Anxiety and depression in patients with lung cancer before and after diagnosis: findings from a population in Glasgow, Scotland

Implementation and Effectiveness of a Veterans Affairs-Based Comprehensive Lung Cancer Survivorship Program

PURPOSE

Few programs exist to address persistent impairment in functional status, quality of life, and mental health in lung cancer survivors. We aimed to determine whether a 12-wk multimodal survivorship program imparts clinical benefit.

METHODS

Any patient at the Durham Veterans Affairs Medical Center with lung cancer and a Karnofsky score of ≥60 could participate. Chronic obstructive pulmonary disease medications were optimized at the enrollment visit. Participants with a Hospital Anxiety and Depression Scale (HADS) score of >8 were offered pharmacotherapy and mental health referral. Participants did home-based exercise with a goal of 1 hr/d, 5 d/wk. They were called weekly to assess exercise progress and review depression/anxiety symptoms. Participants were offered pharmacotherapy for smoking cessation.

RESULTS

Twenty-three (50%) of the first 46 enrollees completed the full 12-wk program. Paired changes from enrollment to completion (mean ± SD) were observed in 6-min walk test (73.6 ± 96.9 m, P = .002), BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise) index (-1.45 ± 1.64 points, P < .001), Duke Activity Status Index (3.84 ± 7.12 points, P = .02), Fried Frailty Index (-0.588 ± 0.939 points, P = .02), modified Medical Research Council dyspnea scale (-0.619 ± 1.284 points, P = .04), Functional Assessment of Cancer Therapy-Lung Emotional subscale score (1.52 ± 2.96 points, P = .03), HADS total score (-2.63 ± 4.34 points, P = .02), and HADS Anxiety subscale score (-1.47 ± 2.29 points, P = .01).

CONCLUSIONS

A comprehensive Lung Cancer Survivorship Program provides clinically meaningful improvements in functional status, quality of life, and mental health.

Psychiatric Symptoms in Oncological Patients at Nuclear Medicine Department

Objective: In the process of PET/CT scanning, patients go through a general evaluation while their medical history is being taken, but it is often overlooked that these patients should be evaluated not only biologically but also bio psychosocially. Psychiatric symptom profiles and help-seeking behaviours of cancer patients were examined in this study. Methods: Cancer patients presented to nuclear medicine clinic filled out sociodemographic data form, psychiatric admission evaluation form, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Symptom Checklist-90 (SCL-90) form for psychiatric symptom screening. Results: In this study 27.8% of the patients had a Beck Depression score ≥18 and were in the risk group for depression, 31.7% of the patients experienced moderate or severe anxiety symptoms. Beck Depression Total and Beck Anxiety Total values were found significantly higher in women than in men. Only 10,2% of the cancer patients reported that they sought psychiatric help in the last 6 months. Among the patients who were risky for depression according to BDI only 25%  had been receiving psychiatric help and in among the patients who were risky for anxiety according to BAI only %26.9 had been receiving psychiatric help Conclusion: Nuclear Medicine physicians' interest in psychiatric symptoms and help-seeking behaviors of cancer patients referred to Nuclear Medicine Clinics is very important in terms of psycho-oncology.

Optimal communication associated with lower risk of acute traumatic stress after lung cancer diagnosis

PURPOSE

The aim of this study was to assess the role of the patient's background and perceived healthcare-related factors in symptoms of acute stress after lung cancer diagnosis.

METHODS

The study population consisted of 89 individuals referred for diagnostic work-up at Landspitali National University Hospital in Iceland and subsequently diagnosed with lung cancer. Before diagnosis, the patients completed questionnaires on sociodemographic characteristics, pre-diagnostic distress (Hospital Anxiety and Depression Scale), social support, and resilience. At a median of 16 days after diagnosis, the patients reported symptoms of acute stress on the Impact of Event Scale-Revised (IES-R) and experience of communication and support from healthcare professionals and family during the diagnostic period.

RESULTS

Patients were on average 68 years and 52% reported high levels of post-diagnostic acute stress (IES-R > 23) while 24% reported symptoms suggestive of clinical significance (IES-R > 32). Prior history of cancer (β = 6.7, 95% CI: 0.1 to 13.3) and pre-diagnostic distress were associated with higher levels of post-diagnostic acute stress (β = 8.8, 95% CI: 2.7 to 14.9), while high educational level (β = - 7.9, 95% CI: - 14.8 to - 1.1) was associated with lower levels. Controlling for the abovementioned factors, the patients' perception of optimal doctor-patient (β = - 9.1, 95% CI: - 14.9 to - 3.3) and family communication (β = - 8.6, 95% CI: - 14.3 to - 2.9) was inversely associated with levels of post-diagnostic acute stress after lung cancer diagnosis.

CONCLUSIONS

A high proportion of patients with newly diagnosed lung cancer experience high levels of acute traumatic stress of potential clinical significance. Efforts to improve doctor-patient and family communication may mitigate the risk of these adverse symptoms.

Relationship Between Nutritional Status and Quality of Life in Patients with Lung Cancer

Introduction

Malnutrition is often co-occur in patients with advanced cancer and are associated with poorer response to treatment therapy and decrease significantly the quality of life (QoL). There is little evidence regarding the relationship between nutritional status and QoL in this patient group.

Purpose of the Study

To assess the relationship between nutritional status and QoL in patients with lung cancer.

Methods

Our cross-sectional, descriptive study included 310 patients. Only standardized instruments were used to perform the study: Mini Nutritional Assessment (MNA) to assess nutritional status and The European Organization for Research and Treatment of Cancer Quality of Life Core-30 (EORTC-QLQ-C30) and Lung Cancer-13 (LC-13) to assess the QoL.

Results

The mean age in the study group was 63.77±9.43. 18.71% of patients were malnourished 44.19% at risk of malnutrition and 37.1% of patients had normal nutritional status. Clinical characteristics showed that 75% of respondents had been diagnosed with non-small-cell lung carcinoma, with an average duration of illness of 1–2 years. Nearly all patients received symptomatic treatment, and one in two had undergone surgery. At subsequent stages, QoL was analyzed in three groups depending on nutritional status risk. Malnourished patients had a lower quality of life and greater severity of cancer symptoms than those with a normal nutritional status (p<0.001). In regression analysis, nutritional status has a significant impact on all QLQ-C30 functional scales. Regression parameters are positive, indicating that better nutritional status is associated with better functioning in specific QLQ domains.

Conclusion

A considerable proportion of lung cancer patients are either malnourished or at risk of malnutrition. Malnutrition correlates negatively with QoL and increases symptom severity. Malnutrition is an independent determinant of lower QoL.

