Age differences in cancer-related stress, spontaneous emotion regulation, and emotional distress

Latent profile analysis of self-management and its association with quality of life differences in patients with cancer treated with immune checkpoint inhibitors

Objective

This study aimed to explore latent profiles of self-management ability in patients with cancer treated with immune checkpoint inhibitors, analyze each subgroup's characteristics, and determine the relationship between self-management and quality of life.

Methods

This cross-sectional study included 393 patients treated with immune checkpoint inhibitors. The participants completed questionnaires containing sociodemographic information, the Functional Assessment of Cancer Therapy-Immune Checkpoint Modulator (FACT-ICM), the Cancer Patient Self-management Evaluation Scale, and the Medical Coping Modes Questionnaire. Latent profile analysis was used to examine potential latent groups of self-management. Multivariate logistic regression was used to analyze the sociodemographic variables in each profile. Kruskal-Wallis H-rank sum test was used to explore the relationships between self-management profiles and quality of life.

Results

The self-management abilities of the patients treated with immune checkpoint inhibitors were grouped into three latent profiles: "low self-management" (16.8%), "average self-management-avoidance of information" (44.3%), and "high self-management" (38.9%). The coping modes, educational levels, medical insurances, age, monthly family income per capita, and communication styles with health care professionals post-discharge significantly influenced the distribution of self-management. There were significant differences in the FACT-ICM scores across all three groups, except for the emotional well-being dimension.

Conclusions

The patients with cancer treated with immune checkpoint inhibitors exhibit three distinct self-management profiles. To enhance patients' quality of life, healthcare professionals should develop targeted self-management strategies focusing on information management and communication between patients and healthcare providers.

Managing Rheumatoid Arthritis in Older Adults with Cancer

Rheumatoid arthritis (RA) is a chronic autoimmune condition disproportionately affecting older adults (> 60 years), who often experience increased disease severity and comorbidities, including cancer. A comprehensive review of the literature was conducted, examining the prevalence of malignancy in patients with RA, associated risk factors, and treatment challenges, including management considerations such as psychological distress and lifestyle modifications. Clinical guidelines and consensus statements were summarized to provide practical insights for optimizing care. Older adults with RA are at an elevated risk for developing cancer due to chronic inflammation, immunosenescence from aging, and shared risk factors such as smoking. Patients with RA tend to have poorer cancer survival rates than individuals without RA, particularly for lung cancer and lymphoma. Immunosuppressive therapies used to treat RA may modestly increase cancer risks but are critical for disease control. Current guidelines emphasize discontinuation or adjustment of RA therapies upon cancer diagnosis, with tailored approaches based on cancer type and stage. Non-pharmacologic interventions, including lifestyle modifications and psychological support, play a vital role in improving quality of life and mitigating disease flares during cancer treatment. The management of RA in older adults with a history of cancer requires a personalized, multidisciplinary approach that balances the need for RA symptom control without affecting cancer outcomes. Shared decision-making, incorporating patient preferences and comorbidities, is critical for optimizing care. Further research is needed to strengthen evidence-based guidelines for this population and address gaps in understanding treatment safety and efficacy.

Screening for psychological distress in cancer care: prevalence and predictive factors among Italian patients using the Concerns and Help Identifier for Medical Patients Checklist

PURPOSE

Psychological distress is highly prevalent among cancer patients. Although several scientific and professional organizations developed guidelines and tools for screening, implementation barriers in cancer care persist. Therefore, it seems to be critical to effectively introduce tools and triage systems that can identify patients' source of distress. The study aims to investigate prevalence and predictors of psychological distress experienced by a mixed sample of adult cancer patients using the Italian version of the Concerns and Help Identifier for Medical Patients (CHIMP_C) Checklist, in order to quickly detect distress.

METHODS

In 2023, 240 adult cancer patients undergoing chemotherapy at the Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori "Giovanni Paolo II" in Bari completed the Emotion Thermometers (ET) and the CHIMP_C Checklist. Socio-demographic and clinical factors were collected from medical records. Pearson and Spearman correlations, chi-square tests, and binomial logistic regressions were performed to investigate prevalence and predictors of psychological distress.

RESULTS

Most participants were female (68.3%), with breast cancer being the most common diagnosis (28.7%). Our findings revealed a significant prevalence of distress (49.58%, with DT scores ≥ 5). Notably, emotional and personal concerns emerged as key predictors and risk factors for elevated ET scores.

CONCLUSION

The combined use of the CHIMP_C Checklist alongside the Emotion Thermometers (ET) could suggest a way for clinicians to identify multifaceted factors contributing to psychological distress in cancer patients during active treatment. This approach not only is focused on facilitating the initiation of timely psychological interventions but also can improve patient access to comprehensive therapeutic programs, thereby enhancing overall quality of care.

Prevalence of current suicidal thoughts and lifetime suicide attempts in individuals with cancer and other chronic diseases in Germany: Evidence for differential associations from a representative community cohort

BACKGROUND

Research indicates an elevated risk for suicidal thoughts and behaviors (STBs) among individuals with cancer, but community-based studies on the prevalence of STBs in comparison to the general population and other chronic diseases are lacking.

METHODS

Data was drawn from the representative population-based, prospective Gutenberg Health Study (GHS). Participants (N = 12,382; age: M = 59.5, SD = 10.8; 48.9 % women) completed highly standardized medical assessments and validated questionnaires such as the PHQ-9. In addition to prevalence estimates (stratified by STBs and gender), logistic regression models were calculated (controlling for confounders).

RESULTS

The sample included 1910 individuals with cancer, 8.2 % of whom reported current suicidal thoughts and 2.0 % reported lifetime suicide attempts. There was neither a significant association between a cancer diagnosis and suicidal thoughts (p = .077) nor suicide attempts (p = .17) in models adjusting for age, gender, and income. Other chronic diseases were linked to suicidal thoughts and attempts only in men.

