Alexithymia and perception of illness in patients with cancer

Prevalence of alexithymia in cancer patients: a systematic review and meta-analysis

PURPOSE

To systematically evaluate the prevalence of alexithymia in cancer patients and to compare the prevalence of alexithymia in different countries, genders, and cancer types.

METHODS

We thoroughly searched PubMed, EMBASE, Web of Science, The Cochrane Library, CINAHL, PsychINFO, China Integrated Knowledge Resource Database, Wanfang Database, Weipu Database, and Chinese Biomedical Database for studies on the prevalence of alexithymia in cancer patients from the inception to April 2, 2023. Based on the Stata 15.0 software package, the prevalence of alexithymia in cancer patients was estimated using a random-effects model in this meta-analysis.

RESULTS

Eighteen studies with a total of 3,196 participants met the eligibility criteria for the meta-analysis. In 18 studies, 37.0% (95% CI: 28.0% - 46.0%) of cancer patients had alexithymia. 13 studies identified that the pooled mean score of alexithymia in cancer patients was 56.91 (95% CI: 54.44% to 59.37%). The prevalence of alexithymia was higher in cancer patients in developing countries (39.7%, 95% CI: 28.7% to 50.7%), males (40.0%, 95% CI: 24.0% to 55.9%), and colorectal cancer patients (47.3%, 95% CI: 21.3% to 93.3%).

CONCLUSIONS

Our study found that the pooled prevalence of alexithymia in cancer patients was 37.0%, and higher in developing countries, males, and patients with colorectal cancer. Understanding the current status of alexithymia in cancer patients, timely identification and treatment by medical practitioners can improve the prognosis of cancer patients.

CLINICAL TRIAL REGISTRATION

The protocol was registered in PROSPERO [CRD42023414665].

Alexithymia, Self-Compassion, Emotional Resilience, and Cognitive Emotion Regulation: Charting the Emotional Journey of Cancer Patients

Cancer's profound impact on emotional well-being necessitates an exploration into the underlying psychological mechanisms influencing depression and anxiety in patients. In this study, we explored the potential role of self-compassion, alexithymia, and cognitive emotion regulation mechanisms in influencing depressive and anxiety symptoms among cancer patients. A total of 151 stage 4 cancer patients participated. Instruments applied included the Beck Depression Scale (BDS), Beck Anxiety Inventory (BAI), Self-Compassion Scale (SCS), Cognitive Emotion Regulation Scale (CERQ), Toronto Alexithymia Scale (TAS), Visual Analogue Scale (VAS), and Brief Psychological Resilience Scale (BRS). The multivariate analysis utilizing the independent variables-SCS, adaptive and maladaptive CERQ, TAS subscales, BRS, and VAS scores-accounted for 39% of the variance seen in BDI (F (8142) = 11.539, p < 0.001). Notably, SCS, adaptive CERQ, and BRS had a negative predictive impact on BDI. Our findings substantiate a statistically significant partial mediatory role of resilience and cognitive emotion regulation in the association between self-compassion and depression. This research accentuates the central role self-compassion, emotional resilience, and cognitive regulation play in the emotional well-being of individuals diagnosed with cancer. Targeted therapeutic interventions focusing on these dimensions may enhance the psychological health of patients, ultimately improving overall treatment outcomes in the oncological setting.

Impact of alexithymia on suicidal ideation among patients with ovarian cancer: a moderated mediation model of self-perceived burden and general self-efficacy

PURPOSE

Suicidal ideation (SI) and alexithymia are common psychological problems among patients with cancer. Studying how alexithymia predicts SI is helpful for its intervention and prevention strategies. The present study aimed to investigate whether self-perceived burden (SPB) mediates the impact of alexithymia on SI and if general self-efficacy moderates the associations of alexithymia with SPB and SI.

METHODS

To measure SI, alexithymia, SPB, and general self-efficacy, 200 patients with ovarian cancer at all stages regardless of the type of treatment completed the Chinese version of the Self-Rating Idea of Suicide Scale, Toronto Alexithymia Scale, Self-Perceived Burden Scale, and General Self-Efficacy Scale in a cross-sectional study. The PROCESS macro for SPSS v4.0 procedure was applied to perform moderated mediation analysis.

RESULTS

SPB significantly mediated the positive impact of alexithymia on SI (a×b = 0.082, 95% confidence interval [CI]: 0.026, 0.157). General self-efficacy significantly moderated the positive association between alexithymia and SPB (β = -0.227, P < 0.001). The mediating role of SPB was gradually reduced as general self-efficacy grew (low: 0.087, 95% CI: 0.010, 0.190; medium: 0.049, 95% CI: 0.006, 0.108; high: 0.010, 95% CI: -0.014, 0.046). Thus, a moderated mediation model involving SPB and general self-efficacy for explaining how alexithymia causes SI was supported.

CONCLUSION

Alexithymia could cause SI by inducing SPB among patients with ovarian cancer. General self-efficacy could attenuate the association between alexithymia and SPB. Interventions aimed at reducing SPB and enhancing general self-efficacy could reduce SI by partially preventing and attenuating the impact of alexithymia.

