Stress and Quality of Life in Cancer Patients: Medical and Psychological Intervention

Effectiveness of qigong and Tai Chi for quality of life in patients with cancer: an umbrella review and meta-analysis

BACKGROUND

Qigong and Tai Chi (QTC) have been adopted by cancer patients as the complementary treatment to their conventional care. This umbrella review aimed to evaluate the clinical effectiveness of QTC in cancer patients' quality of life (QoL) and its safety.

METHODS

Twenty-five databases were searched from their respective inception to March 2025. Systematic reviews (SRs) and meta-analyses of randomized controlled trials (RCTs) assessing cancer patients' QoL after practicing QTC were included. The search strategy included Qigong, Tai Chi, quality of life, cancer, systematic review, and meta analysis. The extracted data was analyzed using standardized mean difference, mean difference, or odds ratio with 95% confidence intervals.

RESULTS

Nine SRs were included in the qualitative analysis, and six of the SRs were included for the meta-analyses. Results showed that QTC may improve cancer patients' overall QoL, physiological scores (physical functioning, fatigue, and sleep quality), psychological scores (mental health and anxiety), and immunity, compared to the control groups. However, meta-analyses did not demonstrate significant differences in subgroup analyses of depression, although it showed that QTC may reduce depression in cancer patients. No serious adverse events of QTC were reported.

CONCLUSION

QTC can be considered a safe intervention method for improving QoL in patients with cancer. Due to substantial heterogeneity, more rigorously-designed RCTs on QTC for cancer patients should be conducted, focusing on standardizing QTC practices and QoL instruments to assess QTC effects.

PROSPERO REGISTRATION NUMBER

CRD42021253216.

The Influence of a Rat Model of Depression and Gastric Ulcer on the Pharmacokinetics of Encorafenib

Encorafenib is used to treat melanoma and colorectal tumors. Depression and gastric ulcer conditions can impact various physiological processes, including drug metabolism and pharmacokinetics. This study investigated the effect of a rat model of depression and gastric ulcers on the pharmacokinetics (PK) of encorafenib using the developed LC-QqQ-MS method. The chronic unpredictable mild stress (CUMS) model of depression and the indomethacin-induced gastric ulcer model were utilized to investigate the effect of depression and gastric ulcers on the pharmacokinetics of orally administered encorafenib. The focus was on parameters such as maximum plasma concentration (Cmax), elimination half-life (t1/2), mean residence time (MRT), volume of distribution (Vd), area under the curve (AUC), and apparent clearance (CL/F). Rats with depression exhibited a significant increase in maximum plasma concentration (Cmax). In contrast, depression led to decreased t1/2 and MRT, implying alterations in the drug's absorption and clearance. On the one hand, rats with gastric ulcers displayed a significant decrease in Cmax, coupled with an extended time to reach maximum plasma concentration (Tmax), prolonged t1/2, MRT, and increased volume of distribution (Vd) of encorafenib. This preclinical study demonstrates that depression and gastric ulcers significantly impact the pharmacokinetics of encorafenib. These findings emphasize the importance of considering these disease conditions when designing encorafenib dosing regimens for optimal therapeutic outcomes in cancer patients.

Attributes and influencing factors of hope levels in breast cancer patients: A latent profile analysis

PURPOSE

This study aims to identify specific sub-types of hope levels in breast cancer (BC) patients and explore the influencing factors.

METHODS

Between August and December 2023, 528 BC patients took part in this study. Latent Profile Analysis (LPA) was employed using the Herth Hope Index, Distress Thermometer, Hospital Anxiety and Depression Scale, Social Support Rating Scale, BC survivors' self-efficacy scale and Functional Assessment of Cancer Therapy-Breast to identify clusters of hope levels.

RESULTS

Three potential categories of hope levels were identified: Low Hope Level-Harmonious-Calm Type (33.71%); Moderate Hope Level-Isolation Fear Type (37.12%); and High Hope Level-Optimistic Coping Type (29.17%). The study established that social support, quality of life, psychological distress, self-efficacy, occupation, income, education and type of surgery are factors influencing hope levels.

CONCLUSION

Hope levels within BC patients exhibit identifiable heterogeneity. By discerning the features associated with hope levels, the focus extends beyond patients' occupations, income, education and surgical procedures. It also underscores the importance of enhancing social support, quality of life and self-efficacy while mitigating psychological distress. This targeted approach aims to formulate interventions specifically designed to effectively elevate hope levels in BC patients.

Lifestyle Behaviors and Needs After Breast Cancer Diagnosis: A Qualitative Assessment

PURPOSE

There is a need to gain a deeper understanding of facilitators and barriers involving lifestyle behaviors among newly diagnosed breast cancer patients. Design: Research team explored influences (e.g., social, cultural, environmental) for healthy lifestyle behaviors (nutrition, physical activity (PA), and self-care).