Implications for Practice

Nutritional assessment should be accompanied by QoL evaluation, so that nutritional interventions can be optimized based on a patient’s individual requirements.

Neuropsychological disorders in non-central nervous system cancer: a review of objective cognitive impairment, depression, and related rehabilitation options

AIM

The objective of the present review was to systematically characterize the types of cognitive impairment that are found in different non-brain types of cancer as measured by objective and validated tests, and also to further examine depression and cognitive function in cancer patients and explore their available rehabilitation treatments.

RESULTS

A total of 29 articles were reviewed. Most of these studies suggest that chemotherapy as well as the combination of chemotherapy and hormonal therapy can influence cognition in different types of cancer patients. Breast cancer patients appear to be the most affected in neuropsychological function, specifically in terms of cognitive impairment and reduced quality of life, as compared to other non-brain solid tumours. Overall, the most impaired functions were verbal ability, memory, executive function, and motor speed.

CONCLUSION

Chemotherapy-related cognitive dysfunction remains under-recognized and undertreated. The various studies reported differing and non-homogenous findings with mixed results, obtained by self-reporting and web-assisted assessment, with other confounding factors such as age and depression during both cancer diagnosis and treatment. An objective neuropsychological assessment is fundamental to avoid underestimation of the extent of chemobrain. Self-reported and web-assisted assessment may ultimately result in confusion between the neuropsychological signs of chemobrain versus those of depression.

Performance Status Is a Risk Factor for Depression before the Diagnosis of Lung Cancer Patients

Objective Previous studies have shown that lung cancer patients experience depression before their diagnosis. However, the patient characteristics that are risk factors for depression before the diagnosis of lung cancer are unclear. We therefore performed this study to identify the characteristics that are risk factors for depression in lung cancer patients. Methods We performed a prospective observational study that included 183 patients who visited our department for suspected lung cancer between August 2014 and March 2017. These patients completed a Quick Inventory of Depressive Symptomatology-Self Report questionnaire. Ten patients with a history of depression were excluded. Results Among the remaining 173 patients, 110 were diagnosed with lung cancer. Among these 110 patients, 57 had depression. A poor performance status (PS) was significantly more prevalent in patients with depression than in those without. Furthermore, a multivariate analysis revealed that a poor PS was the only independent risk factor for depression before the diagnosis of lung cancer. Conclusion Physicians can use this information to evaluate whether patients have depression before the diagnosis of lung cancer.

Depressive Symptoms in Newly Diagnosed Lung Carcinoma: Prevalence and Associated Risk Factors

Background

Depression is a recognized complication of lung cancer underreported in developing countries such as Malaysia. Treating and identifying depression in cancer patients increases survival and quality of life. Our objectives are to study prevalence of depressive symptoms in newly diagnosed lung carcinoma, and examine the relationship of depressive symptoms with other influencing risk factors.

Methods

A 2-year, cross sectional study February 2015–February 2017, was conducted at Hospital Tengku Ampuan Afzan, and Penang General Hospital. One hundred and three patients with newly diagnosed, biopsy confirmed primary lung carcinoma were recruited. Self-rated patient's identification sheet, validated Center for Epidemiologic Studies Depression (CES-D), and Dukes University Religion Index score from three different main languages were used.

Results

Prevalence of current depressive symptoms (CES-D total score ≥16) is 37.9%. The result suggests prevalence of those at high risk of moderate to major depression, may need treatment. Multivariate analysis reveals those with good Eastern Cooperation Oncology Group factor (η2=0.24, p<0.001) married (η2=0.14, p<0.001) with intrinsic religiosity (IR) (η2=0.07, p<0.02) are more resistant to depression.

Conclusion

One in three of lung carcinoma patients, are at increased risk for depression. Clinicians should be aware that risk is highest in those with poor performance status, single, and with poor IR. We suggest routine screening of depression symptoms as it is feasible, to be performed during a regular clinic visit with immediate referral to psychiatrist when indicated.

Depression and its impact on health-related quality of life among Chinese inpatients with lung cancer

Depression is of great concern for patients with cancer. A detailed epidemiological profile of depression in Chinese patients with lung cancer and whether depression impacts patients’ health-related quality of life (HRQOL) remain unknown. This study examined the prevalence and socio-demographic and clinical correlates of depression and its effect on HRQOL in Chinese inpatients with lung cancer of two large general hospitals. A total of 148 inpatients were consecutively recruited, and administered with a standardized questionnaire to collect socio-demographic and clinical data. Depression and HRQOL were assessed with the Hospital Anxiety and Depression Scale and World Health Organization QOL Scale Brief Version, respectively. As high as 43.2% Chinese inpatients with lung cancer had clinically significant depressive symptoms. Multiple logistic regression found that depression was significantly associated with moderate-to-severe pain (OR: 4.43), metastatic cancer (OR: 3.63), a short duration after cancer diagnosis (OR: 1.04), poor performance status (OR: 3.41), and small-cell cancer (OR: 4.52). Depressed patients had significantly poorer HRQOL than not depressed patients in terms of all four domains of HRQOL. After controlling for the potential confounding effects of socio-demographic and clinical factors with analysis of covariance, these group-differences in physical (F = 29.074, P < 0.001), psychological (F = 76.869, P < 0.001), social (F = 21.465, P < 0.001), and environmental (F = 27.685, P < 0.001) HRQOL remained statistically significant. Depression is prevalent in inpatients with lung cancer and independently associated with poor HRQOL. To address this serious issue, effective pain management, psycho-oncology services and, when necessary, psychiatric assessment and treatment, should be routinely provided in oncology departments of Chinese general hospitals.

Longitudinal Changes in Depression Symptoms and Survival Among Patients With Lung Cancer: A National Cohort Assessment

