Psychological distress in cancer patients: hypothesis of a distress model

The mental health impacts of receiving a breast cancer diagnosis: A meta-analysis

BACKGROUND

Receiving a breast cancer diagnosis can be a turning point with negative impacts on mental health, treatment and prognosis. This meta-analysis sought to determine the nature and prevalence of clinically significant psychological distress-related symptoms in the wake of a breast cancer diagnosis.

METHODS

Ten databases were searched between March and August 2020. Thirty-nine quantitative studies were meta-analysed.

RESULTS

The prevalence of clinically significant symptoms was 39% for non-specific distress (n = 13), 34% for anxiety (n = 19), 31% for post-traumatic stress (n = 7) and 20% for depression (n = 25). No studies reporting breast cancer patients' well-being in our specific time frame were found.

CONCLUSION

Mental health can be impacted in at least four domains following a diagnosis of breast cancer and such effects are commonplace. This study outlines a clear need for mitigating the impacts on mental health brought about by breast cancer diagnosis. CRD42020203990.

Body image after mastectomy: A thematic analysis of younger women’s written accounts

This study investigated younger women’s body image after mastectomy. In all, 49 women, aged 29–53 years (mean age: 39 years) who had had bilateral ( n = 8) or unilateral ( n = 41) mastectomy responded to open-ended questions online. Inductive thematic analysis revealed that aesthetics were less important than survival between diagnosis and mastectomy. Following mastectomy, women negotiated new body identities. Treatment effects such as weight gain were significant concerns. However, impacts on body confidence varied, and some participants rejected mainstream body shape ideals and reported feeling proud of their scars. Implications for supporting younger women post-mastectomy, including promotion of body acceptance, are discussed.

Influence of socioeconomic status and BMI on the quality of life after mastectomy in Bangladeshi breast cancer patients in a public hospital

OBJECTIVE

Quality of life after diagnosis and during treatment phases of breast cancer varies across individual to individual, country to country and from ethnicity to ethnicity. So factors affecting it are of growing research interest. The aim of the study was to investigate the influence of socioeconomic status and body mass index on the quality of life of breast cancer patients during the phases of treatment-before and after mastectomy.

METHODS

Two hundred and fifty-one women with breast cancer undergoing surgery were interviewed prior to and after mastectomy in National Institute of Cancer Research and Hospital, Dhaka from January 2012 to March 2013 using European Organization for Research and Treatment of Cancer Core Questionnaire (and QLQ-Br23). Socioeconomic factors like educational status, family income, occupation and body mass index were taken as investigating factors against global health status and breast cancer-related factors.

RESULTS

Significant reduction of the scores found that means deterioration of function in the following domains of the quality of life were found such as physical well-being (P = 0.019), emotional well-being (P = 0.035), cognitive status (P = 0.05) and the breast-specific subscales like BRBI (body image), BRBS (breast symptoms), BRAS (arm symptoms); (P = 0.013, 0.103, 0.015) was observed after surgery in lower income group. Worker group expressed also similar effect on the global health status/quality-of-life scales (P = 0.05, 0.043, 0.021) and breast subscales (P = 0.002, 0.027, 0.05), patients with lower body mass index also have a lower score also. Educational status does not affect the two groups. Younger age group patients expressed much distress.

CONCLUSIONS

Improvement of family income, nutritional status and improvement of working environment might have an impact on the improvement of the quality of life of breast cancer patients during the phases of treatment.

Quality of life outcomes in patients with breast cancer

Health-related quality of life is now considered an important endpoint in cancer clinical trials. It has been shown that assessing quality of life in cancer patients could contribute to improved treatment and could even serve as a prognostic factor along with medical parameters. This paper presents a review of quality of life outcomes in patients with breast cancer according to previous descriptive findings. This is a bibliographic review of the literature covering publications that appeared in English language biomedical journals between 1987 and 2008. The search strategy included a combination of the key words quality of life and breast cancer in the titles of published articles. The major findings are summarized and presented under different headings: evaluation of health-related quality of life i) at the time of diagnosis, ii) during treatment, and iii) after the completion of treatment. Breast cancer patients receiving chemotherapy might experience several side-effects and symptoms that have a negative effect on their quality of life. Also adjuvant hormonal therapies were found to have a similar negative impact on quality of life. Psychological distress-anxiety and depression were found to be common among breast cancer patients. Symptoms-pain, fatigue, and insomnia were among the most common symptoms reported. There was quite an extensive body of literature on quality of life in breast cancer patients. These papers have made a considerable contribution to improving breast cancer care.

Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial

Objectives:

This study compares the effects of an integrated yoga program with brief supportive therapy on distressful symptoms in breast cancer outpatients undergoing adjuvant radiotherapy.

Materials and Methods:

Eighty-eight stage II and III breast cancer outpatients were randomly assigned to receive yoga (n = 44) or brief supportive therapy (n = 44) prior to their radiotherapy treatment. Intervention consisted of yoga sessions lasting 60 min daily while the control group was imparted supportive therapy once in 10 days during the course of their adjuvant radiotherapy. Assessments included Rotterdam Symptom Check List and European Organization for Research in the Treatment of Cancer—Quality of Life (EORTC QoL C30) symptom scale. Assessments were done at baseline and after 6 weeks of radiotherapy treatment.

Results:

A GLM repeated-measures ANOVA showed a significant decrease in psychological distress (P = 0.01), fatigue (P = 0.007), insomnia (P = 0.001), and appetite loss (P = 0.002) over time in the yoga group as compared to controls. There was significant improvement in the activity level (P = 0.02) in the yoga group as compared to controls. There was a significant positive correlation between physical and psychological distress and fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, and constipation. There was a significant negative correlation between the activity level and fatigue, nausea and vomiting, pain, dyspnea, insomnia, and appetite loss.

Conclusion:

The results suggest beneficial effects with yoga intervention in managing cancer-and treatment-related symptoms in breast cancer patients.

Quality-of-life: A study on patients of carcinoma breast and its pitfalls in Indian society

BACKGROUND

Traditionally outcomes of treatment have been limited to survival. However, the disease and its treatment may have an impact on Quality-of- Life (QoL). The major concerns for patients of carcinoma breast involved are survival, appearance and a fear of recurrence. In Indian society we may need a separate and modified approach to assess QoL. AIMS #ENTITYSTARTX00026;

OBJECTIVE

The aim of this study was to assess the QoL of patients of carcinoma breast and to ascertaining pitfalls for suitable correction in future studies on Indian patients. MATERIALS #ENTITYSTARTX00026;

METHODS

250 diagnosed patients of carcinoma breast were studied by a questionnaire on physical and psychological parameters. The results were assessed for applicability to our clientele.

RESULTS

We found that majority of patients enjoy a good and non-capacitating QoL. Factors that may contribute to poorer health perceptions and QoL include experiencing a menopausal transition as part of therapy, and feeling more vulnerable after cancer. Overall QoL was better in the older and illiterate patients. Patients with no co morbidity and early stage disease fared better against patients with co morbidities and advanced stage of malignancy. The parameters used in QoL studies in west may not be directly applicable to Indian patients but it does give us a start. We need to adapt to these parameters and draw our conclusion. But there are many methodological challenges inherent in working with our population. Researchers interested in studying our clientele's QoL need to be cognizant of certain issues to ensure high quality results.

Childhood abuse uncovered in a palliative care audit

Objective:

This article aims to highlight potentially high levels of childhood sexual abuse within Cancer and Palliative Care Service users.

Methods:

During a routine audit, data was collated to quantify a perceived high level of disclosure of pre-existing psychological trauma within the palliative care caseload of a Macmillan Children and Families Therapist. Families comprised adults (generally parents or step-parents), one of whom was terminally ill or recently deceased who had direct responsibility for children and young people aged under 20 years old. Each family had at least two members using the service for advice, emotional support or counselling.

Results:

A childhood sexual abuse rate of 33% for women and 10% for men was revealed. Of 59 families, 49% had one or more members who had experienced childhood sexual abuse. In addition a further 9% of adults had experienced severe physical and emotional abuse in childhood. Many families had faced multiple trauma.

Significance of results:

Palliative care clinicians have access to detailed personal and family history during a highly vulnerable transition. While confidentiality is paramount it is essential to develop better data collection methods and raise the profile of childhood sexual abuse as a major contributing factor to morbidity. A whole family assessment is crucial to ensure child protection and emotional care for children facing the loss and subsequently bereaved of a parent or a carer. Clinicians must be able to offer a range of approaches which provide distressed patients with a history of childhood abuse some sense of emotional containment at the end of life, a challenge which cannot be overstated.