METHOD

One researcher conducted semi-structured interviews. Qualitative data were analyzed through content analysis. Demographic data were collected via survey, and descriptive statistics were generated.

SETTING

Patients were recruited, and interviews conducted via Zoom or phone.

PARTICIPANTS

Twenty-eight newly diagnosed, treatment naïve breast cancer patients were interviewed, a majority were non-Hispanic White women (n=23; 82%) with invasive (n=14; 50%) breast cancer.

RESULTS

Themes related to nutrition, PA, and self-care emerged, including influences (e.g., environmental, cultural, social), barriers, facilitators, and lived experiences. Most patients stressed the importance of maintaining healthy eating habits (n=23), and some were interested in understanding the relationship between nutrition and cancer (n=7). Sixteen reported sustaining their PA levels, while others (n=11) explained barriers, such as time, distance, and pain. All patients reported utilizing self-care strategies, and most reported increased engagement in self-care since being diagnosed (n=14).

CONCLUSION

This study sheds light on factors influencing and hindering the adoption of healthy eating, PA, and self-care strategies among newly diagnosed breast cancer patients. The findings reflect the importance of healthy lifestyle behaviors as critical areas for upstream intervention.

Cannabis Use Among Cancer Patients During Active Treatment: Findings From a Study at an NCI-Designated Cancer Center

OBJECTIVE

This study aims to describe patterns, sources, and reasons for cannabis use among cancer patients during active treatment (+CDTX) compared to no-use during active treatment (-CDTX).

METHODS

Data are from 385 surveys collected via REDCap during phase I of an ongoing study among adult cancer patients seen at an NCI-designated comprehensive cancer center within the last 5 years of treatment. A harmonized survey was created with 11 other NCI centers to assess cannabis use patterns, sources, and reasons for use. Sociodemographics and cancer details were also collected via self-report. Descriptive statistics were calculated and stratified by +/-CDTX. Chi-squared tests were conducted to compare proportions between groups.

RESULTS

Among the sample [49.5 years (SD 15.9); 53.0% male; and 41.6% Hispanic/Latino], 41.0% + CDTX and 59.0% -CDTX. A majority (71.8%) of +CDTX initiated use before diagnosis versus 44.1% in -CDTX (p < 0.0001); patients diagnosed with stage 4 cancer had a statistically significant higher prevalence of +CDTX (60.0%; p = 0.003); 53.3% in radiation reported +CDTX compared to 42.8% in chemotherapy, and 36.4% in immunotherapy. Dispensaries and local dealers were the top sources of cannabis in both groups. Among +CDTX, 44.3% consumed cannabis at least once a day DTX, dominant cannabinoids used were CBD (35.2%), Delta-8-THC (18.3%), and CBD + THC ratio (14.1%); 12.7% were unsure what they consumed. Joints were the most common inhalation method (61.5%), and store-bought candy was the most common edible (39.2%). Depression/mood, pain, and enjoyment were the top three reasons for +CDTX compared to enjoyment, depression/mood, and nausea/upset stomach in -CDTX (p = 0.02).

CONCLUSIONS

Patterns, sources, and reasons for cannabis use varied between +CDTX and -CDTX. Future studies should examine the impacts of cannabis and specific cannabinoids on cancer treatment, drug interactions, survival outcomes, and quality of life.

Impact of Six Months of Three Different Modalities of Exercise on Stress in Post-Treatment Breast Cancer Survivors

BACKGROUND/OBJECTIVES

Extensive evidence suggests that exercise is physically and mentally beneficial for cancer survivors. This study reports on changes in self-reported stress, physiological biomarkers for stress (salivary cortisol), and HR-QOL constructs for fifty breast cancer survivors participating in one of three different exercise programs over 6 months.

METHODS

Fifty post-treatment breast cancer survivors were randomized to either therapeutic yoga-based exercise (YE), comprehensive exercise (CE) (aerobic, resistance, flexibility), or choosing (C) their own exercise activities. Participants completed the Perceived Stress Scale (PSS), Medical Outcomes Short-Form 36® (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). Five samples of salivary cortisol were collected on two consecutive days. The 10 samples were used to calculate the diurnal rhythm slope. Outcome measures were repeated after six months.

RESULTS

All groups improved in HR-QOL measures of PSS; PSQI sleep quality components of latency and daytime functioning; and five of the ten SF-36 scales (Mental Component Scale, Social Functioning subscale, Mental Health subscale, Physical Component Scale, Physical Functioning subscale). Although the CE group observed the most favorable change in cortisol (-0.183), where cortisol slope changes approached significance (p = 0.057), but no significant decrease in cortisol between groups were noted.