LIMITATIONS

Although the investigation of the two kinds of STB are a strength of the study, the items' different time frames complicate comparisons. In addition, the cross-sectional design limits the ability to understand observed relationships and to identify periods of risk.

CONCLUSION

This study expands the evidence base regarding the vulnerability to STBs in individuals with cancer, including long-term survivors. It highlights their heterogeneity, differential risk factors underlying suicidal thoughts and attempts, and the relevance of other (contextual) factors shaping an individual's susceptibility to suicidal crises.

Death Anxiety in Patients With Advanced Cancer and Their Family Caregivers

CONTEXT

Death anxiety is associated with fears of suffering and uncertainty at the end of life. It is also relevant to patients' family caregivers, who can experience fears about the patients' death and dying.

OBJECTIVES

This study investigates the prevalence of death anxiety in advanced cancer patients and their family caregivers and its association with sociodemographic and medical characteristics.

METHODS

We recruited patients with UICC stage IV solid tumors from in- and outpatient oncology and palliative care settings. We administered the Death and Dying Distress Scale to assess clinically significant death anxiety. We analyzed its association with sociodemographic and medical characteristics using simultaneous multiple linear regression analyses.

RESULTS

Death anxiety was prevalent in 37% of patients (N = 481) and 75% of family caregivers (N = 140). Most frequent death anxiety concerns were "feeling distressed about the impact of one's own death on loved ones" (52% of patients) and "feeling distressed about running out of time with their loved one" (69% of family caregivers). Patients who experienced high death anxiety were more likely to be younger (standardized β = -0.1; P=0.005) and have known about their diagnosis for less time (standardized β = -0.1; P=0.046). Being female predicted higher death anxiety in patients (β = 0.12; P=0.041) and family caregivers (β = 0.32; P=0.002).

CONCLUSION

The results indicate that death anxiety is a common, clinically significant problem in patients with advanced cancer and their family caregivers, emphasizing the need for targeted psychological support.

Deeply Saddening Life Events Play a Carcinogenic Role by Inducing Mutations in ALOX12 and FKBP5 Genes

BACKGROUND/OBJECTIVES

In the past few decades, many studies have been conducted to find out that psychological stress and cancer are closely linked. Moreover, it was reported that stress can induce mutations in gene level. Therefore, in this study we want to examine a relationship between stressful life events, gene mutation and cancer.

METHODS

Stressful Life Experiences Screening (SLES), Hospital Anxiety and Depression Scale (HADS) and the Coping with Stress Style Scale (CSS) were applied to the participants to examine relationship between stress and cancer.

RESULTS

NGS results showed higher level of mutations accumulated on FKBP5 and ALOX12 genes in cancer patients who were exposed to stressful life events. The expression status of ALOX12 and FKBP5 genes on patients with or without cancer and several cancer cell lines demonstrated that both ALOX12 and FKBP5 mRNA levels were downregulated only in cancer patients and cancer cell lines but not in cancer free control groups. Re-created overexpression of the WT-ALOX12 and WT-FKBP5 extremely inhibited cellular growth, cellular invasion in cancer cell lines, tumor growth in xenograft model too.

CONCLUSIONS

Our results indicate that Stressful Life Experiences may induce cancer development by increased somatic mutations in ALOX12 and FKBP5 genes.

Use of Follow-Up Psycho-Oncology Consultations in Urological Cancer after Transition from Inpatient to Outpatient Care

INTRODUCTION

In urological oncology, the physical and psychological effects of cancer and its treatment post-discharge highlight the importance of follow-up psycho-oncology consultations. This study examines their utilisation and identifies predictors in urological cancer patients after inpatient care.

METHODS

A prospective, single-centre clinical observational study was conducted. Inpatients with urological cancer and ≥5 points on the Distress Thermometer and/or request for psycho-oncological support were recruited, offered an initial psycho-oncology consultation, and can attend up to five online or on-site appointments within 3 months of discharge. The following variables were collected: socio-demographics, psycho-oncological baseline documentation (PO-BADO), psychosocial distress (Distress Thermometer with problem list), anxiety and depressive symptoms (GAD-2 and PHQ-2), and performance status (ECOG).

RESULTS

A total of 501 patients were screened, 139 were included, and 108 were analysed. Twenty five patients used psycho-oncological follow-up care (n = 16 online). The final hierarchical model predicting the use of follow-up psycho-oncological support included the two predictors: age (OR 0.93, 95% CI 0.90-0.96) and anxiety (OR 1.60, 95% CI 1.11-2.44).

CONCLUSION

Nearly 1 in 4 urological cancer patients use follow-up psycho-oncology consultations, mostly online. Predictors for this usage are younger age and higher levels of anxiety. To improve care, (1) online services reduce barriers; (2) older patients require support with these services; and (3) screening specifically for depression is crucial to ensure that follow-up appointments are scheduled as a mandatory part of hospitalisation.

INTRODUCTION

In urological oncology, the physical and psychological effects of cancer and its treatment post-discharge highlight the importance of follow-up psycho-oncology consultations. This study examines their utilisation and identifies predictors in urological cancer patients after inpatient care.

METHODS

A prospective, single-centre clinical observational study was conducted. Inpatients with urological cancer and ≥5 points on the Distress Thermometer and/or request for psycho-oncological support were recruited, offered an initial psycho-oncology consultation, and can attend up to five online or on-site appointments within 3 months of discharge. The following variables were collected: socio-demographics, psycho-oncological baseline documentation (PO-BADO), psychosocial distress (Distress Thermometer with problem list), anxiety and depressive symptoms (GAD-2 and PHQ-2), and performance status (ECOG).