The Effect and Mechanism of Adverse Childhood Experience on Suicide Ideation in Young Cancer Patients During Coronavirus Disease 2019 (COVID-19) Pandemic

Background and Aim

Coronavirus disease 2019 (COVID-19) is currently prevalent worldwide. This research aimed to explore the effect of adverse childhood experience (ACE) on suicide ideation in young cancer patients during the COVID-19 pandemic. Self-reported questionnaires analyzed the mediating effects of sleep quality, anxiety symptoms, and inflammatory conditions between ACE and suicide ideation.

Materials and Methods

A total of 197 young cancer patients (age 18–40) completed questionnaires and a blood test. Correlation analysis and structural equation model were used to explore the relationships between ACE, sleep quality, anxiety symptom, serum C-reactive protein (CRP) levels and suicide ideation. The mediating roles of sleep quality, anxiety symptoms, and CRP levels on the influence of ACE on suicide ideation were explored.

Results

ACE was positively related to anxiety symptoms, CRP levels, and suicide ideation, and negatively related to sleep quality. Anxiety symptoms and CRP levels were positively related to suicide ideation, while sleep quality was negatively related to suicide ideation. Anxiety symptoms were positively related to CRP levels but negatively related to sleep quality. From these results, we found ACE affected suicide ideation directly and was mediated by roles sleep quality, anxiety symptom and CRP.

Conclusion

ACE not only directly affected suicide ideation but also affected suicide ideation through sleep quality, anxiety symptoms, and inflammatory conditions in young cancer patients during the COVID-19 pandemic. Therefore, targeted intervention and help for cancer patients from the perspective of ACE should be put into practice.

Alexithymia in Family Caregivers of Advanced Cancer Patients Is Associated with High Personalized Pain Goal Scores: A Pilot Study

Background: Alexithymia, or difficulty identifying and describing emotions and sensations, contributes to an increased risk of chronic pain, and low help-seeking. Objective: To investigate whether family caregivers of advanced cancer patients visiting a palliative care department had alexithymia, and whether this was related to their pain intensity, personalized pain goals, and help-seeking for chronic musculoskeletal pain. Design: A single-center cross-sectional survey. Measurements: Pain intensity was evaluated using a numerical rating scale. Pain improvement was evaluated against personal goals. Alexithymia was assessed using the Toronto Alexithymia Scale-20 (TAS-20), and anxiety and depression using the Hospital Anxiety and Depression Scale. Setting/Subjects: Of 320 family caregivers visiting the palliative care department, 152 (47.5%) had chronic musculoskeletal pain; all 152 were included in the study. Results: Alexithymia was observed in 36.2% of participants. Participants with higher scores on the TAS-20 tended to have higher pain intensity scores and personal pain goal scores. TAS-20 score had the strongest correlation with personal pain goals, with a correlation coefficient of 0.555 (p < 0.001). Conclusions: Pain intensity in family caregivers with alexithymia tended to be high. These participants set higher personal pain goals (lower goals for symptom improvement) than those without alexithymia. We found no difference in personal pain goal response between family caregivers with and without alexithymia. When we examine pain in family members with alexithymia who are caring for cancer patients, we need to recognize that they may set higher personal pain goals and seek less help.

Influence of Selected Biomarkers on Stress and Alexithymia in Patients Under Hemodialysis Treatment

Background

Hemodialysis treatment and the high stress brought about by the treatment are the circumstances which set the background for alexithymia. Alexithymic feelings basically emerge as restriction in the world of emotion and thought, and the inability to recognize physiological changes. Biomarkers that are indicators of physical change are influential in the stress lives of individuals. This research was carried out to discover the relationships between, and to determine the influence of urea, creatinine, sodium, potassium, hemoglobin, hematocrit, albumin, calcium, phosphorus and C-reactive protein biomarkers on stress and alexithymia in individuals, who are diagnosed with chronic renal failure and receive hemodialysis treatment.

Methods

The research environment was formed of patients who underwent hemodialysis treatment in a hospital in Turkey. The subject group was comprised of 72 individuals. Demographic data form, biomarker list form, Hemodialysis Stressor Scale and Toronto Alexithymia Scale were used in the research.

Results

It was found that the levels of perceived stress of individuals who participated in the research were high at all dimensions, and 59.7% were alexithymic. The means of the total scale scores of all patients were calculated as 87.81 ± 13.59 for Hemodialysis Stressor Scale and 62.46 ± 9.84 for Toronto Alexithymia Scale. The relationship between the Toronto Alexithymia Scale and Hemodialysis Stressor Scale and selected biomarkers were determined (P < 0.05).

Conclusion

It was concluded that stress and alexithymic feelings were high in patients who received hemodialysis treatment, and that there is a relationship between C-reactive protein, creatinine, sodium, hemoglobin, hematocrit, potassium from the biomarkers and the scales and scale sub-dimensions. It is necessary to increase the awareness of nurses on the importance of the skills to communicate with individuals who have to cope with stress, manage emotions, and have high stress and emotional deprivation.