CONCLUSIONS

Our results suggest that it is the engagement of, rather than the specific type of exercise, which is associated with improved HR-QOL. However, longer-term studies with better adherence monitoring and larger sample sizes are needed to better determine clinical impact.

Navigating the crossroads: cardiometabolic risks in cancer survivorship - a comprehensive review

The landscape of cancer survivorship is increasingly populated by individuals facing a spectrum of cardiometabolic risks, attributed to both their oncological history and treatment regimens. This manuscript synthesizes findings from various studies, highlighting the prevalence of traditional risk factors-hypertension, dyslipidemia, diabetes-as well as emergent concerns like obesity and metabolic syndrome among survivors. The impact of demographic variables, specific cancer types, and treatment modalities on cardiometabolic health is explored. Through a lens of multidisciplinary management and future research directives, we advocate for an integrative approach to cardiometabolic health in cancer survivors, aiming to ensure their victory over cancer extends into long-term well-being. Furthermore, we discuss the outcome implications of these cardiometabolic risk factors on cardiovascular disease development, future cardiovascular events, and overall survival, supported by studies showing improved outcomes through exercise and risk factor control.

Subjective well-being among Iranian breast cancer patients: Exploring the influential role of psychological capital

PURPOSE

Breast cancer is a prevalent and emotionally challenging condition that profoundly affects women worldwide. Effectively managing the mental and emotional dimensions of this disease is crucial for the holistic well-being of patients. Psychological capital (PsyCap) has emerged as a pivotal psychological construct with the potential to effectively address these challenges. This study aims to explore the influential role of PsyCap and its constructs on the subjective well-being (SWB) of Iranian breast cancer patients.

METHODS

A total of 173 breast cancer patients participated in this study, selected through a random sampling approach. Face-to-face interview data on socio-demographics, PsyCap, and SWB were collected using a structured questionnaire. The analytical procedures encompassed independent sample t-tests, ANOVA tests, Pearson correlation tests, and stepwise multiple regression.

RESULTS

The findings revealed that the majority of participants fell within the 41-50 age group (38.7%), with an average age of 46.50 ± 11.76 years, and 35.8% had tumor growth in the upper left lobe. The average PsyCap score was 107.93 ± 1.52 (out of a possible score of 144), whereas SWB scored 196.51 ± 1.90 (out of 291). Notably, PsyCap showed a positive correlation with SWB (r = 0.119), accounting for approximately 8% of the variance in SWB. The final regression model showed the substantial predictive roles of PsyCap (1.667), self-efficacy (-3.692), age (-2.977), and education (-3.939) in shaping SWB.

CONCLUSIONS

Focusing on understanding and addressing factors like PsyCap, self-efficacy, and educational support could improve SWB, offering a potential avenue for comprehensive and individualized psychosocial care for women with breast cancer.

Effects of Aromatherapy on Physical and Psychological Symptoms in Cancer Patients: A Systematic Review and Meta-analysis

BACKGROUND

Numerous physical and psychological symptoms experienced by cancer patients seriously affect their normal lives. Many academics and medical professionals have attempted to use aromatherapy in this situation to help cancer patients manage their physical and emotional problems.

OBJECTIVE

To systematically investigate the efficacy of aromatherapy on physical and psychological symptoms in cancer patients.

METHODS

A systematic review and meta-analysis of randomized controlled trials was performed. Four electronic databases were searched. The review process followed a registered priori review protocol and was reported using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Data extraction and quality assessment were performed in parallel.

RESULTS

Twenty-six studies with 2912 subjects were included. Meta-analysis showed that aromatherapy significantly improved sleep quality, fatigue, anxiety, and depression. We performed a subgroup analysis according to the different plant or animal aromatics contained in the oil, which found that lavender oil significantly reduced preoperative anxiety. In addition, aromatherapy massage was superior to inhaled aromatherapy in reducing anxiety. Moreover, cancer patients who used aromatherapy reduced the frequency of vomiting in 24 hours.

CONCLUSIONS

Aromatherapy is a useful treatment for improving sleep quality and reducing symptoms of fatigue, anxiety, and depression in cancer patients, as well as the frequency of vomiting over 24 hours.

IMPLICATIONS FOR PRACTICE

Healthcare providers can use aromatherapy to alleviate psychological and physical symptoms in cancer patients. The use of lavender oil and massage is recommended in clinical settings to improve anxiety symptoms in cancer patients.

Allostatic Load/Chronic Stress and Cardiovascular Outcomes in Patients Diagnosed With Breast, Lung, or Colorectal Cancer

BACKGROUND

Cardiovascular disease and cancer share a common risk factor: chronic stress/allostatic load (AL). A 1-point increase in AL is linked to up to a 30% higher risk of major cardiac events (MACE) in patients with prostate cancer. However, AL's role in MACE in breast cancer, lung cancer, or colorectal cancer remains unknown.

