Association Between Household Income and Self-Perceived Health Status and Poor Mental and Physical Health Among Cancer Survivors

Patient-centered communication and cancer information-seeking experiences among cancer survivors: A population-based study in the United States

OBJECTIVES

To investigate associations between patient-centered communication (PCC) and two elements of cancer information-seeking experience (i.e., effort and frustration) among cancer survivors.

METHODS

We utilized secondary data from the U.S. National Cancer Institute's Health Information National Trends Survey ([HINTS5 cycles 2 (2018) and 4 (2020)], and [HINTS6 (2022)]) for 1346 self-identified cancer survivors (aged ≥18 years) who reported ever seeking cancer information from any source and ≥one healthcare provider visit during the past 12 months. We fit multivariable logistic regression models to compute adjusted odds ratios (aORs) and associated 95 % confidence intervals (CIs).

RESULTS

Approximately 40 % of cancer survivors reported that it took them significant effort to seek needed cancer information, and 33.8 % felt frustrated doing so. With each unit increase on the PCC score scale, cancer survivors were about 1.5 % and almost 2.0 % less likely to perceive extra effort in seeking cancer information (aOR=0.986; 95 % CI: 0.977, 0.996) or report frustration while doing so (aOR=0.981; 95 % CI: 0.973, 0.990), respectively.

CONCLUSIONS

The findings demonstrate that better PCC is associated with improved cancer information-seeking experiences.

PRACTICE IMPLICATIONS

PCC could potentially empower cancer survivors to take a more active role in self-care and decision-making while reducing uncertainty and optimizing cancer information-seeking experiences.

Social determinants of health on all-cause and cause-specific mortality in US adults with chronic obstructive pulmonary disease: NHANES 2005-2018

BACKGROUND

Social determinants of health (SDoH) are nonmedical societal factors that influence health outcomes. However, their relationship with mortality risk in patients with chronic obstructive pulmonary disease (COPD) remains poorly understood. This study aimed to evaluate the association between SDoH and the risk of all-cause and cause-specific mortality in COPD patients.

METHODS

Data from seven National Health and Nutrition Examination Survey (NHANES) cycles (2005-2018) were analyzed. Kaplan-Meier survival curves and multivariate Cox proportional hazards models were used to assess the association between SDoH and mortality outcomes, including all-cause and cause-specific mortality. The sensitive analyses were performed to check the robustness of the main findings. Nonlinear relationships were explored using restricted cubic spline (RCS) analysis, offering greater flexibility than traditional linear models. Subgroup analyses further assessed the consistency and robustness of findings across different demographic and clinical factors, enhancing the depth and reliability of the results.

RESULTS

Among 1,551 COPD participants, 506 deaths occurred, including 114 from cardio-cerebrovascular diseases and 130 from cancer. Higher SDoH scores were inversely associated with survival outcomes. After adjusting for confounders, individuals with higher SDoH scores had increased risks of all-cause mortality (hazard ratio [HR] = 1.199, 95% confidence intervals [CI]:1.136, 1.264), cancer mortality (HR = 1.236, 95% CI: 1.100, 1.388), and cardio-cerebrovascular mortality (HR = 1.143, 95% CI: 1.022,1.277) compared to those with lower SDoH scores. Sensitivity analyses confirmed the positive correlations between SDoH and mortality in the COPD population. Kaplan-Meier analyses also revealed worse survival outcomes for participants with higher SDoH scores. The agreement between survival analyses and statistical modeling underscores the predictive value of SDoH in this population.

CONCLUSION

The results of our study indicate a notable positive correlation between SDoH score and the likelihood of mortality from all causes and specific causes in patients with COPD.

