Does knowledge of cancer diagnosis affect quality of life? A methodological challenge

The Assessment of Social Isolation and Loneliness in Cancer Patients and Survivors in the Pre-COVID-19 Period: A Systematic Review

BACKGROUND

In the context of cancer research, identifying social isolation and loneliness is a priority given how both exacerbate poor outcomes and lead to increased mortality in oncological populations. The purpose of this systematic review is to identify all quantitative instruments that have been used to assess either social isolation or loneliness in patients previously or currently diagnosed with cancer in the pre-COVID-19 period.

METHOD

PubMed (Web), Scopus, CINAHL, and PsycINFO were searched on August 22, 2019. All databases were searched from inception with no filters applied. The search strategies included terms that captured the following concepts: instruments/tools, social isolation or loneliness, and cancer.

RESULTS

A total of 289 titles/abstracts were returned. Upon review, 114 titles/abstracts were deemed to be potentially eligible and the full text was retrieved. Of the 114 full texts, 69 articles met inclusion criteria and comprised the final sample. Publications span years 1980 through 2019, with the majority (71%) occurring in the last decade prior to this review, between 2009 and 2019. Average age of the study samples, with few exceptions, was often over 50 years old. Many studies used all-female samples, while only one study used an all-male sample. The most common cancer diagnosis of participants was breast cancer. The most common measure was the UCLA Loneliness Scale, used in 22 studies. Most measures we identified were used only once, and 11 measures were used 2-3 times. When the information was given, response ranges were always Likert-type scales most often ranging from 1-4 or 1-5, and sometimes from 1-10 possible response options. In terms of psychometrics, test-retest reliability and validity were rarely reported; by contrast, internal consistency (Cronbach's alpha) was reported more than half of the time (60.9%).

CONCLUSION

When selecting a measure to assess loneliness in cancer populations, the UCLA Loneliness Scale is both psychometrically strong and versatile across patients with different cancers, ages, and racial backgrounds. When selecting a measure to assess social isolation in cancer populations, both the PROMIS-SF V 2.0 social isolation and the Berkman-Syme Network Index are brief and have been used in patients with non-White racial backgrounds.

The association of prognostic awareness with quality of life, spiritual well-being, psychological distress, and pain severity in patients with advanced cancer: Results from the APPROACH Study in Indonesia

BACKGROUND AND OBJECTIVES

Advanced cancer patients' understanding of their illness is key for making informed treatment decisions. Despite the known importance of patients' awareness of their disease prognosis, it is debatable whether this awareness is positively, negatively, or not associated with clinical and psychological outcomes among patients with advanced cancer. This paper aims to determine the prevalence of and factors associated with prognostic awareness and its association with quality of life (QoL), spiritual well-being, pain control, and psychological distress in patients with advanced cancer in Indonesia.

METHODS

This cross-sectional questionnaire-based survey was part of a multicountry study titled "Asian Patient Perspectives Regarding Oncology Awareness, Care and Health (APPROACH)." Patients were asked what they knew about their cancer and treatment. QoL and spiritual well-being were measured using the Functional Assessment of Cancer Therapy - General (FACT-G) and Functional Assessment of Chronic Illness Therapy - Spiritual Well-being (FACIT-Sp) questionnaire. Psychological distress experienced by patients was recorded via the Hospital Anxiety and Depression Scale. Pain severity was also assessed. Data from 160 patients were analyzed using descriptive statistics and multivariable regression models.

RESULTS

Of the 160 patients who participated, 55 (34.4%) were unaware of their cancer stage. Those who were aware of their stage of cancer were younger than those who were not aware (45.7 years vs 50.4 years, p = .015). There was no significant difference in spiritual well-being and other domains of QoL between those who were aware and those who were not aware of their advanced cancer stage. There was also no significant difference in anxiety depression or pain severity, even after adjustment for demographic and clinical characteristics.

SIGNIFICANT OF RESULTS

Given the high prevalence of patients who wrongly thought their cancer was curable, more could be done to improve disease and prognostic understanding among patients with advanced cancer in Indonesia. Those who were aware of their advanced cancer stage did not have a poorer QoL, nor did they have more anxiety or depression than those who were unaware. This finding suggests that concerns about the negative impact of prognostic disclosure may be unfounded.

Awareness of Disease Status Among Patients With Cancer: An Integrative Review

BACKGROUND

As the quality of cancer care improves, oncology patients face a rapidly increasing number of treatment options. Thus, it is vital that they are full and active partners in the treatment decision-making process. Awareness of disease status has been investigated in the literature; it has been inconsistently conceptualized and operationalized.