METHODS AND RESULTS

Patients ≥18 years of age diagnosed with the mentioned 3 cancers of interest (2010-2019) and followed up at a large, hybrid academic-community practice were included in this retrospective cohort study. AL was modeled as an ordinal measure (0-11). Adjusted Fine-Gray competing risks regressions estimated the impact of AL precancer diagnosis on 2-year MACE (a composite of heart failure, ischemic stroke, acute coronary syndrome, and atrial fibrillation). The effect of AL changes over time on MACE was calculated via piecewise Cox regression (before, and 2 months, 6 months, and 1 year after cancer diagnosis). Among 16 467 patients, 50.5% had breast cancer, 27.9% had lung cancer, and 21.4% had colorectal cancer. A 1-point elevation in AL before breast cancer diagnosis corresponded to a 10% heightened associated risk of MACE (adjusted hazard ratio, 1.10 [95% CI, 1.06-1.13]). Similar findings were noted in lung cancer (adjusted hazard ratio, 1.16 [95% CI, 1.12-1.20]) and colorectal cancer (adjusted hazard ratio, 1.13 [95% CI, 1.08-1.19]). When considering AL as a time-varying exposure, the peak associated MACE risk occurred with a 1-point AL rise between 6 and 12 months post- breast cancer, lung cancer, and colorectal cancer diagnosis.

CONCLUSIONS

AL warrants investigation as a potential marker in these patients to identify those at elevated cardiovascular risk and intervene accordingly.

Navigating the crossroads: cardiometabolic risks in cancer survivorship - a comprehensive review

The landscape of cancer survivorship is increasingly populated by individuals facing a spectrum of cardiometabolic risks, attributed to both their oncological history and treatment regimens. This manuscript synthesizes findings from various studies, highlighting the prevalence of traditional risk factors-hypertension, dyslipidemia, diabetes-as well as emergent concerns like obesity and metabolic syndrome among survivors. The impact of demographic variables, specific cancer types, and treatment modalities on cardiometabolic health is explored. Through a lens of multidisciplinary management and future research directives, we advocate for an integrative approach to cardiometabolic health in cancer survivors, aiming to ensure their victory over cancer extends into long-term well-being.

Correlation of death anxiety with coping strategies among Palestinian women with breast cancer: a cross-sectional study

Background

Death anxiety and maladaptive coping accompany breast cancer diagnoses. The coping mechanisms and death anxiety among Palestinian patients with breast cancer have not been studied.

Aim

To assess the prevalence of death anxiety and its relationship with coping strategies among Palestinian women with breast cancer who are treated in Beit Jala Governmental Hospital in Bethlehem.

Method

A cross-sectional design was used, and 214 breast cancer patients who visited the Beit Jala Governmental Hospital in Bethlehem were recruited. Templer's Death Anxiety Scale and the Brief COPE Scale were used. To investigate the relationship between coping strategies and death anxiety, frequency, percentages, chi-square tests, and Pearson's correlation tests were utilized.

Results

The results indicated that 58.40% of the patients experienced death anxiety. The participants who used positive reframing (adjusted odds ratio (AOR) = 1.487, p = < 0.026), self-blame (AOR = 1.309, p = < 0.023), and religion (AOR = 1.260, p = < 0.031) as coping mechanisms were more likely to experience death anxiety. Conversely, the participants who adopted substance use (AOR = 0.657, p < 0.005) and active coping (AOR = 0.629, p < 0.007) as coping strategies had a lower likelihood of experiencing death anxiety.

Conclusion

The study revealed that breast cancer patients tended to use a combination of functional and emotional coping strategies and that a significant proportion of these patients (58.4%) experienced symptoms of death anxiety. This study emphasizes the significance of screening for death anxiety and understanding the coping strategies utilized by the patients. Gaining this understanding will assist in identifying patients who need more guidance and support.

Translation and Validation of the Greek Version of the Questionnaire for Assessing Fear of Radiotherapy in Oncology Patients

This study aims to validate the Greek translation of the Questionnaire for Assessing Fear of Radiotherapy in Oncology Patients (QAFRT). Conducted as a cross-sectional pilot study, it involved 149 cancer patients from two radiotherapy departments in Thessaloniki, Greece. The sample included patients with various cancer types and stages, all of whom were undergoing radiation treatment. The QAFRT, originally containing 15 items measured on a Likert scale, was translated into Greek using the back-translation method. Exploratory factor analysis was performed on the translated version, resulting in a refined 13-item questionnaire encompassing four factors: fear of radiotherapy effectiveness, fear of illness during radiotherapy, fear of radiotherapy's impact on daily life, and fear of side effects and relationships. The reliability of the QAFRT was confirmed with Cronbach's α of 0.82 and intraclass correlation coefficient coefficients ranging from 0.92 to 0.98. The study concludes that the Greek version of the QAFRT is a reliable and valid tool for assessing the fear of radiotherapy in cancer patients, highlighting the need for adequate psychological support for those with high levels of fear.