Long-Term Quality of Life, Cognitive Function, and Symptom Burden Among Chimeric Antigen Receptor T-Cell Recipients and Associated Cytokine Release Syndrome and Neurotoxicity

PURPOSE

Immediate side effects after chimeric antigen receptor (CAR) T-cell therapy are well documented and include cytokine release syndrome (CRS) and immune effector-cell-associated neurotoxicity (ICANS). However, long-term patient-reported outcomes are understudied. Using a social determinants of health (SDoH) framework, we described the long-term health-related quality of life (HRQoL), cognitive function, and symptom burden of patients in sustained remission after CAR T-cell therapy and examined the relationship between acute CRS and ICANS and long-term cognitive function and symptom burden.

METHODS

This cross-sectional study included adults in remission after CAR T-cell therapy for multiple myeloma or B-cell lymphoma who were within 1-5 years post-treatment. We used bivariate analyses to measure associations between clinical and SDoH variables and long-term outcomes and linear regression to examine the relationship between ICANS and CRS toxicity and longer-term outcomes.

RESULTS

Participants (n = 58) were a median of 67 years of age (22-88), 72% had lymphoma, 28% had multiple myeloma, and they were a median of 2 years (1-4.7) post-CAR T-cell infusion. Most of the participants reported good HRQoL. Over one third of participants reported mild-to-moderate impairment in physical function, social roles and activities, or pain domains. Higher income and employment were significantly associated with better physical HRQoL (P < .05). Participants reported low symptom burden, with fatigue most commonly reported. Neither CRS nor ICANS toxicity predicted long-term cognitive function or symptom burden.

CONCLUSION

Patients in long-term remission after CAR T-cell therapy have good HRQoL and cognitive function with minimal symptom burden. Importantly, there was no relationship between CRS and ICANS and long-term symptom burden or cognitive function. Results support the long-term clinical benefit of CAR T-cell therapy.

The Interplay of Chronic Stress and Cancer: Pathophysiology and Implications for Integrated Care

BACKGROUND

Cancer-associated depression is a multifaceted condition that arises from the interplay of biological, psychological, and social factors in individuals diagnosed with cancer. Understanding this condition involves exploring how cancer and its treatments can precipitate depressive symptoms and the mechanisms behind this association. Chronic stress, inflammation, and immunological responses play a crucial role in the development of both cancer and depression. The objective of this review is to describe and synthesize information on the complex interactions between chronic stress, inflammation, immunological responses, and cancer development. Additionally, it aims to review existing evidence regarding mechanisms such as neurotransmitter imbalances, structural brain changes, and genetic predispositions as key contributors to depression in cancer patients.

RECENT FINDINGS

A comprehensive literature search on Cancer-associated Depression was conducted in electronic databases, including APA PsycINFO, Medline, Google Scholar, Embase, PubMed, Scopus, and Web of Science. The research focused on understanding the potential relationship between stress-induced depression and cancer by examining neurochemical, anatomical, immunological, genetic, and psychological changes. The findings revealed a compilation of both quantitative and qualitative studies on depression in cancer patients. Evidence suggested a potential link between cancer-induced stress and depression, with increased levels of proinflammatory cytokines (such as IL-6) and dysregulation of neurotransmitters, including serotonin, contributing to the onset of depression. Furthermore, studies indicated that antidepressants, along with psychological interventions, were effective in managing depression among cancer patients.

CONCLUSION

This narrative review provides insights into the importance of integrating oncology and mental health services to address the psychosocial needs of cancer patients. Future research should focus on the bidirectional interactions between stress and cancer, aiming to improve cancer care by incorporating mental health support. Addressing the mental health aspects of cancer treatment can significantly enhance patient outcomes and overall quality of life.

Illness cognition, illness perception and related factors in patients with lymphangioleiomyomatosis

PURPOSE

To explore the self-perceived illness cognition and perception status, as well as the relevant factors among lymphangioleiomyomatosis (LAM) patients.

METHODS

A web-based questionnaire survey was conducted in September 2023. A total of 121 LAM patients participated (including 16 patients with TSC-LAM), and the survey collected general demographic information, responses to a disease cognition questionnaire, and a simplified disease perception questionnaire.

