-related distress, adjustment to physical changes following treatment, and challenges related to returning to work. Although there are many resources available to assist with these challenges, many patients may not seek this information from their providers during follow-up care visits. This article highlights some of the most common patient concerns related to survivorship in colorectal cancer and serves as a reminder to ask about these concerns throughout the course of treatment and follow-up care.

Potential spillover educational effects of cancer-related direct-to-consumer advertising on cancer patients' increased information seeking behaviors: results from a cohort study

Spillover effects of exposure to direct-to-consumer advertising (DTCA) of cancer treatments on patients' general inquiry about their treatments and managing their illness are not well understood. This study examines the effects of cancer patients' exposure to cancer-related DTCA on subsequent health information seeking behaviors from clinician and non-clinician sources (lay media and interpersonal contacts). Using a longitudinal survey design over 3 years, data was collected from cancer survivors diagnosed with colorectal, breast, or prostate cancer who were randomly sampled from the Pennsylvania Cancer Registry. Study outcome measures include patients' information engagement with their clinicians and information seeking from non-medical sources about cancer treatment and quality of life issues, measured in the second survey. The predictor variable is the frequency of exposure to cancer-related DTCA since diagnosis, measured at the round 1 survey. The analyses utilized lagged-weighted multivariate regressions and adjusted for round 1 levels of patient-clinician engagement, information seeking from nonmedical sources, and confounders. Exposure to cancer-related DTCA is associated with increased levels of subsequent patient-clinician information engagement (B = .023, 95% CI = .005-.040, p = .012), controlling for confounders. In comparison, exposure to DTCA is marginally significant in predicting health information seeking from non-clinician sources (B = .009, 95% CI = -.001-.018, p = .067). Cancer-related DTCA has potentially beneficial spillover effects on health information seeking behaviors among cancer patients. Exposure to DTCA predicts (a little) more patient engagement with their physicians.

An analysis of the association between cancer-related information seeking and adherence to breast cancer surveillance procedures

BACKGROUND

Breast cancer surveillance is important for women with a known history of breast cancer. However, relatively little is known about the prevalence and determinants of adherence to surveillance procedures, including associations with seeking of cancer-related information from medical and nonmedical sources.

METHODS

We conducted a longitudinal cohort study of breast cancer patients diagnosed in Pennsylvania in 2005. Our main analyses included 352 women who were eligible for surveillance and participated in both baseline (~1 year after cancer diagnosis) and follow-up surveys. Outcomes were self-reported doctor visits and physical examination, mammography, and breast self-examination (BSE) at 1-year follow-up.

RESULTS

Most women underwent two or more physical examinations according to recommended guidelines (85%). For mammography, 56% of women were adherent (one mammogram in a year) while 39% reported possible overuse (two or more mammograms). Approximately 60% of respondents reported regular BSE (≥ 5 times in a year). Controlling for potential confounders, higher levels of cancer-related information seeking from nonmedical sources at baseline was associated with regular BSE (OR, 1.52; 95% CI, 1.01-2.29; P, 0.046). There was no significant association between information-seeking behaviors from medical or nonmedical sources and surveillance with physical examination or mammography.

CONCLUSIONS

Seeking cancer-related information from nonmedical sources is associated with regular BSE, a surveillance behavior that is not consistently recommended by professional organizations.

IMPACT

Findings from this study will inform clinicians on the contribution of active information seeking toward breast cancer survivors' adherence to different surveillance behaviors.