Metalloproteinases as Biomarkers and Sociomarkers in Human Health and Disease

Metalloproteinases (MPs) are zinc-dependent enzymes with proteolytic activity and a variety of functions in the pathophysiology of human diseases. The main objectives of this review are to analyze a specific family of MPs, the matrix metalloproteinases (MMPs), in the most common chronic and complex diseases that affect patients' social lives and to better understand the nature of the associations between MMPs and the psychosocial environment. In accordance with the PRISMA extension for a scoping review, an examination was carried out. A collection of 24 studies was analyzed, focusing on the molecular mechanisms of MMP and their connection to the manifestation of social aspects in human disease. The complexity of the relationship between MMP and social problems is presented via an interdisciplinary approach based on complexity paradigm as a new approach for conceptualizing knowledge in health research. Finally, two implications emerge from the study: first, the psychosocial states of individuals have a profound impact on their overall health and disease conditions, which implies the importance of adopting a holistic perspective on human well-being, encompassing both physical and psychosocial aspects. Second, the use of MPs as biomarkers may provide physicians with valuable tools for a better understanding of disease when used in conjunction with "sociomarkers" to develop mathematical predictive models.

Effectiveness of resilience interventions among cancer patients - A systematic review, meta-analysis, and meta-regression of randomised controlled trials

PURPOSE

This systematic review, meta-analysis and meta-regression aimed to (1) evaluate the effects of resilience interventions on cancer patients' resilience and posttraumatic growth and (2) identify essential contents and features of resilience interventions.

METHODS

A systematic review, meta-analysis, and meta-regression analyses were conducted. Published and unpublished randomised controlled trials evaluating the effects of resilience interventions among cancer patients were retrieved from nine databases, trial registries, and grey literature. The mean and standard deviation scores were used to compute the effect sizes.

RESULTS

23 randomised controlled trials comprising 3287 cancer patients were included. The random effects model found that resilience interventions had beneficial impacts on patients' resilience, posttraumatic growth, quality of life, anxiety, and depressive symptoms with moderate to large effects. The subgroup analyses concluded that theoretically guided interventions that adopted synchronous communication delivered physically had greater effect sizes. Interventions comprising skills that promote patients' cognitive flexibility, self-efficacy, self-esteem, self-regulation, and coping had greater effect in comparison with interventions lacking these components. The meta-regression analyses revealed that sample size has a significant effect on posttraumatic growth scores. More well-designed trials are needed to confirm the effects of resilience interventions.

CONCLUSIONS

There is merit in utilizing resilience interventions to improve cancer patients' resilience and psychological well-being. Resilience interventions should be incorporated into the routine care for cancer patients and survivors.

Pandemic Stressors and Adaptive Responses: A Longitudinal Analysis of the Quality of Life and Psychosocial Dynamics among Urothelial Cancer Patients

The 2019 coronavirus disease (COVID-19) pandemic has had a profound influence on different sectors of society, including health. This study hypothesized a significant impact of the pandemic on the quality of life and psychosocial well-being of urothelial cancer patients, specifically anticipating a decrease in anxiety and depression scores as the pandemic progressed. The primary objectives were to assess longitudinal changes in quality of life indexes, evaluate Healthcare Anxiety and Depression Scale (HADS) score trends over three years (2020-2022), and identify any correlational patterns between the progression of the pandemic and anxiety, depression, and stress levels among this cohort. A cross-sectional analysis was conducted on Eastern Cooperative Oncology Group (ECOG) 1 and Tumor Node Metastasis (TNM) stage 1 bladder cancer patients from the Timis County Emergency Clinical Hospital in Romania. Sixty patients were evaluated each year from 2020 to 2022, utilizing a detailed selection process involving the review of both the hospital database and paper records. Key data included demographic information, medical history, and responses to the Patient Health Questionnaire (PHQ-9), Short Form (SF-36), HADS, and Generalized Anxiety Disorder (GAD-7) questionnaires. A total of 163 completed questionnaires were analyzed, providing insight into various aspects of patients' experiences during the pandemic. Notably, the mean hospitalization days ranged from 3.6 ± 2.1 days in 2020 to 4.0 ± 2.4 days in 2022 (p = 0.663). Concerns that current symptoms might be pandemic-related spiked to 63.5% in 2021, but reduced to 50.9% in 2022, with this fluctuation being significant (p = 0.026). The perception of decreased quality of or accessibility to medical care was significant over the years, with a decline to 52.7% in 2022 (p = 0.033). Quality of life assessments demonstrated an upward trend, from an average score of 55.9 ± 8.9 in 2020 to 59.3 ± 8.8 in 2022 (p = 0.049). Interestingly, anxiety levels, as indicated by the HADS survey, revealed a significant decline from a score of 7.8 in 2020 to 6.5 in 2022 (p = 0.008). On the other hand, GAD-7 scores displayed a downward trend over the years, potentially indicative of developed coping strategies (p = 0.034). This study provides a comprehensive insight into the fluctuating dynamics of psychosocial factors and quality of life among urothelial cancer patients during the pandemic years. It underscores a potential adaptive response, as evidenced by the decrease in anxiety levels and an upward trend in the quality of life scores over the period. These findings highlight the resilience and adaptability of this patient cohort amidst the challenges posed by the pandemic, potentially guiding future interventions and supports in similar health crises.