Effects of repetitive stress during the acute phase of Trypanosoma cruzi infection on chronic Chagas' disease in rats

The effect of repetitive stress during acute infection with Trypanosoma cruzi (T. cruzi) on the chronic phase of ensuing Chagas' disease was the focus of this investigation. The aim of this study was to evaluate in Wistar rats the influence of repetitive stress during the acute phase of infection (7 days) with the Y strain of T. cruzi on the chronic phase of the infection (at 180 days). Exposure to ether vapor for 1 min twice a day was used as a stressor. Repetitive stress enhanced the number of circulating parasites and cardiac tissue disorganization, from a moderate to a severe diffuse mononuclear inflammatory process and the presence of amastigote burden in the cardiac fibers. Immunological parameters revealed that repetitive stress triggered a reduced concanavalin A induced splenocyte proliferation in vitro with major effects on the late chronic phase. Serum interleukin-12 concentration decreased in both stressed and infected rats in the early phase of infection although it was higher on 180 days post-infection. These results suggest that repetitive stress can markedly impair the host's immune system and enhance the pathological process during the chronic phase of Chagas' disease.

The future in psychosocial oncology: screening for emotional distress – the sixth vital sign

This article explores the possible future of psychosocial oncology. Advancements in treatment and the concomitant increase in survivorship, combined with a highly educated patient population, will result in huge demands on an already strained healthcare system. Role changes and paradigm shifts will be required in order to cope with these challenges. Issues with current treatment silos and fragmented care systems are presented, and the role of a biopsychosocial approach is discussed.

The association of psycho-social factors and survival in head and neck cancer

OBJECTIVE

Update a previous review examining associations between psycho-social factors and survival in head and neck cancer patients.

DATA SOURCES

Searched Cochrane, Psych info and Embase for the period from 1 January 1995 to 1 June 2007, as well as personal and article reference lists and article archives.

STUDY SELECTION

Identified articles assessed by consensus for eligibility using following criteria: survival as outcome measure; psycho-social factors as prognostic indicators; results specifically for head and neck cancer patients, not including oesophageal or thyroid cancer. Seven of 64 articles fulfilled criteria.

DATA EXTRACTION

Data abstracted independently by two reviewers using pre-determined proformas. Quality also rated using Scottish Intercollegiate Guidelines Network 50 tool.

DATA SYNTHESIS

At baseline, expression of intense psycho-social complaints, higher self-perceived physical ability and self-reported high physical functioning were significantly associated with increased survival. Uncertainty about the diagnosis and treatment was found to be a negative prognostic indicator, as was being single, poor cognitive function, baseline fatigue and alcoholism. Overall quality of life and head and neck pain 12 months after date of diagnosis were found to be significantly associated with survival in one study. However, overall quality of life and depression at the time of diagnosis were not.

CONCLUSIONS

There appears to be some association between selected psycho-social factors and long-term survival from head and neck cancer. However this relationship is currently neither strong nor proven, requiring examination by multi centred trials with standardisation of research definitions and methodologies, and examination of post-treatment psycho-social factors.

Relations between different coping strategies for social stress, tumor development and neuroendocrine and immune activity in male mice

This study analyzes the effects of acute social stress and different coping strategies employed in response to it on the development of B16F10 melanoma pulmonary metastases, the activation of the HPA axis and the NKG2D receptor expression. To this end, male OF1 mice were subjected to 24h of social stress using the sensorial contact model. This model includes three 5-min sessions of direct social interaction with resident cagemates selected for consistent levels of aggression. Subjects' behavior was videotaped and assessed. Six days after the first social interaction (1st social stress), the animals were inoculated with tumor cells or vehicle, and six days later, both tumor-bearing and non tumor-bearing mice were subjected to a second 24h sensorial contact social stress session (2nd social stress). One hour after the 2nd social interaction, corticosterone levels and NKG2D receptor expression were determined. Lung metastatic foci numbers were determined 21 days after inoculation (15 days post-stress). Social stress increased the number of pulmonary metastases and the serum corticosterone level. A combination of cluster and discriminant analyses established the existence of two types of coping strategies: (1) a passive-reactive strategy characterized by subjects dedicating a greater percentage of time to submission, flee and avoidance behaviors; and (2) an active-proactive strategy, characterized by subjects dedicating a greater percentage of time to attack and non social exploration behaviors. Subjects belonging to the passive-reactive group were found to have a higher number of tumor foci, a higher level of corticosterone and a lower NKG2D receptor expression than subjects in the active-proactive group. These data indicate the relationship between different coping strategies for social stress and tumor development.