RESULTS

A total of 501 patients were screened, 139 were included, and 108 were analysed. Twenty five patients used psycho-oncological follow-up care (n = 16 online). The final hierarchical model predicting the use of follow-up psycho-oncological support included the two predictors: age (OR 0.93, 95% CI 0.90-0.96) and anxiety (OR 1.60, 95% CI 1.11-2.44).

CONCLUSION

Nearly 1 in 4 urological cancer patients use follow-up psycho-oncology consultations, mostly online. Predictors for this usage are younger age and higher levels of anxiety. To improve care, (1) online services reduce barriers; (2) older patients require support with these services; and (3) screening specifically for depression is crucial to ensure that follow-up appointments are scheduled as a mandatory part of hospitalisation.

Association between positive affect, flourishing, quality of life, and psychological distress in allogeneic hematopoietic stem cell transplantation

PURPOSE

To examine the associations between state positive psychological well-being (PPWB) constructs, mood, and quality of life (QOL) in hematopoietic stem cell transplantation (HSCT) survivors.

DESIGN

The study was a secondary analysis of cross-sectional data.

SAMPLE/METHODS

We analyzed self-report data assessing positive affect, flourishing, QOL, depression and anxiety, and PTSD symptoms from 158 allogeneic HSCT recipients at day-100 post-transplant enrolled in supportive care studies.

FINDINGS

Univariate analysis showed that factors associated with greater levels of various state PPWB constructs include older age, disability status, greater social support, and presence of graft-versus-host disease. Multivariate analysis showed that state PPWB constructs-greater levels of positive affect and flourishing-were significantly associated with better QOL and lower PTSD, anxiety, and depression symptomatology.

IMPLICATIONS

Our findings suggest that longitudinal studies are needed to examine the links between state PPWB constructs and HSCT outcomes, which may inform population specific interventions and opportunities to improve outcomes.

Unveiling the Hidden Burden: Exploring the Psychological Impact of Gynecological Cancers and Predictive Modeling of Depression in Southwest China

Objective

To explore the psychological impact of gynecological cancers on middle-aged women in Southwest China and identify the risk factors for moderate to severe depressive symptoms.

Methods

This cross-sectional study included 500 patients from Southwest China, divided into two groups: depression (n = 220) and no depression (n = 280). Data on demographics, clinical characteristics, and socioeconomic factors were collected. We developed a logistic regression model to predict depressive symptoms and assessed its accuracy using the area under the receiver operating characteristic curve (AUC).

Results

The study cohort consisted of 500 middle-aged and young female cancer patients with a median age of 44 years. Significant predictors of depressive symptoms included younger age, higher economic stress levels, and out-of-pocket medical expenses. A comparative analysis showed that 220 patients exhibited depression symptoms, with these patients being generally younger (median age 41 years) compared to those without depression (median age 47 years, p < 0.001). Economic stress was consistently higher in the depression group across all cancer types. Patients with ovarian cancer had a reduced risk of depression compared to those with cervical cancer. The predictive model demonstrated high accuracy in identifying depression risk, with an AUC of 0.888. Internal validation yielded an average AUC of 0.885, and external validation produced an AUC of 0.872, underscoring the model's robustness and reliability. These findings emphasize the complex interplay of demographic, socioeconomic, and clinical factors in the psychological well-being of gynecological cancer patients, highlighting the need for tailored psychological and financial support interventions.

Conclusion

Gynecological cancer patients in Southwest China experience significant psychological challenges, particularly younger women and those facing economic stress. Our predictive model can aid in early identification of those at risk for depression, emphasizing the importance of holistic care. Interventions should focus on both psychological and financial support to improve patient outcomes.

Social support moderates the relationship between emotion regulation and health-related quality of life in cancer patients

The relationship between emotion regulation (cognitive reappraisal and expressive suppression) and HRQoL in cancer patients is currently gaining momentum, yet, no research to date has investigated the nature of this relationship. The purpose of this study was to investigate the moderating role of social support in the relationship between ER and HRQoL in Nigerian cancer patients. Participants included 361 cancer patients (female = 56.79%, mean age = 41.61, SD 15.47) conveniently drawn from the oncology unit of the University Teaching Hospital, Nigeria. They completed the measures of Functional Assessment of Cancer Therapy-General (FACT-G), emotion regulation and Perceived Social Support. The moderated regression analysis via PROCESS procedures for SPSS Version 3 was used for data analysis. The results showed that cognitive reappraisal significantly predicted HRQoL (β = 2.12, t = 4.39, p = .000). Social support also significantly predicted HRQoL (β = .73, t = 4.57, p = .000). Most importantly, social support moderated the relationship between cognitive reappraisal and HRQoL (β = -.034, t= -4.23, p = .000), but not between expressive suppression and HRQoL (β = -.015, t= -1.61, p = .10). The moderation slope revealed that cognitive reappraisal significantly predicted HRQoL particularly at lower and moderate levels of social support. These findings reveal that the effect of emotion regulation on HRQoL depends much on an individual's level of perceived social support. It also means that social support boosted the positive impact of emotion regulation on HRQoL. The findings highlighted the importance of social-support and emotion regulation particularly, cognitive-reappraisal in improving health-related quality of life in cancer patients.

Cross-sectional and longitudinal associations of adherence to WCRF/AICR cancer prevention recommendations with health-related quality of life in breast cancer survivors. Health-EpiGEICAM study

OBJECTIVES

Adherence to healthy lifestyle recommendations has been reported to improve health-related quality of life (HRQL) in breast cancer (BC) patients, but the influence of long-term behavioral changes remains unknown. We evaluated the association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and HRQL both, at BC diagnosis and the change 7-12 years later.

DESIGN

Prospective cohort study.

SETTINGS AND PARTICIPANTS

A total of 406 breast cancer survivors, from the EpiGEICAM study, were recruited in 16 Spanish hospitals.