Patient Perspectives and Side-Effects Experience on Chemotherapy of Non-Small Cell Lung Cancer: A Qualitative Study

PURPOSE

This study aimed to explore patients' experiences of palliative chemotherapy for non-small cell lung cancer (NSCLC), how patients adapt to their new and challenging life after chemotherapy, their beliefs, and their quality of life.

PATIENTS AND METHODS

The study used an exploratory descriptive qualitative approach that was designed to explore the experiences and side effects of NSCLC patients on chemotherapy in Pakistan. The study was designed to obtain a deeper understanding of 22 NSCLC patients' experiences, using a face-to-face approach and interviews were conducted. Patients who have completed chemotherapy agreed to participate in semi-structured interviews.

RESULTS

The data were arranged into five themes: hospital facilities and environment, patient's beliefs in alternative treatments, presenting a positive/negative face, life is for living, and health insurance coverage. The major complaints related to bad experiences of chemotherapy-induced side effects, but these patients still managed to complete the full course of their respective chemotherapy. Additionally, the current study revealed the real experience of patients with NSCLC which had been less studied. The patient's experience was summarized into four themes and several subthemes.

CONCLUSION

This study aid healthcare providers when deciding on treatment options that will improve shared decision-making between clinicians and treatment outcomes.

Serum Copeptin in Cardiooncology Practice: Review of Pathophysiological and Clinical Implications

In cardiooncology practice, "early cardiotoxicity" refers to an emerging subclinical myocardial dysfunction/injury in response to certain chemotherapeutic regimens. This condition can progress to overt cardiotoxicity in time and hence warrants proper and timely diagnostic and preventive strategies. Current diagnostic strategies for "early cardiotoxicity" are largely based on conventional biomarkers and certain echocardiographic indices. However, a significant gap still exists in this setting, warranting further strategies to improve diagnosis and overall prognosis in cancer survivors. Copeptin (surrogate marker of the arginine vasopressine axis) might serve as a promising adjunctive guide for the timely detection, risk stratification, and management of early cardiotoxicity on top of conventional strategies largely due to its multifaceted pathophysiological implications in the clinical setting. This work aims to focus on serum copeptin as a marker of "early cardiotoxicity" and its general clinical implications in patients with cancer.

Perceived needs and health-related quality of life in women with breast cancer undergoing chemotherapy: a cross-sectional study

OBJECTIVES

Women with breast cancer have different needs that are various in perceived importance and satisfaction. This study aimed to examine the relationship among perceived needs satisfaction, perceived needs importance with health-related quality of life (HRQoL) in women with breast cancer and determine the intermediary role of perceived needs importance in the relationship between perceived needs satisfaction and HRQoL.

DESIGN

Cross-sectional design.

SETTING

Two tertiary level hospitals in Shaanxi Province, China.

PARTICIPANTS

Women newly diagnosed with breast cancer were recruited.

OUTCOME MEASURES

The Needs Self-Rating Questionnaire for Breast Cancer and the Medical Outcomes Study 36-item Short-Form Health Survey V. 2.0 were used for data collection regarding perceived needs satisfaction, perceived needs importance and HRQoL.

RESULTS

A total of 359 valid questionnaires were collected. The perceived needs importance was negatively associated with physical component summary (PCS) (b=-0.067, p=0.024) and mental component summary (MCS) (b=-0.185, p&lt;0.001). On the contrary, perceived needs satisfaction was positively associated with PCS (c'=0.005, p=0.843), although not statistically significant. Perceived needs satisfaction was positively associated with MCS (c'=0.194, p&lt;0.001) and perceived needs importance (a=0.458, p&lt;0.001). Furthermore, the perceived needs importance suppressed the relationship between perceived needs satisfaction and PCS (a*b=-0.031; 95% CI -0.058 to -0.004) and the relationship between perceived needs satisfaction and MCS (a*b=-0.085; 95% CI -0.138 to -0.043).