Purpose Depression symptoms are common among patients with lung cancer; however, longitudinal changes and their impact on survival are understudied. Methods This was a prospective, observational study from the Cancer Care Outcomes Research and Surveillance Consortium from five US geographically defined regions from September 2003 through December 2005. Patients enrolled within 3 months of their lung cancer diagnosis were eligible. The eight-item Center for Epidemiologic Studies Depression scale was administered at diagnosis and 12 months' follow-up. The main outcome was survival, which was evaluated using Kaplan-Meyer curves and adjusted Cox proportional hazards modeling. Results Among 1,790 participants, 681 (38%) had depression symptoms at baseline and an additional 105 (14%) developed new-onset depression symptoms during treatment. At baseline, depression symptoms were associated with increased mortality (hazard ratio [HR], 1.17; 95% CI, 1.03 to 1.32; P = .01). Participants were classified into the following four groups based on longitudinal changes in depression symptoms from baseline to follow-up: never depression symptoms (n = 640), new-onset depression symptoms (n = 105), depression symptom remission (n = 156), and persistent depression symptoms (n = 254) and HRs were calculated. Using the never-depression symptoms group as a reference group, HRs were as follows: new-onset depression symptoms, 1.50 (95% CI, 1.12 to 2.01; P = .006); depression symptom remission, 1.02 (95% CI, 0.79 to 1.31; P = .89), and persistent depression symptoms, 1.42 (95% CI, 1.15 to 1.75; P = .001). At baseline, depression symptoms were associated with increased mortality among participants with early-stage disease (stages I and II; HR, 1.61; 95% CI, 1.26 to 2.04), but not late-stage disease (stages III and IV; HR, 1.05; 95% CI, 0.91 to 1.22). At follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease (HR, 1.71; 95% CI, 1.27 to 2.31) and those with late-stage disease (HR, 1.32; 95% CI, 1.04 to 1.69). Conclusion Among patients with lung cancer, longitudinal changes in depression symptoms are associated with differences in mortality, particularly among patients with early-stage disease. Symptom remission is associated with a similar mortality rate as never having had depression.

Analgesic effectiveness and tolerability of oral oxycodone/naloxone and pregabalin in patients with lung cancer and neuropathic pain: an observational analysis

INTRODUCTION

Cancer-related pain has a severe negative impact on quality of life. Combination analgesic therapy with oxycodone and pregabalin is effective for treating neuropathic cancer pain. We investigated the efficacy and tolerability of a dose-escalation combination therapy with prolonged-release oxycodone/naloxone (OXN-PR) and pregabalin in patients with non-small-cell lung cancer and severe neuropathic pain.

METHODS

This was a 4-week, open-label, observational study. Patients were treated with OXN-PR and pregabalin. Average pain intensity ([API] measured on a 0-10 numerical rating scale) and neuropathic pain (Douleur Neuropathique 4) were assessed at study entry and at follow-up visits. The primary endpoint was response to treatment, defined as a reduction of API at T28 ≥30% from baseline. Secondary endpoints included other efficacy measures, as well as patient satisfaction and quality of life (Brief Pain Inventory Short Form), Hospital Anxiety and Depression Scale, and Symptom Distress Scale; bowel function was also assessed.

RESULTS

A total of 56 patients were enrolled. API at baseline was 8.0±0.9, and decreased after 4 weeks by 48% (4.2±1.9; P<0.0001 vs baseline); 46 (82.1%) patients responded to treatment. Significant improvements were also reported in number/severity of breakthrough cancer pain episodes (P=0.001), Brief Pain Inventory Short Form (P=0.0002), Symptom Distress Scale (P<0.0001), Hospital Anxiety and Depression Scale depression (P=0.0006) and anxiety (P<0.0001) subscales, and bowel function (P=0.0003). At study end, 37 (66.0%) patients were satisfied/very satisfied with the new analgesic treatment. Combination therapy had a good safety profile.

CONCLUSION

OXN-PR and pregabalin were safe and highly effective in a real-world setting of severe neuropathic cancer pain, with a high rate of satisfaction, without interference on bowel function.

Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis

Background

Undergoing diagnostic evaluation for cancer has been associated with a high prevalence of anxiety and depression and affected health-related quality of life (HRQoL). The aims of this study were to assess HRQoL, anxiety, and depression pre- and post-diagnosis in patients undergoing diagnostic evaluations for cancer due to non-specific symptoms; to examine changes over time in relation to final diagnosis (cancer yes/no); and to assess the predictive value of pre-diagnostic psychological, socio-demographic and clinical factors.

Methods

A prospective, multicenter survey study of patients suspected to have cancer based on non-specific symptoms was performed. Participants completed the EORTC-QLQ-C30 quality of life scale, HADS, SOC-13 and self-rated health before and after completing diagnostic evaluations. Intra- and inter-group differences between patients diagnosed with cancer versus patients with non-cancer diagnoses were calculated. The impact of baseline psychological, socio-demographic, and medical factors on HRQoL, anxiety and depression at follow-up was explored by bootstrapped multivariate linear regression analyses and logistic regression analyses.

Results

A total of 838 patients participated in this study; 679 (81 %) completed the follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of the follow-up. Patients presented initially with a high burden of symptoms and affected role and emotional functioning and global health/QL, irrespective of diagnosis. The prevalence of clinical anxiety prior to knowledge of the diagnosis was 32 % in patients with cancer and 35 % in patients who received a non-cancer diagnosis. HRQoL and anxiety improved after diagnosis, and a larger improvement was seen in patients who received a non-cancer diagnosis. There were no intra- or inter-group differences in the depression scores. The strongest predictors of global QL, anxiety, and depression after a known diagnosis were baseline scores, co-morbidity and poor self-rated health.

Conclusions

Patients undergoing diagnostic evaluations for cancer based on non-specific symptoms experience a high prevalence of anxiety and affected quality of life prior to knowledge of the diagnosis. The predictive value of the baseline scores is important when assessing the psychological impact of undergoing diagnostic evaluations for cancer.

Risk factors for postoperative anxiety and depression after surgical treatment for lung cancer†

OBJECTIVES

Psychological distress associated with cancer treatment is an emerging issue in the management of cancer patients. The aim of this study was to identify the prevalence of postoperative anxiety and depression after surgical treatment for lung cancer, and to assess the risk factors associated with these phenomena.

METHODS

Patients who underwent curative surgical resection for primary lung cancer were included in this study. Patients with complex treatment histories (recurrent or metastatic lung cancer or neoadjuvant treatment) and those taking psychiatric medication were excluded. We prospectively evaluated the degrees of pre- and postoperative anxiety and depression using a Hospital Anxiety Depression Scale questionnaire. The relationships between clinical and patient factors and anxiety and depression after surgical treatment for lung cancer were assessed.

RESULTS

A total of 278 patients were enrolled. The mean age was 62 years. Thoracoscopic resection was performed in 246 patients (89%). The prevalence rates of preoperative anxiety and depression were 8% (n = 22) and 12% (n = 32), and changed to 9% (n = 26) and 19% (n = 54) postoperatively (P = 0.37 and <0.001, respectively). Gender, age, marital status, advanced clinical stage, alcohol abuse, smoking status, length of hospital stay, pulmonary function and preoperative comorbidities were not associated with postoperative anxiety and depression. Multivariate analysis revealed that thoracotomy was a risk factor for postoperative anxiety after adjusting for preoperative anxiety (odds ratio [OR] = 4.5, P = 0.002). Thoracotomy (OR = 3.4, P = 0.009), postoperative dyspnoea (OR = 4.8, P < 0.001), severe pain (OR = 3.9, P = 0.001) and diabetes mellitus (OR = 3.0, P = 0.012) were identified as risk factors for postoperative depression after adjusting for preoperative depression. Twenty-four patients were referred to mental health professionals and provided with supportive psychotherapy or pharmacological intervention. Of these, 14 patients (56%) were diagnosed with an adjustment disorder.