MEASUREMENTS

Epidemiological, clinical, dietary, physical activity and HRQL information was collected both at recruitment and 7-12 years later. A 7-item score to measure compliance with recommendations was assessed according to the 2018 WCRF/AICR scoring criteria. HRQL was evaluated using SF-36 questionnaire. Linear mixed models for longitudinal data were used to assess the cross-sectional and longitudinal association between adherence score and the physical and mental component summary scores.

RESULTS

At diagnosis, for each unit increase in WCRF/AICR score adherence, the HRQL physical domain increased 0.78 points (95%CI: -0.04 to 1.60; P trend:0.06). The mean change in physical HRQL from diagnosis to follow-up per unit increase in within-subject adherence score was 0.73 points (95%CI: -0.18 to 1.65; P trend: 0.12). For the mental domain, no association was observed with compliance with the recommendations at diagnosis, nor with changes in adherence over time.

CONCLUSIONS

Our results suggest that Increased adherence to WCRF/AICR cancer prevention recommendations over time could contribute to slightly improved long-term physical HRQoL in BC survivors.

The Mediating Role of Resilience in the Relationship Between Hope and Spiritual Well-being in Cancer Patients: A Study From Turkey

BACKGROUND

Cancer is a significant public health concern in the healthcare landscape. Amidst this challenging journey, the levels of hope, spiritual well-being, and resilience in patients with cancer have emerged as pivotal factors influencing the healing process.

OBJECTIVE

This study aimed to evaluate the relationship between hope and spiritual well-being in cancer patients and the mediating role of resilience in the relationship between hope and spiritual well-being levels.

METHODS

This study is a descriptive, cross-sectional, correlational study. The study included 152 cancer patients undergoing treatment. A patient information form, the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-SP-12) Scale, the Dispositional Hope Scale, and the Brief Resilience Scale were used to collect study data.

RESULTS

Positive and meaningful correlations were observed between the Dispositional Hope Scale and FACIT-SP-12, Brief Resilience Scale, and FACIT-SP-12 (r = 0.390, P < .05; r = 0.246, P < .05). Mediation analysis indicated that Brief Resilience Scale scores partially mediated the relationship between the Dispositional Hope Scale and FACIT-SP-12 Scale scores; the indirect effect of hope on spiritual well-being through resilience was 0.351 (P < .05).

CONCLUSION

The study has indicated a direct relationship between hope and spiritual well-being, and resilience partially mediated the relationship between hope and spiritual well-being.

IMPLICATIONS FOR PRACTICE

It is significant to provide psychosocial care to cancer patients to increase their resilience levels and to support their hope and spiritual well-being.

Relationship between self-psychological adjustment and post-traumatic growth in patients with lung cancer undergoing chemotherapy: a cross-sectional study

OBJECTIVES

This study aimed to determine the potential profiles of self-psychological adjustment in patients with lung cancer undergoing chemotherapy, including sense of coherence (SOC) and positive cognitive emotion regulation (PCER). The relationship between these profiles with post-traumatic growth (PTG) and the relevant factors of self-psychological adjustment in different profiles was analysed.

DESIGN

Cross-sectional study.

SETTING

Patients with lung cancer undergoing chemotherapy in China.

PARTICIPANTS

A total of 330 patients with lung cancer undergoing chemotherapy were recruited out of which 321 completed the questionnaires effectively.

METHODS

Latent profile analysis was used to identify self-psychological adjustment classes based on the two subscales of the Sense of Coherence Scale and Cognitive Emotion Regulation Questionnaire. One-way analysis of variance and multinomial logistic regression were performed to examine the subgroup association with characteristics and PTG.

RESULTS

Three latent profiles of self-psychological adjustment were identified: low level (54.5%), high SOC-low PCER (15.6%) and high PCER (29.9%). The results of univariate analysis showed a significant difference in PTG scores among different self-psychological adjustment subgroups (F=11.55, p<0.001). Patients in the high-PCER group were more likely living in urban areas (OR=2.41, 95% CI 1.17 to 4.97, p=0.02), and time since cancer diagnosis was ≥6 months and <1 year (OR=3.54, 95% CI 1.3 to 9.64, p<0.001).

CONCLUSION

This study revealed that most patients with lung cancer undergoing chemotherapy belonged to the low-level group. Three profiles are associated with PTG. There were differences in characteristics between patients treated with chemotherapy for lung cancer in the high-PCER and low-PCER groups. Thus, these profiles provide useful information for developing targeted individualised interventions based on demographic characteristics that would assist PTG in patients with lung cancer undergoing chemotherapy.

Cisplatin induces BDNF downregulation in middle-aged female rat model while BDNF enhancement attenuates cisplatin neurotoxicity

Cancer-related cognitive impairments (CRCI) are neurological complications associated with cancer treatment, and greatly affect cancer survivors' quality of life. Brain-derived neurotrophic factor (BDNF) plays an essential role in neurogenesis, learning and memory. The reduction of BDNF is associated with the decrease in cognitive function in various neurological disorders. Few pre-clinical studies have reported on the effects of chemotherapy and medical stress on BDNF levels and cognition. The present study aimed to compare the effects of medical stress and cisplatin on serum BDNF levels and cognitive function in 9-month-old female Sprague Dawley rats to age-matched controls. Serum BDNF levels were collected longitudinally during cisplatin treatment, and cognitive function was assessed by novel object recognition (NOR) 14 weeks post-cisplatin initiation. Terminal BDNF levels were collected 24 weeks after cisplatin initiation. In cultured hippocampal neurons, we screened three neuroprotective agents, riluzole (an approved treatment for amyotrophic lateral sclerosis), as well as the ampakines CX546 and CX1739. We assessed dendritic arborization by Sholl analysis and dendritic spine density by quantifying postsynaptic density-95 (PSD-95) puncta. Cisplatin and exposure to medical stress reduced serum BDNF levels and impaired object discrimination in NOR compared to age-matched controls. Pharmacological BDNF augmentation protected neurons against cisplatin-induced reductions in dendritic branching and PSD-95. Ampakines (CX546 and CX1739) and riluzole did not affect the antitumor efficacy of cisplatin in vitro. In conclusion, we established the first middle-aged rat model of cisplatin-induced CRCI, assessing the contribution of medical stress and longitudinal changes in BDNF levels on cognitive function, although future studies are warranted to assess the efficacy of BDNF enhancement in vivo on synaptic plasticity. Collectively, our results indicate that cancer treatment exerts long-lasting changes in BDNF levels, and support BDNF enhancement as a potential preventative approach to target CRCI with therapeutics that are FDA approved and/or in clinical study for other indications.