OBJECTIVE

The aim of this integrative review was to develop a conceptual definition and model of the awareness of disease status among patients with cancer.

METHODS

Whittemore and Knafl's integrative review methodology guided this article. We obtained data through a systematic search of 8 databases. Key terms utilized were awareness, perception, truth disclosure, diagnosis, prognosis, terminal illness, status, neoplasm, and metastasis. Dates through January 2020 were searched to capture all relevant articles. Sixty-nine articles met inclusion criteria.

RESULTS

The integrative review methodology guided the development of a conceptual definition and model. The concept of "awareness of disease status" was defined as the individual patient's understanding of being diagnosed and treated for cancer based on the multifactorial components of individual patient characteristics and contextually driven communication practices of healthcare providers. This understanding is dynamic and changes throughout the disease trajectory.

CONCLUSION

These findings will inform consistency in the literature. Such consistency may improve person-centered clinical communication, care planning practices, and, ultimately, cancer-related outcomes.

IMPLICATIONS FOR PRACTICE

With a greater understanding of the complexity of patients' awareness of disease status, nurses will be able to guide their patients to make informed decisions throughout their disease trajectory.

Effect of synbiotic supplementation on matrix metalloproteinase enzymes, quality of life and dietary intake and weight changes in rectal cancer patients undergoing neoadjuvant chemoradiotherapy

BACKGROUND: Probiotic/synbiotic has the important role of in altering intestinal bacteria, reducing inflammation and improvement of intestinal diseases. OBJECTIVE: We aimed to investigate the effect of synbiotic supplementation on matrix metalloproteinase (MMP) enzymes, hs-CRP, quality of life, dietary intake and weight changes in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (CRT). METHODS: In this study, 46 rectal cancer patients were recruited. Patients were allocated to the synbiotic (n = 23) group or placebo groups (n = 23) receiving 2 synbiotic or placebo capsules for six weeks. Anthropometric measurements, quality of life, dietary intakes, and serum levels of MMP-2, MMP-9, and hs-CRP were compared before and after intervention with the use of statistical tests. RESULTS: The mean energy, carbohydrate, and protein intake of patients increased in the synbiotic group, while in the placebo group, post intervention, significant reduction was noticed in these parameters (P < 0.05). Synbiotic supplementation caused improvement in global health status, symptom scale scores and scores of functional scale. At the end of intervention, the elevation in hs-CRP, MMP-2, and MMP-9 levels in the placebo group was approximately two and four times higher than the synbiotic group respectively. CONCLUSION: According to our results, synbiotic supplementation may be helpful in cancer patients undergoing CRT. However, further studies must consider synbiotic as a new complementary treatment.

Feasibility of Early Application of an Advance Directive at the Time of First-Line Palliative Chemotherapy in Patients With Incurable Cancer: A Prospective Study

CONTEXT

This study aimed to evaluate the feasibility of an advance directive (AD) at the time of starting first-line palliative chemotherapy. We investigated changes in emotional distress, quality of life (QoL), and attitudes toward anticancer treatments between before and after AD.

METHODS

Patients with advanced cancer who had just started palliative chemotherapy were prospectively enrolled. We assessed attitudes toward chemotherapy, Hospital Anxiety and Depression Scale (HADS), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ) before conducting the AD and subsequently performed the AD after the first cycle of chemotherapy. Follow-up evaluations using same parameters were performed in the next cycle visit.

RESULTS

During the study period, 104 patients started palliative chemotherapy. Among them, 41 patients (11 with cognitive impairment at baseline, 14 with clinical deteriorations after the first cycle of chemotherapy, 6 with follow-up loss, 7 without proxy, 3 with protocol violations) were excluded, and the AD were recommended in the remaining 64 patients (proportion of AD recommendation: 62%). Among the 64 patients, 44 agreed to conduct the AD (proportion of AD consent: 69%). There were no significant changes before and after AD in terms of HADS and EORTC-QLQ. Attitudes regarding chemotherapy were also unchanged (P = .773). A total of 36 (82%) patients followed physician's recommendations, with the exception of 8 patients who terminated chemotherapy due to refusal or loss to follow-up.

CONCLUSIONS

Considering our results showing no significant changes in depression and anxiety scores, QoL, and attitudes toward anticancer treatments after the AD, early integration of the AD at initiation of first-line palliative chemotherapy might be feasible.