CONCLUSIONS

Postoperative psychological distress and, in particular, depression increased after surgical treatment for lung cancer. Postoperative anxiety and depression were aggravated by residual symptoms after surgery. Careful psychological evaluation and appropriate management are required to improve patients' quality of life after lung cancer surgery.

Mood and anxiety disorders as early manifestations of medical illness: a systematic review

BACKGROUND

Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis.

METHODS

MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were 'prodrome/early symptom', combined using the Boolean 'AND' operator with 'anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean 'AND' operator with 'medical illness/medical disorder'. PRISMA guidelines were followed.

RESULTS

A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent.

CONCLUSIONS

Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

Improved survival with stereotactic ablative radiotherapy (SABR) over lobectomy for early stage non-small cell lung cancer (NSCLC): addressing the fallout of disruptive randomized data

The gold-standard therapy for early stage non-small cell lung cancer (esNSCLC) has historically been lobectomy with mediastinal lymph node dissection. However, up to one-third of patients with esNSCLC are considered medically-inoperable due to factors such as advanced age and comorbid illnesses. The past decade has witnessed a dramatic increase in the use of high-dose conformal radiotherapy delivered over 1-5 fractions, synonymously termed stereotactic ablative radiotherapy (SABR) or stereotactic body radiation therapy (SBRT). High rates of tumor control and favorable toxicity profiles have led to the adoption of SABR as the treatment of choice for medically-inoperable patients. Limited but growing data exist using SABR for medically-operable patients who are also candidates for lobectomy. A recent pooled analysis of two multicenter prospective randomized trials, the STARS (NCT00840749) and ROSEL (NCT00687986) protocols, published by Chang and colleagues (PMID 25981812) reported improved overall survival (OS) and reduced toxicity with SABR over lobectomy for medically-operable patients with esNSCLC. In this article we review the outcomes of this analysis in the context of existing radiotherapy and surgical data for NSCLC. Further, we discuss the potential causes and implications of these provocative results, including the shifting balance between oncologic control and treatment-related mortality in comparisons of SABR and surgical resection, termed the Head Start Effect.

[Changes in quality of life and anxiety of lung cancer patients underwent chemotherapy]

背景与目的

通过观察肺癌患者化疗前后生活质量及焦虑情绪的改变，探讨化疗对肺癌患者生活质量及焦虑情绪的影响。

方法

随机抽取住院化疗的肺癌患者58例，分别于化疗前、化疗后2周期1星期内、化疗后4周期1星期内评估临床疗效，并进行肺癌患者生活质量量表（QLQ-C30）和ZUNG焦虑自评量表（SAS）评分。

结果

化疗前，生活质量功能领域、疲乏、呼吸困难条目得分较高，有焦虑情绪的占56%，SAS得分为49.54±5.64；焦虑症状与失眠轻度相关（P < 0.05）；化疗后2周期，呼吸困难得分下降，失眠、食欲丧失得分上升，较化疗前相比差异有统计学意义（P < 0.05）；有焦虑情绪的占80%，SAS得分为52.48±6.10，较化疗前相比差异有统计学意义（P < 0.05）；有基础病患者SAS得分高于无基础病患者，差异有统计学意义（P < 0.05）；焦虑症状与疲乏、呼吸困难轻度相关（P < 0.05）。化疗后4周期，躯体、角色、情绪、社会功能得分下降明显，恶心呕心、食欲不振、便秘、经济困难条目得分上升，较化疗后2周期相比差异有统计学意义（P < 0.05）；有焦虑情绪的占72%，SAS得分为54.82±6.55，较化疗后2周期相比无统计学差异；SAS得分与KPS呈负相关（P < 0.05）；焦虑症状与疲乏、失眠相关（P < 0.01），与便秘轻度相关（P < 0.05）。

结论

化疗过程中，部分肺癌患者躯体症状得到缓解，焦虑情绪明显增加，生活质量有所下降，医务工作者应及时评价患者生活质量及情绪改变，提高患者生活质量，积极地对患者进行心理疏导治疗。

The voice of postsurgical lung cancer patients regarding supportive care needs

OBJECTIVE

Individuals with lung cancer present with multiple comorbid conditions and complex treatment plans. They are frequently vulnerable during critical transitions in the cancer survivorship trajectory. Limited research exists on the postsurgical non-small-cell lung cancer (NSCLC) population, relative to unmet supportive care needs. However, what is known is that the lung cancer population reports significantly more unmet supportive care needs than other cancer populations. The purpose of this study was to identify the postsurgical NSCLC patients' unmet supportive care needs during transition from hospital to home and through recovery after participating in a 16-week exercise intervention.

MATERIALS AND METHODS

Participants were 53-73 years of age with NSCLC (stage Ib-IIIa) and participated in a 16-week light-intensity exercise program after hospital discharge. For this study, participants were interviewed 12-18 months post-thoracotomy. A qualitative design was used, incorporating a semistructured guide with open-ended questions to support discussion regarding recovery experiences through 16 weeks after transitioning from hospital to home. The interview was transcribed verbatim, and data were analyzed using content analysis. Content themes were independently coded by investigators and later combined into a single report verified through participant verification of the report.

RESULTS

Participants reviewed and agreed with the focus group report. Dominant themes included: 1) unpreparedness for post-thoracotomy recovery; 2) significant unmet needs upon hospital discharge and throughout the cancer survivorship trajectory; 3) unexpected symptom burden after initial month of recovery; 4) the quality of information given when pain and fatigue were troublesome during recovery; and 5) the effectiveness of exercise during the recovery process.

CONCLUSION

Understanding the changing needs of this population during these transitions will assist in the development of targeted supportive care interventions, to preempt negative outcomes associated with breakdowns in care during critical transition periods of the cancer survivorship trajectory.

Integrating palliative care in lung cancer: an early feasibility study

AIM

The aim of this preliminary study was to evaluate the feasibility of conducting an effectiveness trial of early access to palliative care services for people with lung cancer through use of an integrated outpatient model.