Prognostic awareness and prognostic information preferences among advanced cancer patients in Kenya

BACKGROUND

 Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information.

AIM

 To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya.

SETTING

 Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya.

METHODS

 The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information.

RESULTS

 More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information.

CONCLUSION

 Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya.Contribution: Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.

Is There a Difference in Unmet Supportive Care Needs Between Older and Younger Outpatients Receiving Chemotherapy?

Objective: This study investigated whether there was a difference in unmet supportive care needs between older and younger cancer patients who receive chemotherapy. Background: Physiological, physical, cognitive, and social functions, which play a key role in coping with cancer, are impaired due to aging. Age-related physiological changes and psychosocial factors and comorbid medical conditions make some of the needs of older cancer patients unique and complex. At the heart of meeting these needs lies the concept of supportive care. First step of meeting their needs is to determine these needs. Study Design and Methods: The study was conducted in the Daytime Treatment Unit of the oncology hospital of a university in Ankara, Turkey. The study sample consisted of 93 patients aged 65 years or older and 93 patients under 65 years of age. Both groups were similar in terms of sex, cancer type, and chemotherapy protocols. Data were collected using a Patient Information Form and Supportive Care Needs Scale-Short Turkish Version and analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and Bonferroni correction. Results: Participants had a median total score of 1.92. Their "daily life needs" and "sexuality needs" subscale scores were highest and lowest, respectively. Older patients had lower median total scores than younger patients. Younger patients had higher median "health care and information needs" and "sexuality needs" subscale scores than older patients. Conclusion: Elderly patients reported fewer unmet needs than younger patients. This may be due to age-related cultural factors as they may have difficulty expressing their needs. Implications: Results suggest to focus on the fact that patients' needs change with age and that they have difficulty expressing their needs.

Comparative Study of the Quality of Life and Coping Strategies in Oncology Patients

BACKGROUND

Despite the current data on morbidity and mortality, a growing number of patients with a diagnosis of cancer survive due to an early diagnosis and advances in treatment modalities. This study aimed to compare the quality of life and coping strategies in three groups of patients with cancer and identify associated clinical and sociodemographic characteristics.

METHODS

A comparative study was conducted with outpatients at a public hospital in the state of São Paulo, Brazil. The 300 participants were assigned to three groups: patients in palliative care (Group A), patients in post-treatment follow-up with no evidence of disease (Group B), and patients undergoing treatment for cancer (Group C). Data collection involved the use of the McGill Quality of Life Questionnaire and the Ways of Coping Questionnaire. No generic quality-of-life assessment tool was utilized, as it would not be able to appropriately evaluate the impact of the disease on the specific group of patients receiving palliative care.

RESULTS

Coping strategies were underused. Participants in the palliative care group had poorer quality of life, particularly in the psychological well-being and physical symptom domains. Age, currently undergoing treatment, and level of education were significantly associated with coping scores. Age, gender, income, and the absence of pharmacological pain control were independently associated with quality-of-life scores. Moreover, a positive association was found between coping and quality of life.

CONCLUSION

Cancer patients in palliative care generally report a lower quality of life. However, male patients, those who did not rely on pharmacological pain control, and those with higher coping scores reported a better perception of their quality of life. This perception tended to decrease with age and income level. Patients currently undergoing treatment for the disease were more likely to use coping strategies. Patients with higher education and quality-of-life scores also had better coping scores. However, the use of coping strategies decreased with age.

Socioeconomic Factors Predict Long-Term Quality of Life of Cancer Survivors: An International Survey

INTRODUCTION

Despite advances in cancer treatment, the quality of life (QOL) of survivors varies significantly. We assessed the correlation between socioeconomic factors and long-term QOL in a global cohort of cancer survivors.

MATERIALS AND METHODS

Patients were offered surveys via online support groups. Using the Short Form-12 validated questionnaire, physical QOL (PQOL) and mental QOL (MQOL) well-being were compared to the general population. Socioeconomic factors were assessed with regression analysis for impact on QOL.

RESULTS

Seven hundred eighty two survivors from six continents responded. They were 57 ± 13 y and 68% female, 90.8% White, with 43 distinct cancer diagnoses. All survivors had PQOL and MQOL scores lower than the general population. Lower education level, household income, and non-White race all correlated with reduced PQOL and/or MQOL. Age was negatively correlated with PQOL (r = -0.08, P = 0.03) and positively correlated with MQOL (r = 0.142, P < 0.001). Care at large regional/academic centers was associated with higher MQOL (42 ± 14 versus 38 ± 11, P = 0.005). Age (β = -0.1, P = 0.04), education (β = 1.1, P = 0.005), and income (β = 2.0, P < 0.001) were predictors of PQOL, while age (β = 0.2, P < 0.001), income (β = 1.7, P = 0.002), and community hospital care (β = -3.6, P = 0.013) were predictors of MQOL.

CONCLUSIONS

In a large international survey of cancer survivors, we identified socioeconomic factors and their associations with QOL. Further work should be directed to provide durable support across all socioeconomic classes.