Distress overlaps with anxiety and depression in patients with head and neck cancer

Psychological problems in cancer patients often go unrecognized until they are specifically sought. This is more in patients with depression as they are reluctant to complain about their symptoms. The present study was carried out to evaluate the relation of distress with anxiety and depression in 123 patients with head and neck cancers using Distress Inventory for Cancer version 2 (DIC2) and the Hospital Anxiety and Depression scale (HADS). The mean DIC 2 scores were 24.6 while that of subscales ranged from 2.6 to 11.0. Fifteen patients were found to have clinical caseness for anxiety while 12 (10%) were caseness for depression. Total distress, emotional and social distress subscales were found to have positive correlation with anxiety and depression suggesting a possible overlap of two constructs. In multivariate analysis only belief in god was found to significantly affect the distress. Results of present study suggest significant psychological morbidity in head neck cancer patients undergoing curative treatment. This is the first study reporting on the psychometric properties of distress inventory on cancer version 2 since its validation, the results suggest a possible overlap of two constructs similar to that seen with other tools on distress and this may have major implications for clinical practice.

Early effect of surgery on quality of life in women with operable breast cancer

BACKGROUND

Quality of life (QOL) after a diagnosis of breast cancer varies considerably across individuals. The treatment modality of the patients significantly contributes to their QOL. The present study reports the initial findings on the early effects of surgery in patients with breast cancer.

METHODS

Two hundred and fifty-one women with breast cancer undergoing surgery were interviewed prior to and after the surgery using the Functional Assessment of Cancer Therapy for Breast (FACT-B). Trial Outcome Index (TOI) was calculated besides total and subscale scores. The results were analyzed using paired t-test and two-sample paired Wilcoxon signed rank test. Multivariate analysis was carried out using repeated measures general liner model with 2-way interactions.

RESULTS

Significant reduction in physical well-being (P = 0.001), functional well-being (P = 0.00) and the breast-specific subscale (P = 0.000) was observed after surgery. No significant change was observed in social or emotional well-being. Total FACT scores and TOI too showed significant declines (P = 0.000; and P = 0.000 respectively) on univariate analysis. Multivariate analysis, however, showed no difference in QOL after surgery, but QOL was significantly poor among women undergoing mastectomy.

CONCLUSIONS

Results of the present study indicate no significant change in overall QOL immediately after the surgery, probably reflecting strong family and social support for these women. QOL was significantly better among women undergoing breast conservation compared with mastectomy.

Quality of life determinants in women with breast cancer undergoing treatment with curative intent

BACKGROUND

The diagnosis of breast cancer and its subsequent treatment has significant impact on the woman's physical functioning, mental health and her well-being, and thereby causes substantial disruption to quality of life (QOL). Factors like patient education, spousal support and employment status, financial stability etc., have been found to influence QOL in the breast cancer patient. The present study attempts to identify the determinants of QOL in a cohort of Indian breast cancer patients.

PATIENTS AND METHODS

Functional Assessment of Cancer Therapy-Breast (FACT-B) Version 4 Malayalam was used to assess quality of life in 502 breast cancer patients undergoing treatment with curative intent. The data on social, demographic, disease, treatment, and follow-up were collected from case records. Data was analysed using Analysis of Variance (ANOVA) and multinomial logistic regression.

RESULTS

The mean age of the patients was 47.7 years with 44.6% of the women being pre-menopausal. The FACT-B mean score was 90.6 (Standard Deviation [SD] = 18.4). The mean scores of the subscales were - Physical well-being 19.6 (SD = 4.7), Social well-being 19.9 (SD = 5.3), Emotional well-being 14 (SD = 4.9), Functional well-being 13.0 (SD = 5.7), and the Breast subscale 23.8 (SD = 4.4). Younger women (< 45 years), women having unmarried children, nodal and/or metastatic disease, and those currently undergoing active treatment showed significantly poorer QOL scores in the univariate analysis. However multivariate analysis indicated that the religion, stage, pain, spouse education, nodal status, and distance travelled to reach the treatment centre as indicative of patient QOL.

CONCLUSION

QOL derangements are common in breast cancer patients necessitating the provisions for patient access to psychosocial services. However, because of the huge patient load, a screening process to identify those meriting intervention over the general population would be a viable solution.