METHODS

Newly diagnosed patients with lung cancer receiving palliative-intent treatment or best supportive care treatment were recruited over a 5-month period from one out-patient clinic in Scotland. Patients were offered a clinical review appointment with a palliative medicine consultant at two time points: baseline and 12 weeks later. Prior to each appointment patients completed three outcome measures addressing symptom severity, wellbeing, and health-care needs. One-to-one interviews were also conducted to explore patients' experiences of being involved in the study.

RESULTS

Three patients participated in the study. The main reasons for low recruitment were patients' deteriorating condition and unwillingness to undertake extra hospital visits. However, qualitative data indicated that the participants found this extra layer of supportive care useful in identifying and managing their needs, as well as enabling future planning.

CONCLUSION

Further testing is needed to ascertain the feasibility of conducting a trial of integrating early access to palliative care services into routine practice for people with lung cancer.

Study protocol of a randomized controlled trial comparing Mindfulness-Based Stress Reduction with treatment as usual in reducing psychological distress in patients with lung cancer and their partners: the MILON study

BACKGROUND

Lung cancer is the leading cause of cancer death worldwide and characterized by a poor prognosis. It has a major impact on the psychological wellbeing of patients and their partners. Recently, it has been shown that Mindfulness-Based Stress Reduction (MBSR) is effective in reducing anxiety and depressive symptoms in cancer patients. The generalization of these results is limited since most participants were female patients with breast cancer. Moreover, only one study examined the effectiveness of MBSR in partners of cancer patients. Therefore, in the present trial we study the effectiveness of MBSR versus treatment as usual (TAU) in patients with lung cancer and their partners.

METHODS/DESIGN

A parallel group, randomized controlled trial is conducted to compare MBSR with TAU. Lung cancer patients who have received or are still under treatment, and their partners are recruited. Assessments will take place at baseline, post intervention and at three-month follow-up. The primary outcome is psychological distress (i.e. anxiety and depressive symptoms). Secondary outcomes are quality of life (only for patients), caregiver appraisal (only for partners), relationship quality and spirituality. In addition, cost-effectiveness ratio (only in patients) and several process variables are assessed.

DISCUSSION

This trial will provide information about the clinical and cost-effectiveness of MBSR compared to TAU in patients with lung cancer and their partners.

Effect of psychosocial factors on cancer risk and survival

Psychosocial factors such as personality traits and depression may alter immune and endocrine function, with possible effects on cancer incidence and survival. Although these factors have been extensively studied as risk and prognostic factors for cancer, the associations remain unclear. The author used data from prospective cohort studies in population-based and clinical databases to investigate these relations. The findings do not support the hypotheses that personality traits and depression are direct risk factors for cancer and cancer survival.Some researchers have recently reported that cancer affects the psychological status of the partners and family members of cancer patients. The mechanisms underlying this hypothesis imply the existence of not only psychological distress from caregiving and grief but also a shared unhealthy lifestyle. Only a few studies have suggested that major psychosocial problems develop in partners of cancer patients. The present study used nationwide population-based data to investigate depression risk among male partners of women with breast cancer. The results support the hypothesis that such men are at increased risk of depression.In conclusion, the effects of personality traits and depression on cancer risk and survival appear to be extremely small. In addition, partners of cancer patients were at increased risk of depression. Screening partners and family members of cancer patients for depressive symptoms is therefore an important concern for research in psycho-oncology.

Prevalence of anxiety and depression and their risk factors in Chinese cancer patients

PURPOSE

This paper aimed to obtain information on the levels of anxiety and depression among cancer patients in China. The factors influencing these psychological problems were also analyzed.

METHODS

A total of 1,217 cancer patients were interviewed, and each participant was asked to complete a self-administered questionnaire. The anxiety status, depression status, disease stage, tumor site, pain status, and performance status of the patients during the week prior to the interview were assessed.

RESULTS

The anxiety and depression prevalence rates were 6.49 and 66.72 %, respectively. The prevalence rates of depression were 60.62 % for head and neck cancer, 77.19 % for lung cancer, 57.9 % for breast cancer, 75.81 % for esophagus cancer, 63.40 % for stomach cancer, 68.42 % for liver cancer, 54.37 % for colorectal cancer, and 71.13 % for cervix cancer. The factors influencing depression of patients were performance status (P < 0.0001), pain (P = 0.0003), age (P < 0.0001), and education level (P < 0.0001). The risk factors of anxiety were performance status (P = 0.0007), age (P < 0.0001), and gender (P < 0.0001).

CONCLUSIONS

Depression was a more important psychological problem than anxiety in cancer patients. Compared with 3.8 % of the prevalence of depression in normal population, depression level was high among Chinese cancer patients. Patients with lung, esophagus, and cervix cancers were the high-risk groups for depression. Poor performance status, pain, old age, and low-level education were the predicting factors for depression.

A 30-year perspective on psychosocial issues in lung cancer: how lung cancer "Came out of the Closet"

Psychological responses to lung cancer have changed over the past 30 years as perceptions of the disease have changed. Previously seen as a fatal diagnosis, it is now regarded as a cancer whose treatment is increasingly effective as the science of the disease advances. The stigma of smoking is diminishing as more is learned about genetic factors and as more nonsmokers are diagnosed. Support groups are now widely available. The increasing social support and greater knowledge of lung cancer provide a more supportive environment in which patients cope with lung cancer today compared with 30 years ago.

The faster the better?—A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways

OBJECTIVE

To perform a systematic review of articles published in the last 25 years on prevalence and course of distress and quality of life surrounding the diagnostic process of suspected cancer, and the influence of rapid diagnostic programs.

METHODS

Twenty-three articles were identified via Pubmed, PsycINFO, and reference lists of articles. Except for three randomized clinical trials and one case control study all studies were uncontrolled cohort studies.

RESULTS

Most studies involved patients with suspected breast cancer and therefore had a sex selection bias. Four studies on the effect of rapid outpatient diagnostic programs were found.Studies showed very high prevalence of anxiety, decreasing in case of a benign diagnosis but increasing or sustaining in patients waiting for results or after cancer diagnosis though not significantly more in rapid programs. Quality of life was low and showed varying patterns.

CONCLUSIONS

Distress in the diagnostic phase of cancer is a major problem and the rapid decrease of anxiety in patients eventually not diagnosed with cancer suggests a benefit of rapid diagnostic programs. The available evidence however is limited and shows some inconsistencies. Studies differ in subjects, objective and are limited by quality and quantity. Conflicting results prohibit a conclusion on patients ultimately diagnosed with cancer.

Depression and survival in Chinese patients with gastric cancer: a prospective study

AIM

Depression is thought to be a predictor of poor survival among cancer patients. In our study, we aimed to investigate the association between depression and survival in patients with gastric cancer.