Sleep dysfunction associated with worse chemotherapy-induced peripheral neurotoxicity functional outcomes

PURPOSE

Sleep problems are commonly reported by cancer survivors; however, knowledge of the impact of chemotherapy-induced peripheral neurotoxicity (CIPN) on sleep quality remains limited. In this study, we explored the impact of CIPN on sleep quality, as well as identified clinical characteristics associated with poor sleep quality.

METHODS

Participants were assessed cross-sectionally post-neurotoxic chemotherapy. CIPN severity was graded using a range of questionnaires that assessed CIPN severity and quality of life, as well as neurological grading scales. Sleep quality was assessed using a self-rated questionnaire (Pittsburgh Sleep Quality Index, PSQI). Participants with poor sleep quality were further grouped according to whether sleep impairment was due to CIPN or other factors.

RESULTS

Among 77 participants who reported CIPN, 75% (n = 58) reported poor sleep quality. Of those, 41% (n = 24) reported CIPN as contributing to sleep impairment, while 59% (n = 34) reported other causes. Participants with CIPN-induced sleep impairments had higher CIPN severity across all outcome measures, as well as greater neuropathic pain (all p < 0.05). Furthermore, participants with CIPN-induced sleep impairments reported worse impact of neuropathy on physical and social functioning, as well as emotional well-being (all p < 0.05).

CONCLUSIONS

Participants with CIPN-induced poor sleep quality reported worse scores across all CIPN severity measures. This emphasises the negative impacts of CIPN symptoms on quality of life of chemotherapy-treated patients and highlights the importance of sleep quality assessment in cancer survivors.

Worry and Mindfulness Differentially Impact Symptom Burden Following Treatment Among Breast Cancer Survivors: Findings From a Randomized Crossover Trial

BACKGROUND

Breast cancer survivors often experience many somatic and cognitive side effects resulting from their cancer diagnosis and treatment, including higher rates of pain, fatigue, and memory/concentration problems. Emotion regulation offers opportunities to either enhance or dampen physical health.

PURPOSE

In a secondary analysis of a double-blind randomized controlled trial (RCT) using a typhoid vaccine to assess factors associated with breast cancer survivors' inflammatory responses, we assessed how two specific aspects of emotion regulation, mindfulness, and worry, corresponded to acute changes in focus problems, memory problems, and fatigue along with performance on pain sensitivity and cognitive tasks across two visits among breast cancer survivors.

METHODS

Breast cancer survivors (N = 149) completed two 8.5-hr visits at a clinical research center. Survivors were randomized to either the vaccine/saline placebo or a placebo/vaccine sequence. Worry and mindfulness questionnaires provided data on trait-level emotion regulation abilities. Fatigue, memory problems, and focus difficulties were assessed via Likert scales six times-once before the injections and then every 90 min for 7.5 hr thereafter. Women also completed a pain sensitivity task and several cognitive tasks at each visit.

RESULTS

Findings from this study showed that breast cancer survivors who worried more and were less mindful experienced subjective memory problems, focus problems, and cold pain sensitivity across two visits and irrespective of injection type. Lower mindfulness also corresponded to higher subjective fatigue and hot pain sensitivity and objective ratings. Emotion regulation skills did not predict objective pain sensitivity or cognitive problems.

CONCLUSION

Results from this study highlight the benefits of adaptive emotion regulation in helping mitigate symptoms associated with breast cancer survivorship.

Patient-Reported Outcomes Measurement Information System in patients with gastrointestinal cancer: a scoping review

PURPOSE

The purpose of this study was to identify and evaluate the use of the Patient-Reported Outcomes Measurement Information System in patients with gastrointestinal cancer, as well as provide references for analyzing treatment outcomes, gauging prognostic risk, and assessing clinical symptoms and function in gastrointestinal cancer patients.

METHODS

PubMed, Web of Science, ProQuest, Embase, and CINAHL were systematically searched using keywords and controlled vocabulary through January 2023.

RESULTS

The scoping review collected 30 studies published from 2012 to 2022, including observational studies (n = 21), interventional studies (n = 4), and mixed studies (n = 5). Outcome indicators included mood, pain, fatigue, sleep, the ability to perform activities of daily living, social functioning, and other health problems.

CONCLUSION

Being a self-report questionnaire, the Patient-Reported Outcomes Measurement Information System offers a full assessment of patient's symptoms and quality of life, and accurately captures their actual thoughts, feelings, and experiences. Individuals with gastrointestinal cancer made frequent use of the Patient-Reported Outcomes Measurement Information System to provide an accurate measure of their health status.

Religious attitude, spirituality and mental adjustment in Turkish geriatric oncology patients

AIM

This study was conducted to determine the relationship between religious attitudes and spirituality levels of geriatric oncology patients and their psychological reactions to cancer.

METHODS

The sample consisted of 261 geriatric oncology patients who were inpatients in oncology and hematology clinics of a university hospital. The research was conducted between 30 July 2020 and 26 January 2022. Data were collected using the Mental Adjustment to Cancer (MAC) scale, the Ok-Religious Attitude (ORA) scale, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) scale. The effect of the ORA scale and FACIT-SP scale scores on the MAC scale were analyzed using path analysis.

RESULTS

A positive relationship was found between Spiritual Well-Being and Fighting (β = 0.028, p < 0.001) and Anxious Anticipation (β = 0.024, p < 0.001); a negative relationship was found between Fatalism (β = -0.023, p < 0.001), Helplessness/Hopelessness (β = -0.04, p < 0.001) and Denial/Avoidance (β = -0.026; p < 0.001). A positive relationship was found between Religious Attitude and Fighting Spirit (β = 0.154, p = 0.009) and Anxious Anticipation (β = 0.231, p < 0.001), while a negative relationship was found between Religious Attitude and Despair/Hopelessness (β = -0.413, p < 0.001).