Body image transformation after breast cancer diagnosis and treatment in southern Thai women

Objective:

To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer.

Methods:

Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods.

Results:

Participants’ body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization.

Conclusion:

The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.

Investigating the Quality of Life and the Related Factors in Iranian Women with Breast Cancer

Introduction:

Nowadays breast cancer is the most important factor concerning the women’s health which can affect the quality of life (QOL). This study was performed with aim to investigate the QOL and the related factors in Iranian women diagnosed with breast cancer in 2014-2015.

Methods:

This cross-sectional study was performed on 94 women with breast cancer who were selected by convenience sampling in Mashhad, Iran from 2014-2015. The data were collected through Demographic and Clinical Questionnaire and EORTC QLQ-C30.V3 Standard Questionnaire. Data was analyzed by SPSS software (version 18) and also descriptive statistics and linear regression analysis. P<0.05 was considered statistically significant.

Results:

The mean of total score for the quality of life was 71.45± 22.28. In the area of the symptoms of disease, the highest score belonged to insomnia (22.73± 14.89) and fatigue (19.81± 14.42). In the functional area, physical and emotional scales accounted for the highest (91.35±9.67) and lowest (78.55±2.84) scores, respectively. The results of multiple regression analysis showed that the variables of age, social status, radiotherapy, and hormone therapy are effective factors in the QOL.

Conclusion:

Breast cancer can affect the women’s QOL. Therefore, efforts to promote the QOL in breast cancer patients is considered as one of the most important topics in women’s health care. This requires more attention to identify various aspects of life and find effective ways to promote and improve the QOL in these patients.

Attitudes toward Telling the Truth to Cancer Patients in Iran: A Review Article

Background:Patients generally have the right to be informed of their condition, but the debate over the issue of truth disclosure is still present. The attempt of this study is to review the approaches toward truth- telling to cancer patients in Iran. Materials and Methods: This study is a narrative review that included articles published in Iran on attitudes toward telling the truth to cancer patients. The present study extracted data from articles published in PubMed, Science Direct, Scientific Information Database (SID), Magiran, Iran Medex, Google Scholar, Iranian Research Institute for Information Science and Technology with key terms such as truth disclosure, breaking bad news, death awareness and disclosure of diagnosis without any time restriction. Results: Totally, 21 articles including 14 in English and 7 in Persian were selected and reviewed. The results of the study have shown that although treatment team and caregivers are unwilling to disclose the truth to patients, they have a tendency to obtain more information about their disease. Conclusion: As the incidence of cancer has increased worldwide, telling the truth to patients seeking more information about cancer disease would be inevitable, but more studies are required to provide scientific procedures based on evidence for truth disclosure, not the whole, to cancer patients.

Does awareness of diagnosis influence health related quality of life in north Indian patients with lung cancer ?

Background & objectives:

Several patients with cancer in India are not aware of their diagnosis. We evaluated the impact of awareness of cancer diagnosis on health-related quality of life (HRQL) in newly diagnosed patients with lung cancer.

Methods:

A total of 391 treatment-naïve patients with lung cancer, seen at the Lung Cancer Clinic of a tertiary care hospital in north India, were categorized into those aware of their diagnosis (group A) and those not aware (group B). All patients answered Hindi versions of abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref) and European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30), and its lung cancer module, EORTC QLQ-LC13. Various domain scores were computed and compared between the two groups. Analysis of covariance was used to determine significance of differences after adjustment for potential confounding factors.

Results:

Only 117 (29.9%) patients were aware of their diagnosis. Of all, 302 (77.2%) patients had non-small cell lung cancer, and 301 (77.0%) had advanced disease. All HRQL domain scores were similar between the two groups, except that group B patients had significantly poorer median (interquartile range) Physical [39.3 (28.6-50.0) vs 46.4 (28.6-57.1)] and Environment [46.9 (40.6-56.3) vs 53.1 (0.6-65.6)] domain scores of WHOQOL-Bref, and Physical function [60.0 (40.0-73.3) vs 66.7 (46.7-80.0)] and Fatigue [66.7 (55.6-77.8) vs 66.7 (44.4-66.7)] scores of QLQ-C30. After adjusting for gender, age, education, family income, and tumour extent, these differences were not significant.

Interpretation & conclusions:

Disclosure of cancer diagnosis, or lack of it, had no significant impact on HRQL in patients with lung cancer after adjustment of potential confounders.