RESULTS

LAM patients have a higher level of negative illness cognition and a lower level of positive illness cognition, specifically characterized by helplessness (15.74 ± 4.68 points), acceptance (16.00 ± 3.28 points), and perceived benefits (16.92 ± 3.86 points). Single-factor analysis of variance found significant correlations between cultural level, age, family average monthly income, use of rapamycin, use of home oxygen therapy, hospitalization frequency, disease duration, severity of respiratory distress, activity limitation, and the helplessness score of LAM patients (p ≤ 0.05); the number of children was significantly associated with acceptance scores of LAM patients (p ≤ 0.05); and whether surgery had been performed was significantly associated with acceptance and perceived benefits scores of LAM patients (p ≤ 0.05). Disease duration and activity limitation entered the regression equation for helplessness dimension, while whether surgery had been performed entered the regression equation for perceived benefits dimension, but no factor entered the regression equation for acceptance dimension. Applying the same analysis to disease perception, we found that the average score of the Illness Perception Questionnaire was 45.43 ± 8.97, with lower scores in the reverse-scored items of individual control, treatment, and understanding.

CONCLUSIONS

LAM patients exhibit higher levels of helplessness, particularly among those with longer disease duration and greater activity limitations, leading to a more negative perception of the disease. Additionally, patients who have undergone surgical procedures tend to perceive fewer benefits. Furthermore, there is a significant correlation between illness perception and factors such as rapamycin usage, home oxygen therapy, disease duration and activity limitations caused by LAM. This indicates that clinical healthcare providers should pay more attention to LAM patients and their associated groups, providing both informational and psychological support.

Caregiving responsibility and psychological distress among community-dwelling cancer survivors in the United States

PURPOSE

There are over 18 million cancer survivors in the U.S., with a projected increase of 24.4% over the next decade. Currently, little is known about the relationship between a cancer survivor's caregiving responsibility and their psychological distress. This study examines whether cancer survivors who assume the role of informal caregivers (surviving caregivers) experience greater psychological distress than cancer survivors without caregiving responsibilities.

METHODS

Data were drawn from the National Cancer Institute's Health Information National Trends Survey (HINTS5, Cycles 1 through 4, 2017-2020). The analytical sample included 2,579 U.S. cancer survivors. Caregiving responsibility was self-reported, and psychological distress was assessed through the Patient Health Questionnaire-4 (PHQ-4). Accounting for the complex design features of HINTS and jackknife replicate weights, a multivariable multinomial logistic regression model was fit to compute adjusted odds ratios (aORs) and their associated 95% confidence intervals (CIs).

RESULTS

Overall, 19.3% of cancer survivors had mild psychological distress, and 10.9% had moderate to severe psychological distress. Approximately 19.1% of the cancer survivors self-reported caregiving responsibilities. Compared to cancer survivors with no caregiving responsibilities, surviving caregivers had more than twofold greater odds of experiencing mild (aOR = 2.25; 95% CI: 1.17, 4.29) and moderate to severe (aOR = 2.18; 95% CI: 1.07, 4.46) psychological distress. Other factors associated with greater psychological distress among cancer survivors included female sex, lower perceived health status, and having one or more chronic diseases.

CONCLUSIONS

Our findings indicate that caregiving among cancer survivors has a substantial adverse impact on their mental and emotional well-being. Cancer surviving caregivers are a distinct subgroup that navigates both survivorship and caregiving burdens at the same time. There is a need to identify and develop tailored interventions, programs, and resources for this vulnerable group of cancer survivors.

Association between social determinants of health and survival among the US cancer survivors population

BACKGROUND

Racial and ethnic disparities in mortality persist among US cancer survivors, with social determinants of health (SDoH) may have a significant impact on these disparities.