CONCLUSION

For women with breast cancer, higher perceived needs satisfaction is associated with higher HRQoL. However, higher perceived needs importance would be conversely associated with lower HRQoL by suppressing the positive association of perceived needs satisfaction with HRQoL. Healthcare providers should pay more attention to those who have high perceived needs importance but low perceived needs satisfaction and fulfil the important needs.

Role for a Web-Based Intervention to Alleviate Distress in People With Newly Diagnosed Testicular Cancer: Mixed Methods Study

BACKGROUND

Distress is common immediately after diagnosis of testicular cancer. It has historically been difficult to engage people in care models to alleviate distress because of complex factors, including differential coping strategies and influences of social gender norms. Existing support specifically focuses on long-term survivors of testicular cancer, leaving an unmet need for age-appropriate and sex-sensitized support for individuals with distress shortly after diagnosis.

OBJECTIVE

We evaluated a web-based intervention, Nuts & Bolts, designed to provide support and alleviate distress after diagnosis of testicular cancer.

METHODS

Using a mixed methods design to evaluate the acceptability, feasibility, and impact of Nuts & Bolts on distress, we randomly assigned participants with recently diagnosed testicular cancer (1:1) access to Nuts & Bolts at the time of consent (early) or alternatively, 1 week later (day 8; delayed). Participants completed serial questionnaires across a 4- to 5-week period to evaluate levels of distress (measured by the National Comprehensive Cancer Network Distress Thermometer [DT]; scored 0-10), anxiety, and depression (Hospital Anxiety and Depression Score [HADS]-Anxiety and HADS-Depression; each scored 0-21). The primary end point was change in distress between consent and day 8. Secondary end points of distress, anxiety, and depression were assessed at defined intervals during follow-up. Optional, semistructured interviews occurring after completion of quantitative assessments were thematically analyzed.

RESULTS

Overall, 39 participants were enrolled in this study. The median time from orchidectomy to study consent was 14.8 (range 3-62) days. Moderate or high levels of distress evaluated using DT were reported in 58% (23/39) of participants at consent and reduced to 13% (5/38) after 1 week of observation. Early intervention with Nuts & Bolts did not significantly decrease the mean DT score by day 8 compared with delayed intervention (early: 4.56-2.74 vs delayed: 4.47-2.74; P=.85), who did not yet have access to the website. A higher baseline DT score was significantly predictive of reduction in DT score during this period (P<.001). Median DT, HADS-Anxiety, and HADS-Depression scores reduced between orchidectomy and 3 weeks postoperatively and then remained stable throughout the observation period. Thematic analysis of 16 semistructured interviews revealed 4 key themes, "Nuts & Bolts is a helpful tool," "Maximizing benefits of the website," "Whirlwind of diagnosis and readiness for treatment," and "Primary stressors and worries," as well as multiple subthemes.

CONCLUSIONS

Distress is common following the diagnosis of testicular cancer; however, it decreases over time. Nuts & Bolts was considered useful, acceptable, and relevant by individuals diagnosed with testicular cancer, with strong support for the intervention rendered by thematic analyses of semistructured interviews. The best time to introduce support, such as Nuts & Bolts, is yet to be determined; however, it may be most beneficial as soon as testicular cancer is strongly suspected or diagnosed.

Stress Estimation Model for the Sustainable Health of Cancer Patients

Good health is the most important and very necessary characteristic for stress-free, skillful, and hardworking people with a cooperative environment to create a sustainable society. Validating two algorithms, namely, sequential minimal optimization for regression (SMOreg) using vector machine and linear regression (LR) and using their predicted cancer patients' cases, this study presents a patient's stress estimation model (PSEM) to forecast their families' stress for patients' sustainable health and better care with early management by under-study cancer hospitals. The year-wise predictions (1998-2010) by LR and SMOreg are verified by comparing with observed values. The statistical difference between the predictions (2021-2030) by these models is analyzed using a statistical t-test. From the data of 217067 patients, patients' stress-impacting factors are extracted to be used in the proposed PSEM. By considering the total population of under-study areas and getting the predicted population (2021-2030) of each area, the proposed PSEM forecasts overall stress for expected cancer patients (2021-2030). Root mean square error (RMSE) (1076.15.46) for LR is less than RSME for SMOreg (1223.75); hence, LR remains better than SMOreg in forecasting (2011-2020). There is no significant statistical difference between values (2021-2030) predicted by LR and SMOreg (p value = 0.767 > 0.05). The average stress for a family member of a cancer patient is 72.71%. It is concluded that under-study areas face a minimum of 2.18% stress, on average 30.98% stress, and a maximum of 94.81% overall stress because of 179561 expected cancer patients of all major types from 2021 to 2030.