Undergoing Diagnostic Evaluation for Possible Cancer Affects the Health-Related Quality of Life in Patients Presenting with Non-Specific Symptoms

AIM

Undergoing diagnostic evaluation for possible cancer can affect health-related quality of life (HRQoL). The aims of this study were to examine the HRQoL in patients undergoing a diagnostic evaluation for possible cancer due to non-specific symptoms and further to investigate the impact of socio-demographic and medical factors associated with HRQoL at the time of diagnosis.

METHODS

This was a prospective, multicenter survey study that included patients who were referred for a diagnostic evaluation due to non-specific cancer symptoms. Participants completed the EORTC-QLQ-C30 quality of life scale before and after completing the diagnostic evaluation. The baseline and follow-up EORTC-QLQ-C30 scores were compared with reference populations. The impact of socio-demographic and medical factors on HRQoL at follow-up was explored by bootstrapped multivariate linear regression.

RESULTS

A total of 838 patients participated in the study; 680 (81%) also completed follow-up. Twenty-two percent of the patients received a cancer diagnosis at the end of follow-up. Patients presented initially with a high burden of symptoms, less role and emotional functioning and a lower global health/QoL. Most domains improved after diagnosis and no clinically important difference between baseline and follow-up scores was found. Patients reported effects on HRQoL both at baseline and at follow-up compared with the Danish reference population and had similar scores as a cancer reference population. Co-morbidity, being unemployed and receiving a cancer diagnosis had the greatest effect on HRQoL around the time of diagnosis.

CONCLUSIONS

Patients with non-specific symptoms reported an affected HRQoL while undergoing a diagnostic evaluation for possible cancer. Morbidity, being unemployed and receiving a cancer diagnosis had the greatest effect on HRQoL around the time of diagnosis.

Use of the lung cancer-specific Quality of Life Questionnaire EORTC QLQ-LC13 in clinical trials: A systematic review of the literature 20 years after its development

The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) covers 13 typical symptoms of lung cancer patients and was the first module developed in conjunction with the EORTC core quality-of-life (QL) questionnaire. This review investigates how the module has been used and reported in cancer clinical trials in the 20 years since its publication. Thirty-six databases were searched with a prespecified algorithm. This search plus an additional hand search generated 770 hits, 240 of which were clinical studies. Two raters extracted data using a coding scheme. Analyses focused on the randomized controlled trials (RCTs). Of the 240 clinical studies that were identified using the LC13, 109 (45%) were RCTs. More than half of the RCTs were phase 3 trials (n = 58). Twenty RCTs considered QL as the primary endpoint, and 68 considered it as a secondary endpoint. QL results were addressed in the results section of the article (n = 89) or in the abstract (n = 92); and, in half of the articles, QL results were presented in the form of tables (n = 53) or figures (n = 43). Furthermore, QL results had an impact on the evaluation of the therapy that could be clearly demonstrated in the 47 RCTs that yielded QL differences between treatment and control groups. The EORTC QLQ-LC13 fulfilled its mission to be used as a standard instrument in lung cancer clinical trials. An update of the LC13 is underway to keep up with new therapeutic trends and to ensure optimized and relevant QL assessment in future trials.

LIFE QUALITY RELATED TO SPIRITUAL HEALTH AND FACTORS AFFECTING IT IN PATIENTS AFFLICTED BY DIGESTIVE SYSTEM METASTATIC CANCER

INTRODUCTION

Spiritual health is of the basic elements in chronic patients. This concept can be considered as an important approach in promoting physical & spiritual health & life quality.

GOAL

The present study has been planned aiming to study life quality related to metastatic phase gastrointestinal (digestive) cancer referring to Mazandaran Medical Science University Educational Center in Iran.

MATERIAL AND METHODS

This research has been done by descriptive-analytical method with 250 patients through available sampling method. The data has been collected via spiritual health & life quality questionnaire. The data analysis has been performed by calculating X², T Test, variance analysis and Pearson correlation coefficient.

RESULTS

The mean & standard deviation of the patients were 12.56 ±94/47. The highest relationship between age & spirituality was related to ages over 60. There was a meaningful statistical relationship between spirituality & life quality scale (p<0.001), between spirituality & respiratory disorder (p<0.047), anorexia (p<0.004), exhaustion (p<0.006), financial problems (p<0.006).

CONCLUSION

regarding the results, we can perceive the necessity behind improving spiritual health aspect as an influencing factor on the patients' life quality. Through enhancing spiritual beliefs, it is possible to help the patients' spiritual quality get promoted.