METHODS

The subjects were a total of 300 patients aged 20-75 years who had histological confirmed diagnosis of gastric cancer from January 2004 to May 2006. Three months after patients diagnosis, depression was scored using by the Depression Status Inventory (DSI) designed by Willian WK Zung. The follow-up period consisted of a total of 13,643 person-months. A Cox's regression analysis was used to assess the association between depression and survival.

RESULTS

The percentage of subjects with depression according to the DSI depression criteria was 31%. Tumor stage and treatment methods were significantly associated with depression of patients. Age (60 years or older), annual income, tumor stage, lymph nodes metastasis and treatment were significantly associated with increased hazard ratio (HR) for gastric cancer survival. The adjusted HR for mortality risk in gastric cancer patients with depression tended to be high (HR=3.34, 95% CI=1.23-5.49) and a significant trend was found (P<0.05).

CONCLUSION

The data obtained in this prospective study in Chinese support the hypothesis that depression is associated with poor survival among gastric cancer patients. Further studies with a large sample and longer term follow-up period are needed.

Clinical biopsychosocial risk factors for depression in lung cancer patients: a comprehensive analysis using data from the Lung Cancer Database Project

BACKGROUND

Various risk factors for depression in lung cancer patients have been suggested but have been examined separately in studies with relatively small sample sizes. The present study examined the biopsychosocial risk factors of depression in lung cancer patients, focusing on psychological factors in the largest patient sample reported to date.

PATIENTS AND METHODS

A total of 1334 consecutively recruited lung cancer patients were selected, and data on cancer-related variables, personal characteristics, health behaviors, physical symptoms, and psychological factors were obtained. The participants were divided into groups with or without depression using the Hospital Anxiety and Depression Scale.

RESULTS

Among the recruited patients, 165 (12.4%) manifested depression. The results of a binary logistic regression analysis were significant (overall R2, 36.5%), and a greater risk for depression was strongly associated with psychological factors, such as personality characteristics (neuroticism) and coping style (low fighting spirit, helplessness/hopelessness, and anxious preoccupation). Although the contributions of cancer-related variables, personal characteristics, health behaviors, and clinical state were relatively low, cancer stage, cancer type, sex, and age correlated significantly with depression.

CONCLUSION

Depression was most strongly linked with personality traits and coping style, and using screening instruments to identify these factors may be useful for preventive interventions.

The impact of lung cancer on patients and carers

This article aims to provide a brief review of the literature with regard to the impact of lung cancer on patients and their informal carers. Compared to other types of cancer, the distress associated with lung cancer has been found to be the most intense. Rather than focusing on symptoms in isolation recent emphasis regarding the symptom experience has been on symptoms clusters, as understanding these clusters may improve the management of ongoing and unrelieved symptoms. However, the disparities in methodology are significant barriers to producing comparable results, although recent efforts have been made to address these. Whilst research into symptoms has enormous potential for the management of symptom clusters, it needs to move away from the essentially reductionist stance which currently dominates and broaden its scope to one that acknowledges the complexity of the experience of symptom clusters from the perspective of the patient and their informal carer. Poor management of symptoms complicates patient care and potentially contributes to the heavy burden which often falls on family caregivers, especially as the disease progresses. The majority of studies focus on the experiences of primary care providers, most often the partner/spouse. Such studies have shown that spouses of patients with lung cancer exhibit significant distress and lower levels of quality of life than the general population. Research also indicates that significant others go through a transition process due to changes brought about by the diagnosis of lung cancer and struggle to endure and overcome difficulties and distress. Significant others were seen to suffer during this process of transition and experienced altered relationships. Clinicians working with patients suffering from lung cancer and their carers should intervene to enhance their quality of life from diagnosis, during the disease trajectory and during bereavement. Interventions need to be developed to support both patients and carers.

Intimacy processes and psychological distress among couples coping with head and neck or lung cancers

OBJECTIVE

Couples coping with head and neck and lung cancers are at increased risk for psychological and relationship distress given patients' poor prognosis and aggressive and sometimes disfiguring treatments. The relationship intimacy model of couples' psychosocial adaptation proposes that relationship intimacy mediates associations between couples' cancer-related support communication and psychological distress. Because the components of this model have not yet been evaluated in the same study, we examined associations between three types of cancer-related support communication (self-disclosure, perceived partner disclosure, and protective buffering), intimacy (global and cancer-specific), and global distress among patients coping with either head and neck or lung cancer and their partners.

METHOD

One hundred and nine patients undergoing active treatment and their partners whose average time since diagnosis was 15 months completed cross-sectional surveys.

RESULTS

For both patients and their partners, multilevel analyses using the actor-partner interdependence model showed that global and cancer-specific intimacy fully mediated associations between self- and perceived partner disclosure and distress; global intimacy partially mediated the association between protective buffering and distress. Evidence for moderated mediation was found; specifically, lower levels of distress were reported as a function of global and cancer-specific intimacy, but these associations were stronger for partners than for patients.

CONCLUSIONS

Enhancing relationship intimacy by disclosing cancer-related concerns may facilitate both partners' adjustment to these illnesses.

Assessment of depression and anxiety in adult cancer outpatients: a cross-sectional study

Background

The prevalence of anxiety and depressive disorders in cancer patients and its associated factors in Pakistan is not known. There is a need to develop an evidence base to help introduce interventions as untreated depression and anxiety can lead to significant morbidity. We assessed the prevalence of depression and anxiety among adult outpatients with and without cancer as well as the effect of various demographic, clinical and behavioral factors on levels of depression and anxiety in cancer patients.

Methods

This cross-sectional study was carried out in outpatient departments of Multan Institute of Nuclear Medicine and Radiotherapy and Nishtar Medical College Hospital, Multan. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to define the presence of depression and anxiety in study participants. The sample consisted of 150 diagnosed cancer patients and 268 participants without cancer (control group).

Results

The mean age of cancer patients was 40.85 years (SD = 16.46) and median illness duration was 5.5 months, while the mean age of the control group was 39.58 years (SD = 11.74). Overall, 66.0% of the cancer patients were found to have depression and anxiety using a cutoff score of 20 on AKUADS. Among the control group, 109 subjects (40.7%) had depression and anxiety. Cancer patients were significantly more likely to suffer from distress compared to the control group (OR = 2.83, 95% CI = 1.89-4.25, P = 0.0001). Performing logistic regression analysis showed that age up to 40 years significantly influenced the prevalence of depression and anxiety in cancer patients. There was no statistically significant difference between gender, marital status, locality, education, income, occupation, physical activity, smoking, cancer site, illness duration and mode of treatment, surgery related to cancer and presence of depression and anxiety. Cancers highly associated with depression and anxiety were gastrointestinal malignancies, chest tumors and breast cancer.