CONCLUSIONS

Patients' religious attitudes and spiritual well-being levels affected their psychological reactions to cancer, increased their "fighting spirit" and their "anxious preoccupation" about the disease, and decreased their helplessness/hopelessness, fatalism, denial and avoidance.

Cisplatin Induces BDNF Downregulation in Middle-Aged Female Rat Model while BDNF Enhancement Attenuates Cisplatin Neurotoxicity

Cancer-related cognitive impairments (CRCI) are debilitating consequences of cancer treatment with platinum agents (e.g., cisplatin) that greatly alter cancer survivors' health-related quality of life. Brain-derived neurotrophic factor (BDNF) plays an essential role in neurogenesis, learning, and memory, and the reduction of BDNF is associated with the development of cognitive impairment in various neurological disorders, including CRCI. Our previous CRCI rodent studies have shown that cisplatin reduces hippocampal neurogenesis and BDNF expression and increases hippocampal apoptosis, which is associated with cognitive impairments. Few studies have reported on the effects of chemotherapy and medical stress on serum BDNF levels and cognition in middle-aged female rat models. The present study aimed to compare the effects of medical stress and cisplatin on serum BDNF levels and cognitive performance in 9-month-old female Sprague Dawley rats to age-matched controls. Serum BDNF levels were collected longitudinally during cisplatin treatment, and cognitive function was assessed by novel object recognition (NOR) 14 weeks post-cisplatin initiation. Terminal BDNF levels were collected ten weeks after cisplatin completion. We also screened three BDNF-augmenting compounds, riluzole, ampakine CX546, and CX1739, for their neuroprotective effects on hippocampal neurons, in vitro . We assessed dendritic arborization by Sholl analysis and dendritic spine density by quantifying postsynaptic density-95 (PSD95) puncta. Cisplatin and exposure to medical stress reduced serum BDNF levels and impaired object discrimination in NOR compared to age-matched controls. Pharmacological BDNF augmentation protected neurons against cisplatin-induced reductions in dendritic branching and PSD95. Ampakines (CX546 and CX1739) but not riluzole altered the antitumor efficacy of cisplatin in two human ovarian cancer cell lines, OVCAR8 and SKOV3.ip1, in vitro. In conclusion, we established the first middle-aged rat model of cisplatin-induced CRCI, assessing the contribution of medical stress and longitudinal changes in BDNF levels with cognitive function. We conducted an in vitro screening of BDNF-enhancing agents to evaluate their potential neuroprotective effects against cisplatin-induced neurotoxicity and their effect on ovarian cancer cell viability.

Quality of life after treatment with immune checkpoint inhibitors for lung cancer; the impact of age

INTRODUCTION

Immune checkpoint inhibitors (ICIs) have revolutionized lung cancer treatment. However, it remains unclear as to whether changes in Health-Related Quality-of-Life (HRQoL) are associated with the age of lung cancer patients treated using ICIs. This study aimed to evaluate this possible association and to compare ICI-treated patients' HRQoL scores with normative data of an age-matched non-cancer general population.

METHODS

Lung cancer patients from the OncoLifeS data-biobank were included if they were treated with ICIs, irrespective of other treatments, at the University Medical Center Groningen between 2015 and 2021 and had completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTCQLQ-C30), both at the start of ICI treatment and after six months. Association of age as a continuous variable (per 10 years) and changes in HRQoL scores between baseline and 6 months was assessed using multivariable regression analyses. Clinical relevance of differences in HRQoL scores between OncoLifeS and the general population was classified into trivial, small, medium, and large, for three age groups (<60, 60-69 and ≥ 70 years).

RESULTS

151 patients were included with a mean age of 65.8 years. An increase in age per 10 years was associated with a larger decrease in the summary HRQoL score(β = -3.28,CI95%-6.42;-0.14), physical(β = -4.8, CI95% -8.71;-0.88), cognitive(β = -4.51,CI95%-8.24;-0.78), role functioning(β = -5.41,CI95%-10.78;-0.05), symptom burden(β = -3.66,CI95%-6.6;-0.73), and smaller negative changes in financial difficulties(β = 6.5 95 % CI 3.16; 9.85). OncoLifeS HRQoL scores were lower than those of the general population and differences were most often classified as large and medium.

CONCLUSION

Older lung cancer patients experience larger deteriorations in most HRQoL domains after 6 months of ICI treatment. Also, these patients showed significantly lower HRQoL scores compared to the general population.

The Effects of Lack of Awareness in Age-Related Quality of Life, Coping with Stress, and Depression among Patients with Malignant Melanoma

Almost one-third of all malignant melanoma patients exhibit emotional stress indicating the need for professional care. Considering this, patients' psychological needs are routinely overlooked and unfulfilled, even though there is substantial evidence that psychological therapies may enhance psychosocial outcomes for melanoma patients, such as low mood, sadness, and anxiety. Among developing countries and some health systems in developed regions, the lack of awareness and screening methods for skin cancer creates a high risk of psychological issues associated with more advanced diseases. Therefore, the current study aimed to investigate and compare the impact of malignant melanoma awareness for screening, prevention, and treatment on the patient's quality of life and coping with stress and depression, based on patients' age. This cross-sectional study recruited 238 patients with malignant melanoma distributed into two groups, Group A patients between 18 and 65 years and Group B patients older than 65. There were no significant gender differences and cancer staging differences between groups, although self-reported depressed mood and anhedonia were significantly more frequent in younger adults with malignant melanoma (43.8% vs. 28.9%). From the unstandardized surveys, it was observed that significantly fewer patients from Group B knew that melanoma could be caused by sun exposure (34.2% vs. 52.2%), and they were less likely to use sunscreen or visit a doctor to evaluate their skin moles (25.9% vs. 14.5%). Elderly patients preferred television as the main source of information, and only 68.4% of patients from Group B were using smart devices. There was a significantly higher physical score on the SF-12 scale among Group A patients, although patients from Group B scored higher in the mental health assessment, and the perceived helplessness on the PSS-10 scale was significantly higher compared to younger adults with melanoma (2.97 vs. 2.71, p-value = 0.036). Lower scores on the physical and mental SF-12 questionnaire determined a higher presence of depressive symptoms (rho = -0.352, respectively rho = -0.273). Higher scores on the DLQI sexual difficulties and treatment difficulties also correlated significantly with the presence of depressive symptoms and anhedonia (rho = 0.341, respectively rho = 0.264). Awareness campaigns for malignant melanoma should focus on the elderly population, too, using the television as the main communication channel. On the other hand, the more informed and knowledgeable group of adults younger than 65 are more likely to experience psychological problems and should be targeted for psycho-oncological aid.