Quality of life after lung resection for lung cancer

Radical and palliative treatments for non-small cell lung cancer (NSCLC) have been reported to have a significant impact on the patient quality of life (QoL). The increasing improvements in lung cancer diagnosis and cures in recent years have changed the perspectives of quantity and quality of the life after cancer in these patients. However, despite a growing interest about patient reported outcome measures (PROMs) in surgical oncology, we are quite distant from a routine collection of QoL data after pulmonary resection for NSCLC. The presence of this gap is due to several reasons: the lack of validated surgical-specific questionnaires, the inappropriate consideration of traditional objective parameters as surrogates of QoL outcomes and the difficulties in dealing with missing items in this type of research. However, a recent the European Society of Thoracic Surgeons (ESTS) survey exploring the use of QoL data in our field has revealed that almost half of the units responding to the questionnaire collect QoL informations from their patients. Increased consensus and collaboration between surgeons are needed to include routinely PROMs in randomized controlled trials. The objective of this paper is to review the best available evidence published in the literature and regarding QoL after lung resection for cancer, aiming at identifying topics deserving further investigations.

Depression and socio-economical burden are more common in primary caregivers of patients who are not aware of their cancer: TURQUOISE Study by the Palliative Care Working Committee of the Turkish Oncology Group (TOG)

In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross-sectional survey study using a 5-point Likert-type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n = 476) among all subjects (n = 968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho-social effects of cancer should focus intensively on both the patients and their caregivers in Turkey.

Osteoarthritis medical labelling and health-related quality of life in the general population

Background

Osteoarthritis is the most common chronic joint disease. In the absence of an effective medical treatment and due to the chronic nature of this condition, an osteoarthritis medical diagnosis may finally result in decreased health-related quality of life. Therefore, the aim of this study was to measure the impact of the osteoarthritis medical labelling on physical and mental health-related quality of life.

Methods

Subjects (n = 1132, 58.7% women) were approached as participants of an urban population-based cohort (EPIPorto). Self-reported information on previous diagnosis of knee, hip or hand osteoarthritis was obtained and rheumatologists established knee, hip or hand osteoarthritis clinical diagnosis in symptomatic individuals. Physical and mental dimensions of health-related quality of life were evaluated using the self-administered Medical Outcomes Study: 36-Item Short Form Survey. Crude and adjusted linear regression coefficients (beta) and the corresponding 95% confidence intervals (95% CI) were computed to estimate the associations between being labelled as an osteoarthritis case and health-related quality of life.

Results

Regardless of disease medical labelling, individuals with osteoarthritis scored significantly lower physical health-related quality of life when compared to those without joint disease (knee_unexposed: beta = −5.3, 95% CI: −7.6, −3.1; knee_exposed: beta = −6.0, 95% CI: −8.4, −3.7; hip_unexposed: beta = −6.0, 95% CI: −9.8, −2.3; hip_exposed: beta = −11.0, 95% CI: −15.6, −6.4; hand_unexposed: beta = −4.3, 95% CI: −6.5, −2.0; hand_exposed: beta = −4.3, 95% CI: −6.6, −2.1). The same was not observed regarding mental health-related quality of life. Among subjects with clinically confirmed osteoarthritis, the medical labelling of this joint disease was not significantly associated to health-related quality of life.

Conclusions

The labelling of knee, hip and hand osteoarthritis diagnosis may not add specific benefit to osteoarthritis patients in terms of its capability to improve health-related quality of life.

Quality of Life and its Related Factors Among Iranian Patients with Metastatic Gastrointestinal Tract Cancer: A Cross-sectional Study

Context:

Quality of life (QoL) is an important issue in all cancer patients; especially in patients with metastatic cancer. But there is very little information available about QoL in patients with metastatic gastrointestinal cancer.

Aims:

The aim of this study was to evaluate the quality of life and its associated factors among Iranian patients with metastatic gastrointestinal tract cancer.

Materials and Methods:

In this cross-sectional study, a total of 250 patients with metastatic gastrointestinal tract cancer were recruited from the one oncology center related to the Mazandaran University of Medical Sciences, Sari, between March 2012 and August 2013. Their QoL was evaluated using the EORTC QLQ-C30 questionnaire (Persian version).

Results:

In this study, the overall QoL score of patients with gastrointestinal tract cancer was 57.63, which was relatively optimal. There was a statistically significant relationship between symptoms scale and general health status domains of quality of life with age (P < 0.05). Also, there was a significant association between patients’ gender and their social functioning (P = 0.017) and also their emotional functioning (P = 0.015).