METHODS

A population-based cohort study of a nationally representative sample of adult cancer survivors, who participated in the US National Health and Nutrition Examination Survey from 1999 to 2018 was included. Sociodemographic characteristics and SDoH were self-reported using standardized questionnaires in each survey cycle. The SDoH was examined by race and estimated for associations with primary outcomes, which included all-cause and cancer-specific mortality. Multiple mediation analysis was performed to assess the contribution of each unfavorable SDoH to racial disparities to all-cause and cancer-specific mortality.

RESULTS

Among 5163 cancer survivors (2724 [57.7%] females and 3580 [69.3%] non-Hispanic White individuals), only 881 (24.9%) did not report an unfavorable SDoH. During the follow-up period of up to 249 months (median 81 months), 1964 deaths were recorded (cancer, 624; cardiovascular, 529; other causes, 811). Disparities in all-cause and cancer-specific mortality were observed between non-Hispanic Black and White cancer survivors. Unemployment, lower economic status, education less than high school, government or no private insurance, renting a home or other arrangements, and social isolation were significantly and independently associated with worse overall survival. Unemployment, lower economic status, and social isolation were significantly associated with cancer-specific mortality. Compared to patients without an unfavorable SDoH, the risk of all-cause mortality was gradually increased in those with a cumulative number of unfavorable SDoHs (1 unfavorable SDoH: hazard ratio [HR] = 1.54, 95% CI 1.25-1.89; 2 unfavorable SDoHs: HR = 1.81, 95% CI 1.46-2.24; 3 unfavorable SDoHs: HR = 2.42, 95% CI 1.97-2.97; 4 unfavorable SDoHs: HR = 3.22, 95% CI 2.48-4.19; 5 unfavorable SDoHs: HR = 3.99, 95% CI 2.99-5.33; 6 unfavorable SDoHs: HR = 6.34 95% CI 4.51-8.90). A similar trend existed for cancer-specific mortality.

CONCLUSIONS

In this cohort study of a nationally representative sample of US cancer survivors, a greater number of unfavorable SDoH was associated with increased risks of mortality from all causes and cancer. Unfavorable SDoH levels were critical risk factors for all-cause and cancer-specific mortality, as well as the underlying cause of racial all-cause mortality disparities among US cancer survivors.

Predictors of Psychiatric Complications in Patients with Pancreatic Cancer: A Retrospective Cohort Study

BACKGROUND

The relevant survey has shown a high incidence of psychiatric complications in patients with pancreatic cancer. While some studies have explored the factors influencing psychological complications in pancreatic cancer patients, some factors validated in other populations have not been confirmed in the pancreatic cancer population. This study aims to explore the predictors of psychiatric complications in patients with pancreatic cancer.

METHODS

Patients with pancreatic cancer admitted to Yueqing People's Hospital Affiliated to Wenzhou Medical University, from January 2021 to January 2022 were retrospectively analyzed. The structured clinical interview (SCID-I) based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used by nurses to assess the incidence of psychiatric complications during hospitalization (baseline) and 3 months after the start of treatment. Binary logistic regression was used to identify predictors of psychiatric complications.

RESULTS

80 patients were enrolled in this study and 8 patients were diagnosed with psychiatric complications at base line. Among the rest 72 patients, 8 patients (11.11%) had new-onset psychiatric complications at 3-month follow-up. Gender (Odds Ratio (OR) = 1.674, p = 0.019), monthly income (OR = 1.735, p = 0.023) and sadness (M.D. Anderson Symptom Inventory (MDASI)) (OR = 1.804, p = 0.001) were all predictors for psychiatric complications in patients with pancreatic cancer.

CONCLUSIONS

Gender, monthly income and MDASI score are predictors of psychiatric complications in patients with pancreatic cancer.

Comorbidities and perceived health status in persons with history of cancer in the USA

PURPOSE

Comorbidities can further challenge prognosis and general wellbeing of cancer patients. This study aimed to assess the association between comorbidities and perceived health status (PHS) of US persons with cancer.