Coping with Stress in Neoplastic Diseases

Introduction: Disease-related stress is a common phenomenon. It also occurs in neoplastic diseases. Since physical and mental health are interrelated, it is important to make sure that treatment covers these two areas. Therefore, it is essential to learn how patients with neoplastic diseases can cope with stress. Materials and Methods: The respondents are 306 patients suffering from neoplastic diseases, associated in patient advocacy groups. The method is the Brief-COPE (Coping Orientation to Problems Experienced) questionnaire. Results: The following stress management strategies were most commonly adopted by the patients: acceptance (median 2.25; 25−75% IQR 2.0−3.0), active coping (median 2.0; 25−75% IQR (interquartile range) 1.5−2.0), planning (median 2.0; 25−75% IQR 2.0−2.0), emotional support (median 2.0; 25−75% IQR 1.5−2.0), instrumental support (median 2.0; 25−75% IQR 2.0−2.0), self-distraction (median 2.0; 25−75% IQR 1.5−3.0), and venting (median 2.0; 25−75% IQR 1.5−3.0). A decision to adopt a particular stress management strategy by patients with neoplastic diseases was highly affected by demographic factors (p < 0.05), such as sex, education, age, place of residence and employment. Conclusions: Teaching stress management strategies should be a part of the education process among patients with neoplastic diseases. Before or in the course of treatment, an oncology patient should be educated on the prevention of mental health disorders. The ability to cope with stress is one of the key competences for the course of neoplastic diseases and it can affect the treatment process. Stress management in chronic diseases, including neoplastic diseases, should be approached not only at the level of an individual person but also at the level of the health system as a whole.

Perceptions of somatic and affective symptoms and psychosocial care utilization in younger and older survivors of lung cancer

OBJECTIVE

Rates of depression identification in oncology settings and referral to psychosocial services remain low. Patients with lung cancer face an elevated risk of depression relative to patients with other cancers. This study explored perceptions of somatic and affective symptoms and psychosocial care utilization among younger and older lung cancer survivors.

METHODS

We conducted in-depth interviews with 20 adults at two academic medical centers in Boston, MA, who had received a lung cancer diagnosis in the past 24 months. A semi-structured interview guide was used to assess experiences with, and perceptions of, depression symptoms and psychosocial services. Interviews were audio-recorded, transcribed, and coded to identify themes. We also explored differences between younger (<65years; N=9) and older (>65years; N=11) patients.

RESULTS

Participants commonly described somatic symptoms (i.e., changes in appetite, sleep, or energy levels) and affective symptoms (i.e., worry, fear, sadness) as side effects of cancer treatment. Older participants more commonly contextualized these symptoms with information about how they impacted daily life. Both younger and older participants faced barriers to accessing psychosocial services, with older adults more commonly referencing stigma of service referral and utilization.

DISCUSSION

Patients with lung cancer associated both somatic and affective symptoms with their cancer and its treatment, with age differences in how symptoms were described and how psychosocial referrals may be perceived. More systematic integration of psychosocial care into cancer care may help to increase the identification of depression in lung cancer and reduce barriers to psychosocial service utilization.

Delineating the role of binge eating in cancer research

PURPOSE

Binge eating is defined as consumption of a large amount of food accompanied by a sense of loss of control over eating. While binge eating is associated with poor physical, behavioral, and psychosocial health, it has not been studied in cancer research. Therefore, the overarching goal of this review is to delineate the role of binge eating in cancer research and to spur new research in this area. Specifically, in this review, we outlined (1) binge eating as a possible risk factor that contributes to cancer risk, (2) how binge eating may develop after cancer diagnosis, and (3) how binge eating may be associated with health and relapse during survivorship.

CONCLUSIONS

It is critical to elucidate the role of binge eating in the prevention of cancer and long-term cancer survivorship. This review suggested a number of ways that binge eating may increase risk for cancer as well as several pathways that may lead to the development of binge eating after cancer diagnosis.

LEVEL OF EVIDENCE

Level V: narrative review.

Unmet need for mental health services in indolent lymphoma: age differences over one-year post-diagnosis

This study examined distress and mental health service use in patients with newly diagnosed indolent lymphoma over the first-year post-diagnosis, as well as differences by age. Patients with indolent lymphoma completed online self-report measure of distress and whether they accessed mental health services (Yes/No) every four months for a total of four surveys. The baseline sample consisted of 74 patients; 41.9% were age 65 years and older, 24.3% endorsed elevated distress, and 16.2% accessed mental health services. Across time, less than half (36.4-46.7%) of distressed patients accessed mental health services. In patients younger than 65 years, a greater proportion of distressed than non-distressed patients accessed mental health services. However, distress was not associated with mental health service use in older adults. Future research should evaluate issues driving distress and access to mental health care in patients with indolent lymphomas, including age-based approaches.