Conclusions:

The findings suggest that in patients with metastatic gastrointestinal cancers, the most affected functions in their QoL were social and emotional functioning which get worse with age. Thus, providing psychological counseling and psychotherapy services to deliver culturally appropriate mental health care and social support for these patients and their families’ which can lead to the improvement of QoL in these patients is strongly recommended.

Hope-based intervention for individuals susceptible to colorectal cancer: a pilot study

Individuals undergoing genetic testing for hereditary colorectal cancer (HCRC) are prone to develop psychological problems. This study investigated the short-term efficacy of a hope-based intervention program in increasing hope levels and decreasing psychopathology among HCRC genetic testing recipients. A longitudinal study was carried out on HCRC genetic testing recipients recruited by the Hereditary Gastrointestinal Cancer Registry. Participants joined a hope-based intervention program consisting of six sessions of weekly closed group therapy. Psychological questionnaires were administered immediately before the first and after the last sessions of the program measuring hope, anxiety and depression levels of the participants. There were 22 participants (7 men and 15 women) at a mean age of 49.4 ± 9.6 years. Women tended to have higher level of anxiety than men at pre-intervention. Paired sample t tests were conducted. Hope levels increased significantly from pre- to post-intervention (pre-total hope score = 5.56; post-total hope score = 6.07; t(1) = −0.281, p < 0.05). Anxiety level also decreased significantly from pre- to post-intervention (pre-anxiety score = 7.38; post-anxiety score = 5.90; t (1) = 2.35, p < 0.05). Our findings imply that hope-based intervention program would be effective in enhancing hope in HCRC genetic testing recipients. The program may also be more effective in alleviating anxiety than depression in these individuals.

Awareness of incurable cancer status and health-related quality of life among advanced cancer patients: a prospective cohort study

BACKGROUND

Many patients near death report an interest in knowing their prognoses. Patients' awareness of disease status may lead to more appropriate care and maintained or improved quality of life. However, it is not known whether advanced cancer patients' awareness of disease status is associated with patients' quality of life.

AIM

We aimed to examine the effect of patients' awareness of disease status on the health-related quality of life (HRQOL) among advanced cancer patients undergoing palliative chemotherapy.

DESIGN

In this prospective cohort study, patients were followed-up at 4-6 weeks and 2-3 months after the initial palliative chemotherapy. Patients' awareness of disease status, and demographic and clinical characteristics were assessed at baseline, and depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) and HRQOL using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were assessed three times.

SETTING / PARTICIPANTS

In total, 100 patients with advanced cancer starting palliative chemotherapy were recruited from two tertiary university hospitals and from the Korea National Cancer Center.

RESULTS

Patients with advanced cancer undergoing palliative chemotherapy experienced deteriorated HRQOL. Of these, the patients who were aware of their disease status as incurable had significantly higher role (p=0.002), emotional (p=0.025), and social functioning (p=0.002), and lower fatigue (p=0.008), appetite loss (p=0.039), constipation (p=0.032), financial difficulties (p=0.019), and anxiety (p=0.041) compared with patients unaware of disease status.

CONCLUSION

Our findings demonstrate the importance of patients' awareness of disease status to HRQOL.

Effect of the disclosure of MS diagnosis on anxiety, mood and quality of life of patients: a prospective study

BACKGROUND

In the light of the new diagnostic criteria for multiple sclerosis (MS) and currently available early treatment, this study aimed to explore whether, and to what extent, disclosure of the diagnosis of MS or clinically isolated syndrome (CIS) affects patients' anxiety, mood and quality of life (QoL).

METHODS

Eligible participants were all patients referred for the first time to the Neurological Unit who had manifested symptoms suggestive of MS for no more than 6 months. All patients were evaluated for (i) QoL (SEIQoL and MS-QoL54), (ii) Anxiety (STAI) and Depression (CMDI) on study inclusion (T0), 30 days after diagnosis disclosure (T30), and after 1 (T1y) and 2 (T2y) years' follow-up.