Conclusions

This study highlights high prevalence rates of depression and anxiety in cancer patients. Younger age was associated with a higher likelihood of meeting criteria for psychological morbidity. The findings support screening patients for symptoms of depression and anxiety as part of standard cancer care and referring those at a higher risk of developing psychological morbidity for appropriate care.

Actigraphic assessment of daily sleep-activity pattern abnormalities reflects self-assessed depression and anxiety in outpatients with advanced non-small cell lung cancer

OBJECTIVES

We measured subjectively evaluated depression and anxiety, and objectively measured daily sleep-activity patterns in inpatients and outpatients with advanced non-small cell lung cancer (NSCLC) and determined whether cancer-associated depression and anxiety are accompanied by characteristic circadian rhythm abnormalities.

METHODS

Equal numbers of inpatients (n=42) and outpatients (n=42) with advanced NSCLC were studied. Baseline depression and anxiety, assessed by the Hospital Anxiety and Depression Scale (HADS), and actigraphy were recorded before chemotherapy initiation. The effects of the presence and severity of chronic obstructive pulmonary disease (COPD) on depression, anxiety, and actigraphy were assessed only among the 42 outpatients.

RESULTS

Anxiety occurred in 40% and depression in 25% of these lung cancer patients, equally among inpatients and outpatients. All patients suffer extremely disturbed daily sleep-activity cycles but each patient also maintains some degree of circadian organization. Outpatients maintain more robust daily activity patterns and longer, more consolidated nighttime sleep compared with inpatients. The more disrupted the daily sleep-activity rhythm, the worse the depression and/or anxiety scores for outpatients. These relationships are obscured among inpatients. COPD has no independent measurable effects on the daily organization of sleep-activity, depression, or anxiety.

CONCLUSIONS

Lung cancer patients whose diurnal activity is disturbed by prolonged and frequent sedentary episodes and whose sleep is disturbed by frequent and prolonged waking are most anxious and depressed. These findings and relationships are masked by hospitalization. Since diurnal exercise improves both sleep and mood, it is reasonable to test whether enhancing daytime activity and nighttime sleep can diminish cancer-associated depression.

[Lung cancer: psychological and psychiatric aspects]

According to the literature, lung cancer patients experience greater emotional distress than other cancer patients, with scores as high as 61,6%. Poor prognosis, guilt and stigma associated with a history of smoking, may be related with this morbidity. Several studies mention the prevalence of depression to be between 16 and 22%. As distress affects the family as well, mostly those members involved in the patient care, they should not be forgotten and must be involved in the treatment plan. The authors conclude that lung cancer patients' distress is highly prevalent and interferes with quality of live and, possibly, prognosis. Therefore, psychosocial care should be integrated early in cancer treatment.

Symptom severity 1 to 4 months after thoracotomy for lung cancer

BACKGROUND

Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery.

OBJECTIVES

To describe symptom severity during the first 4 months after thoracotomy for non-small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months.

METHODS

Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies-Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms.

RESULTS

Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months.

CONCLUSIONS

Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.

Symptom Severity 1 to 4 Months After Thoracotomy for Lung Cancer

Background Information about the severity of symptoms during recovery from surgery for lung cancer can be useful in planning and anticipating needs for recovery.

Objectives To describe symptom severity during the first 4 months after thoracotomy for non–small cell lung cancer and factors associated with overall symptom severity at 1 and 4 months.

Methods Ninety-four patients were assessed at 1, 2, and 4 months after thoracotomy by using the Lung Cancer Symptom Scale, Brief Pain Inventory, Schwartz Fatigue Scale, Dyspnea Index, and Center for Epidemiology Studies–Depression Scale (CES-D). Clinically meaningful changes, decrease in the proportion of patients with severe symptoms, and relationships among symptoms were determined. Mixed effects models for repeated measures were used to evaluate changes in severity. Multiple regression models were used to examine correlates of overall symptoms.

Results Mean symptom severity significantly decreased over time for most symptoms. Only disrupted appetite, pain, and dyspnea had clinically meaningful improvement at 4 months. Severe symptoms included fatigue (57%), dyspnea (49%), cough (29%), and pain (20%). Prevalence of depressed mood decreased at 4 months. Most patients (77%) had comorbid conditions. Number of comorbid conditions and CES-D explained 54% of the variance in symptom severity at 1 month; comorbid conditions, male sex, neoadjuvant treatment, and CES-D score explained 50% of the variance at 4 months.

Conclusions Severe symptoms continued 4 months after surgery for some patients, indicating the need for support during recovery, especially for patients with multiple comorbid conditions and depressed mood.

Negative psychological aspects and survival in lung cancer patients

We conducted a prospective cohort study in Japan to investigate associations between negative psychological aspects and cancer survival. Between July 1999 and July 2004, a total of 1178 lung cancer patients were enrolled. The questionnaire asked about socioeconomic variables, smoking status, clinical symptoms, and psychological aspects after diagnosis. Negative psychological aspects were assessed for the subscales of helplessness/hopelessness and depression. Clinical stage, performance status (PS), and histologic type were obtained from medical charts. The subjects were followed up until December 2004, and 686 had died. A Cox regression model was used to estimate the hazards ratio (HR) of all-cause mortality. After adjustment for socioeconomic variables and smoking status in addition to sex, age, and histologic type, both helplessness/hopelessness and depression subscales showed significant linear positive associations with the risk of mortality (p for trend<0.001 for both). However, after adjustment for clinical state variables in addition to sex, age, and histologic type, these significant linear positive associations were no longer observed (p for trend=0.41 and 0.26, respectively). Our data supported the hypothesis that the association between helplessness/hopelessness and depression and the risk of mortality among lung cancer patients was largely confounded by clinical state variables including clinical stage, PS, and clinical symptoms.

Palliative Care Consultation, Quality-of-Life Measurements, and Bereavement for End-of-Life Care in Patients With Lung Cancer

OBJECTIVE

To develop clinical practice guidelines for application of palliative care consultation, quality-of-life measurements, and appropriate bereavement activities for patients with lung cancer.

METHODS

To review the pertinent medical literature on palliative care consultation, quality-of-life measurements, and bereavement for patients with lung cancer, developing multidisciplinary discussions with authorities in these areas, and evolving written guidelines for end-of-life care of these patients.

RESULTS

Palliative care consultation has developed into a new specialty with credentialing of experts in this field based on extensive experience with patients in end-of-life circumstances including those with lung cancer. Bereavement studies of the physical and emotional morbidity of family members and caregivers before, during, and after the death of a cancer patient have supported truthful communication, consideration of psychological problems, effective palliative care, understanding of the patient's spiritual and cultural background, and sufficient forewarning of impending death.

