Psycho-Oncology: A Review for the General Psychiatrist

Global trends in psycho-oncology research investments 2016-2020: A content analysis

OBJECTIVE

An estimated one-third of cancer patients experience a clinically significant psychological disorder, however it is unclear to what extent this is reflected in research funding. To address this a systematic analysis the allocation of psycho-oncology research funding globally between 2016 and 2020 was conducted.

METHODS

A global dataset of 66,388 cancer research awards, from 2016 to 2020 inclusive and totalling $24.5 billion USD was assembled from public and philanthropic funders. Each award was previously categorised by cancer site type and research theme, including psychosocial research and these awards were further sub-categorised for this analysis.

RESULTS

There was $523m of funding awarded for psychological research across 1122 studies: 2.14% of all cancer research funding during this period ($24.5 billion). Median funding per award was $97,473 (IQR $36,864 - $453,051). Within psychological research, mental health received most funding ($174m, 33.5% of psychological funding). Cognitive behavioural therapy (CBT) focused research was the specific psychological support with the highest proportion of funding at $14 million. By country of funder, the USA provided most investment ($375.5 m, 71.8%).

CONCLUSIONS

Psycho-oncology research received relatively little funding, for example, when compared with pre-clinical cancer research. There needs to be a shift from pre-clinical science to research that benefits cancer patients in the shorter-term. Low- and middle-income countries, and ethnic minorities in higher-income settings, were underrepresented despite having a large cancer burden, indicating inequities that need to be addressed.

Mindfulness-based cognitive therapy for psycho-oncology patients: an exploratory study

OBJECTIVES

Mindfulness-based cognitive therapy (MBCT) is a group-based intervention similar to mindfulness-based stress reduction, but which includes cognitive therapy techniques. This study investigates its usefulness in the treatment of depressive, anxiety and stress/distress symptoms in cancer patients referred to a psycho-oncology service. It also examines whether effect on depression is mediated by self-compassion.

METHOD

In phase 1 of this study, 16 cancer patients with mild/moderate psychological distress were randomised to MBCT (n=8) or treatment as usual (TAU; n=8), and assessed pre- and post-treatment. Analysis of variance was performed to examine the effect of treatment on anxiety and depression. In phase 2, the TAU group received the intervention, and results of pre- and post-MBCT assessments were combined with those receiving MBCT in phase 1. Finally, both groups were followed up at 3 months.

RESULTS

In phase 1, the MBCT group had a significant improvement in mindfulness and a decrease in anxiety. Statistically significant improvements in both depression and anxiety were found at 3 month follow-up. Self-compassion appeared to mediate the effect on anxiety/depression.

CONCLUSION

This small pilot study suggests that MBCT may have a beneficial effect on psychological variables often adversely affected in cancer in a heterogeneous cancer population.

Body mass index and suicidal behaviors: a critical review of epidemiological evidence

INTRODUCTION

Obesity has been associated with an elevated risk of depression and other mental health symptoms. An increasing number of robust prospective studies, however, counter-intuitively and consistently suggested that body mass index (BMI) was inversely associated with the risk of completed suicide in a dose-response fashion. The current contribution appraised the epidemiological evidence and examined the nature of the purported relationship.

METHOD

We conducted a systematic review of English publications of original studies using the terms "obesity", "overweight", "body mass index", "BMI", "attempted suicide", "completed suicide", "suicide ideation", "suicidal behaviors" and "suicide". Data were extracted primarily through MEDLINE and PUBMED databases.

RESULTS

Almost all cohort studies reported an inverse relationship between BMI and the risk of completed suicide irrespective of region of origin and the gender of study participants. Overall, among men, a high BMI was associated with a low risk of attempted or completed suicide. There was a paradox among women, namely, a high BMI was associated with an elevated risk of attempted suicide but a low risk of completed suicide.

LIMITATIONS

As a narrative review, the current report was interpretive and qualitative in nature.

CONCLUSION

Consideration of observational data, methodological issues stemmed from the rarity of deaths by suicide, homogeneity of study populations, heterogeneity of suicide methods, and the corresponding neurobiological changes made interpretation difficult. Intercultural cohort observations across countries may help to weigh the contributions from biological and socio-cultural factors. The purported association not only represents a scientific challenge, it's also an opportunity potentially leading to important insights into prevention of suicide death.

Low cholesterol is associated with depression among US household population

OBJECTIVE

Serum cholesterol was reported to be associated with depressed mood, but the studies conducted among household population are rare.

METHODS

We used the data of 4115 men and 4275 women aged 18 or older, who completed a depression screening interview and had blood collected as a part of the National Health and Nutrition Examination Survey, 2005-2008. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were gender-specifically categorized into lower, intermediate, and upper quartiles. Depression was measured using the Patient Health Questionnaire, a 9-item screening instrument asking about the frequency of depression symptoms over the past 2 weeks.

RESULTS

After adjustment for socio-demographics and behavioral risks, a U-shaped association was detected between severe depression and LDL-C among men. The odds ratios (ORs) of severe depression were 5.13 (95% CI=1.74-15.09), 1 (reference) and 2.28 (1.07-4.86) respectively for the men with lower (<169 mg/dL), intermediate (169-221 mg/dL), and upper quartile (≥ 222 mg/dL) LDL-C. Among women, lower HDL-C was significantly associated with an elevated odds of severe depression [OR=2.96 (1.59-5.52)] compared with upper quartile of HDL-C, the association diminished after adjustment for covariates [OR=1.24 (0.66-2.32)]. No clear pattern of association between cholesterol and moderate depression was observed from either men or women.

LIMITATION

The inherent limitation of cross-sectional design prevented the authors from investigating causality.

CONCLUSIONS

A U-shaped association was identified between LDL-C and severe depression among men. Further studies are necessary to explore the biological mechanism and identify the clinical implication among populations vulnerable to psychiatric disorders.