RESULTS

Two hundred and twenty-nine patients were enrolled; 93 of these were unaware of their diagnosis. Patients who already knew their diagnosis (100 with CIS and 22 with MS) were excluded from the main analyses and used to perform control analyses. At the end of the screening, an MS diagnosis was disclosed to 18 of the 93 patients, whereas a CIS diagnosis was disclosed to 62 patients (12 patients received a diagnosis other than MS or CIS). Thirty days after diagnosis disclosure, irrespective of the diagnosis disclosed, both QoL and Anxiety and Depression were significantly rated as better compared to the start of screening, (p(s) < 0.03), and this improvement remained stable over the two annual follow-ups. However, as suggested by a significant 'Time' × 'Diagnosis' interaction with regard to both QoL and Anxiety and Depression (p(s) < 0.02), the effect of the disclosure in the short term differed depending on CIS or MS diagnosis. Specifically, on MSQoL, which is a health-related QoL scale, we found a statically significant improvement, immediately after the diagnosis disclosure, in both the MS and CIS groups (p(s) < 0.01). Differently, on SEIQoL, which is a non health-related QoL measure, and on the anxiety scale, we observed a statistically significant improvement only in the group which received a MS diagnosis (p(s) < 0.03).

CONCLUSIONS

This first prospective study provides objective data showing that early disclosure of MS diagnosis improves both the patient's QoL and psychological well-being. In addition, the results seem to suggest that CIS disclosure does not lead to the same favourable effects.

Quality of life in Chinese home-based advanced cancer patients: does awareness of cancer diagnosis matter?

The aim of this study was to assess the quality of life (QOL) of Chinese home-based advanced-stage cancer patients and to evaluate the association between the disclosure of cancer diagnosis and QOL. An interview-based survey was conducted from December 2009 to June 2010 in the home-based hospice of the First Affiliated Hospital of Chongqing Medical University, China. The principal finding of this study demonstrated that patients who did not have knowledge of their diagnosis exhibited better physical and emotional QOL compared with those who had knowledge of their diagnosis.

Change in health-related quality of life of newly diagnosed cancer patients, cancer survivors, and controls

BACKGROUND

Data from the 1998 Health Outcomes Survey (HOS) of patients who were enrolled in Medicare managed care and follow-up data from the 2000 HOS resurvey were analyzed to examine changes in health-related quality of life (HRQOL) of newly diagnosed cancer patients, cancer survivors, and patients without cancer.

METHODS

In 1998, the HOS was mailed to a random sample of 279,135 beneficiaries, and 167,096 respondents (60%) returned completed surveys. Those who were diagnosed with cancer (22,747) were frequency age-matched to an equal number of patients with no cancer. In 2000, the HOS was mailed to the same cohort of beneficiaries. Complete data at both baseline and follow-up were available on 16,850 individuals for inclusion in the current study.

RESULTS

After 2 years, respondents who had been diagnosed with cancer at baseline continued to have lower scores on all but 3 scales of the 36-item short-form HRQOL measure. However, there was no evidence that they were declining any faster than or catching up with noncancer patients. Those who had been newly diagnosed with cancer since the baseline survey had lower mean scale scores than the no-cancer group on all scales and lower mean scores than the cancer survivors on all subscales except Bodily Pain, Vitality, and Mental Health.

CONCLUSIONS

This study demonstrated that, after 2 years, cancer survivors continued to have poorer HRQOL than the no-cancer group. Newly diagnosed cancer patients had poorer quality of life than both the longer term cancer survivors and the no-cancer group.

Genetic testing for Lynch syndrome in the first year of colorectal cancer: a review of the psychological impact

An increasing number of patients with colorectal cancer (CRC) receive genetic counselling within 1 year after diagnosis. Little is known whether specific subgroups are more vulnerable for genetic testing related distress. A literature review was conducted to identify the psychological impact of CRC in the first year, and the additional impact of genetic testing. The electronic databases of PubMed, PsychInfo, Embase and the Cochrane Library were searched to identify all reports published between January 1997 and October 2007 on the psychological impact of (1) CRC-diagnosis up to 1 year after treatment and of (2) genetic testing for Lynch syndrome in patients with CRC. Studies on the psychological impact of genetic testing in newly diagnosed patient with CRC were not available. Either CRC patients diagnosed several years ago were studied and the focus was also often on the psychological impact of genetic testing prior to DNA-test disclosure. They show that limitations in emotional and social functioning can persist up to 1 year after CRC treatment, especially in those with a stoma or diagnosed before age 60. Female patients and male patients diagnosed before age 50 appear to be more vulnerable to genetic test-related distress. It is well known that being treated for CRC has great impact on psychological functioning. Little is known about the psychological impact during the first year after diagnosis and very little is known about the additional psychological effect of genetic testing for hereditary cancer in this period. We found presumptive evidence that specific subgroups of patients with CRC are more vulnerable for genetic-testing-related distress.

Disclosure of cancer diagnosis and quality of life in cancer patients: should it be the same everywhere?