METHODS

This cross-sectional study used 2019 Medical Expenditure Panel Survey (MEPS) data and included individuals who were alive throughout the year, aged 18 to 84 years, and had diagnosis for cancer. Using adjusted logistic regression models, we estimated the association of comorbidities (no, few [1/2], and more [3 or more] comorbidities) with PHS. Analyses accounted for the complex design of MEPS.

RESULTS

The dataset included 28,512 participants, 1739 of which were eligible for the study. Of these, 11.16% (95% CI 9.64, 12.59%); 41.73% (95% CI 39.21, 43.96%); and 47.10% (95% CI 44.86, 49.73%) reported having no, few, and more comorbidities, respectively. While breast (N = 356), prostate (N = 276), and melanoma (N = 273) were the most common cancers, hypertension (88.3%), hypercholesterolemia (49.5%), and arthritis (48%) were the most prevalent comorbidities. Adjusted logistic regression showed that, compared with those with no comorbidities, persons with few and more comorbidities had 1.58 (95% CI = 0.79, 3.15) and 2.27 (95% CI = 1.19, 4.32) times greater odds of poor PHS. Younger or male patients, those with less formal education, low-income, pain, functional limitation, or poor perception of mental health were more likely to regard their health as poor.

CONCLUSION

About 88% of persons with history of cancer in the USA aged 18-84 years reported at least one comorbidity. Having more comorbidities, along with several other variables, was associated with poor PHS. Comorbidities management must be given special consideration to improve the prognosis and general wellbeing of persons with cancer.

More income, less depression? Revisiting the nonlinear and heterogeneous relationship between income and mental health

This paper uses a large-scale nationally representative dataset to examine the nonlinear effect of income on mental health. To investigate their causal relationship, the exogenous impact of automation on income is utilized as the instrument variable (IV). In addition, to explore their nonlinear relationship, both income and its quadratic term are included in regressions. It is found that the impact of income on mental health is U-shaped rather than linear. The turning point (7.698) of this nonlinear relation is near the midpoint of the income interval ([0, 16.113]). This suggests that depression declines as income increases at the lower-income level. However, beyond middle income, further increases in income take pronounced mental health costs, leading to a positive relationship between the two factors. We further exclude the possibility of more complex nonlinear relationships by testing higher order terms of income. In addition, robustness checks, using other instrument variables and mental health indicators, different IV models and placebo analysis, all support above conclusions. Heterogeneity analysis demonstrates that males, older workers, ethnic minorities and those with lower health and socioeconomic status experience higher levels of depression. Highly educated and urban residents suffer from greater mental disorders after the turning point. Religious believers and Communist Party of China members are mentally healthier at lower income levels, meaning that religious and political beliefs moderate the relationship between income and mental health.

Age as a moderator for the association between depression and self-rated health among cancer survivors: a U.S. based population study

BACKGROUND

Self-rated health (SRH) is a salient outcome for cancer survivors. Although depression is a well-studied correlate with SRH, few studies have focused on the role of cancer survivors' age on the association between depression and SRH. This study evaluates demographic and psychosocial factors associated with cancer survivors' SRH. We also assess the moderating role of age to the association between depression and SRH.

MATERIALS AND METHODS

This paper analyzed 2,470 U.S. cancer survivors from the 2019 National Health Interview Survey. Two ordered logistic regression models with complex survey weights were used for analyses. Missing data was addressed using multiple imputations by chained equations.

RESULTS

Being female, higher education and higher income were positively associated with better SRH. While the relationship between higher education and higher income was consistent with previous findings, the positive association between being female and SRH was different from previous studies. Age significantly moderated the association between depression and SRH, evidenced by results of the joint tests of all interaction term coefficients being statistically significant, F(2, 544.6) = 5.13, p < 0.01.

CONCLUSIONS

The findings of the study highlighted the significance of screening for social determinants of health and health disparity when supporting cancer survivors. Additionally, findings of this study emphasized the significance of adopting an age-specific approach when evaluating and addressing depression across different age groups of cancer survivors.