CONCLUSION

Multidisciplinary investigations and experiences, with emphasis on consultation and delivery of palliative care, timely use of quality-of-life measurements for morbidities of treatment modalities and prognosis, and an understanding of the multifaceted complexities of the bereavement process, have clarified additional responsibilities of the attending physician.

Anxiety and depression in patients with gastrointestinal cancer: does knowledge of cancer diagnosis matter?

Background

Gastrointestinal cancer is the first leading cause of cancer related deaths in men and the second among women in Iran. An investigation was carried out to examine anxiety and depression in this group of patients and to investigate whether the knowledge of cancer diagnosis affect their psychological distress.

Methods

This was a cross sectional study of anxiety and depression in patients with gastrointestinal cancer attending to the Tehran Cancer Institute. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS). This is a widely used valid questionnaire to measure psychological distress in cancer patients. Demographic and clinical data also were collected to examine anxiety and depression in sub-group of patients especially in those who knew their cancer diagnosis and those who did not.

Results

In all 142 patients were studied. The mean age of patients was 54.1 (SD = 14.8), 56% were male, 52% did not know their cancer diagnosis, and their diagnosis was related to esophagus (29%), stomach (30%), small intestine (3%), colon (22%) and rectum (16%). The mean anxiety score was 7.6 (SD = 4.5) and for the depression this was 8.4 (SD = 3.8). Overall 47.2% and 57% of patients scored high on both anxiety and depression. There were no significant differences between gender, educational level, marital status, cancer site and anxiety and depression scores whereas those who knew their diagnosis showed a significant higher degree of psychological distress [mean (SD) anxiety score: knew diagnosis 9.1 (4.2) vs. 6.3 (4.4) did not know diagnosis, P < 0.001; mean (SD) depression score: knew diagnosis 9.1 (4.1) vs. 7.9 (3.6) did not know diagnosis, P = 0.05]. Performing logistic regression analysis while controlling for demographic and clinical variables studied the results indicated that those who knew their cancer diagnosis showed a significant higher risk of anxiety [OR: 2.7, 95% CI: 1.1–6.8] and depression [OR: 2.8, 95% CI: 1.1–7.2].

Conclusion

Psychological distress was higher in those who knew their cancer diagnosis. It seems that the cultural issues and the way we provide information for cancer patients play important role in their improved or decreased psychological well-being.

Prospective analysis of depression and psychological distress before and after surgical resection of lung cancer

OBJECTIVES

The psychological effects of surgery have received little attention in patients with lung cancer, so it is unclear how much psychological support is required by these patients. This study was done to assess the mental state of patients with lung cancer before and after surgery and to determine their need for psychological care.

METHODS

A group of 165 patients with lung cancer scheduled for surgical treatment were included in this study. They were asked to complete the Profile of Mood States questionnaire before surgery and on discharge after completion of treatment. The data on mood from the questionnaires were analyzed.

RESULTS

Tension-anxiety improved significantly after surgery, whereas the fatigue score increased significantly. The scores for depression-dejection and confusion were elevated before surgery and were unchanged afterward.

CONCLUSIONS

Patients with lung cancer were depressed before surgery and remained depressed after their operations, although postoperative tension-anxiety diminished. These results indicate that lung cancer patients need psychological support to alleviate depression during the perioperative period.

Screening for depressive symptoms in patients with unresectable lung cancer

INTRODUCTION

Early identification of psychological distress and depression is important to optimise the quality of life in patients with advanced non-small cell lung cancer (NSCLC). The prevalence of depression may vary, depending on the time since diagnosis of cancer, results of the treatment and the prognosis. The purpose of this study was to compare the efficacy of a self-administered screening tool (Hospital Anxiety and Depression Scale (HADS)) with a health professional administered tool (Montgomery-Asberg Depression Rating Scale (MADRS)) and to explore the variability of major affective symptoms in patients with unresectable lung cancer during the initial 7-8 weeks of chemotherapy treatment for their illness.

MATERIAL AND METHODS

Patients with newly diagnosed unresectable lung cancer were screened on four occasions for anxiety and depressive symptoms simultaneously using the self-rated HADS and the MADRS administered by a psycho-oncologist or a trained research associate. The first assessment was done within 1 week of diagnosis and was repeated on 3 occasions during the initial 2 cycles of chemotherapy.

RESULTS

Forty-nine patients, aged 38-82 years (median age 63 years) were enrolled. All patients had advanced NSCLC (stages 3A, 3B and 4) and 61% (30 patients) had an ECOG performance status (PS) of 1 or greater. The point prevalence of depression measured by an interviewer using the MADRS at visits 1-4 was 49%, 51%, 47%, and 41%, respectively. The point prevalence of self-reported depression (HADS) was significantly (p < 0.001) lower at each assessment point (18%, 20%, 6%, 12%) compared to health professional detected depression (MADRS). Although MADRS and HADS showed very strong (Pearson's correlation = 0.8) and significant (p < 0.001) correlation, the concordance rate in identifying the same cases of depression was only 54%. CLINICAL IMPLICATION AND CONCLUSION: The prevalence of depression among advanced lung cancer patients is high and varies very little during the first 2 cycles of chemotherapy. Among a variety of tools available for the screening of depression, a semi-structured interview is more effective at identifying clinically significant depression than a self-administered questionnaire.

A Qualitative Study of the Experiences During Radiotherapy of Swedish Patients Suffering From Lung Cancer

PURPOSE/OBJECTIVES

To describe experiences during radiotherapy of patients suffering from lung cancer.

DESIGN

Inductive, qualitative.

SETTING

A radiotherapy department in the south of Sweden.

SAMPLE

15 patients with lung cancer undergoing their second week of radiotherapy.

METHODOLOGIC APPROACH

Interviews were conducted in a hospital setting, transcribed, and content analyzed.

MAIN RESEARCH VARIABLES

Experiences during radiotherapy.

FINDINGS

The patients' experiences fall into four categories: fatigue, physical distress, managing disease- and treatment-related issues, and obstacles to managing. Fatigue was a major experience expressed in terms of low energy levels and low fitness, sometimes leading to social isolation.

CONCLUSIONS

Nurses need to implement interventions to minimize side effects of radiotherapy and maximize patients' abilities to manage the disease and the treatment.

INTERPRETATION

Informing and educating patients about pretreatment and assessing fatigue as well as implementing interventions (e.g., nurse-patient interaction, support, information, encouragement, focus on the patients' own resources) may lead to improved comprehensive care during radiation therapy.