Background

Evidence suggests that truth telling and honest disclosure of cancer diagnosis could lead to improved outcomes in cancer patients. To examine such findings in Iran, this trial aimed to study the various dimensions of quality of life in patients with gastrointestinal cancer and to compare these variables among those who knew their diagnosis and those who did not.

Methods

A consecutive sample of patients with gastrointestinal cancer being treated in Cancer Institute in Tehran, Iran was prospectively evaluated. A psychologist interviewed patients using the Iranian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Patients were categorized into two groups: those who knew their diagnosis and those who did not. Independent sample t-test was used for group comparisons.

Results

In all 142 patients were interviewed. A significant proportion (52%) of patients did not know their cancer diagnosis and 48% of patients were aware that they had cancer. They were quite similar in most characteristics. The comparison of quality of life between two groups indicated that those knew their diagnosis showed a significant lower degree of physical (P = 0.001), emotional (P = 0.01) and social functioning (P < 0.001), whereas the global quality of life and other functional scales including role functioning and cognitive functioning did not show significant result. There were no statistically significant differences between symptoms scores between two groups, except for fatigue suggesting a higher score in patients who knew their diagnosis (P = 0.01). The financial difficulties were also significantly higher in patients who knew their cancer diagnosis (P = 0.005). Performing analysis of variance while controlling for age, educational status, cancer site, and knowledge of cancer diagnosis, the results showed that the knowledge of cancer diagnosis independently still contributed to the significant differences observed between two groups.

Conclusion

Contrary to expectation the findings indicated that patients who did not know their cancer diagnosis had a better physical, social and emotional quality of life. It seems that due to cultural differences between countries cancer disclosure guidelines perhaps should be differing.

Economic assessment of contrast-enhanced ultrasonography for evaluation of focal liver lesions: a multicentre Italian experience

BACKGROUND

The aim of this study was to evaluate the clinical and economic consequences of the introduction of contrast-enhanced ultrasonography (CEUS) into the diagnostic clinical algorithm for the characterization of incidental focal liver lesions (FLLs).

METHODS

This prospective study enrolled 485 subjects at three hospitals in Italy. Two diagnostic algorithms were utilized: (1) a classic patient work-up, which included baseline US followed by a CT or MR examination, and (2) a new patient management scheme in which, following the baseline US, a CEUS examination was performed. For each pathway, both direct and indirect health costs for the National Health System (NHS) at two of the three hospitals involved in the study were calculated. Clinical outcome was measured in terms of number of cases correctly diagnosed, using contrast-enhanced CT/contrast-enhanced MR as the reference standard.

RESULTS

CEUS correctly differentiated (benign vs. malignant) 559 of 575 lesions (97.2%), with a sensitivity of 98.1% and a specificity of 95.7%. Histological characterization was correct in 502 of 575 lesions (87%) with a sensitivity of 90.5% and a specificity of 85.4%. In terms of cost, the conventional diagnostic algorithm incurred for the NHS a total cost of Euro 134.576,60 vs. Euro 55.674,30 with CEUS, for a saving of Euro 78.902 (Euro 162 per patient). For the hospitals, the total cost was Euro 147.045 without CEUS vs Euro 61.979 with CEUS, for a saving of Euro 85.065,96 or Euro 175,39 per patient.

CONCLUSION

The routine use of CEUS for the characterization of FLLs provides significant cost savings, both for the NHS and for the hospital.

Prostate cancer diagnosis: the impact on patients' mental health

Because the introduction of PSA testing has increased the reported incidence of prostate cancer, this study assessed the mental impact on men after receiving a diagnosis of prostate cancer. Participants in a prostate cancer screening trial (ERSPC) completed a questionnaire on health and, if diagnosed with prostate cancer, at two additional time points. In the pre-screening phase 3800 men (response 88%) completed the questionnaire. Of screen-diagnosed men (n=82) 52 (response 63%) completed two additional assessments. Gleason scores were < or=7 in 96% of men. Mental and self-rated overall health worsened significantly immediately after diagnosis (P < or=0.04). Six months later these scores improved and no longer differed significantly from the pre-diagnosis score. After obtaining a pre-diagnosis assessment in prospective prostate cancer patients we found a significant negative mental impact of prostate cancer diagnosis based on PSA testing. We recommend that clinicians share their knowledge on the generally favourable prognosis with their patients. The methodological implication is that considering a post-diagnosis assessment as 'baseline' may lead to an underestimation of the patient's mental health.