The moderating role of coping flexibility in reports of somatic symptoms among early breast cancer patients

OBJECTIVE

The current study assessed breast cancer patients' somatic symptoms during the first six months post diagnosis and examined the moderating role of coping flexibility (i.e., trauma-focused and forward-focused coping strategies) on the association between reported somatic symptoms three months after breast cancer diagnosis and somatic symptoms six months after diagnosis.

METHOD AND MEASURES

An international sample of 702 women diagnosed with breast cancer from four countries (Finland, Israel, Italy, Portugal) completed self-reported questionnaires at three time points: at the time of diagnosis (M0), three months post diagnosis (M3), and six months post diagnosis (M6). The questionnaires included the coping flexibility scale and questions about demographics, medical data, and somatic symptoms.

RESULTS

The highest level of somatic symptoms was reported after three months post diagnosis (M3), as compared to M0 and M6. Both trauma-focused and forward-focused coping strategies moderated the relationship between somatic symptoms at M3 and somatic symptoms at M6.

CONCLUSION

The findings highlight the importance of assessing somatic symptoms soon after breast cancer diagnosis and throughout the early phase of treatment. Coping flexibility can buffer the stability of the somatic symptoms during this initial phase.

Coping strategies of stress and its associated factors among breast cancer patients in Tikur Anbesa specialized hospital, Ethiopia: Institution-based cross-sectional study

Background

Diagnosed with breast malignancy can be stressful, affecting several domains of life, affecting physical, emotional, and spiritual well-being that can lead to stress. To adapt to stress, the patient can use different coping methods. Therefore the objective of this research was to assess coping strategies for stress and its associated factors among breast cancer patients in Tikur Anbesa specialized hospital, Ethiopia.

Methods and materials

The institution-based cross-sectional study was carried out among 272 study participants attending Tikur Anbessa specialized hospital from February to April 2020. The data was collected using a structured questionnaire and analyzed using Stata 4.2. Descriptive statistics was employed for data analysis and tables and figures were used to present the results. Binary logistic regression was used to identify variables that affected the outcome variables.

Result

Majority (45.8%) of the study participants were in the age range 40–54 years. About 51.1% [95% CI (45.1–57.2)] of breast cancer patients have positive coping strategies to stress in the current study. About 64% solve stress through the Confrontive strategy and more than 73% of participants solve their problems by distancing. In self-controlling coping mechanisms, most participants do positive coping strategies. Having social support and taking only chemotherapy increased positive coping strategy but being single and time since diagnosis (1–3 years) increased negative coping.

Conclusions

About 51% of breast cancer patients have a positive coping strategy. Since the majority of breast cancer patients in the current study experienced negative coping strategies, it is better to expand health education regarding stress coping strategies. In addition, it is better to link patients to clinical psychologists and organizations that aimed to social support to cancer patients.

Development and validation of a rapid psychosocial well-being screening tool in patients with metastatic breast cancer

Objective

Methods

Results

Conclusion

Psychosocial determinants of intention to seek palliative care among the public in lebanon: A cross-sectional study

Objectives: This study aimed to assess the psychosocial determinants of intention to seek palliative care for the client themselves, or intention to enroll a family member in palliative care among the public in Lebanon. Methods: A cross-sectional study was initiated in 2020 on a convenience sample of adults permanently living in the Greater Beirut (GB) area; people with no current or previous experience with palliative care either for themselves or for someone dear to them were included. Verbal consent was obtained before data collection, and participants received a questionnaire to be self-completed, statistical analysis was performed using SPSS statistics version 23.0. Results: A total of 875 participants with a mean age of 42 years were interviewed, of whom 24 participants (2.7%) had had a previous experience with PC, either personally or with someone very close to them. The best-fit multivariate predictive model for intention to use PC included older age, positive attitude, and higher perceived control on one's health. The multivariate model for intention to recommend use was significantly associated with a positive attitude, higher perceived control, and lower perceived barriers. Conclusions: Promotional activities should be conducted to provide the Lebanese public with accurate, detailed, and direct information about the benefits of PC, involving essentially physicians. Future research should explore the decision-making process in "real-time" situations, and within our specific psychosocial, cultural, and organizational context.

The molecular mechanism of chronic stress affecting the occurrence and development of breast cancer and potential drug therapy

According to the 2020 data released by the International Agency for Research on Cancer, breast cancer has surpassed lung cancer as the world's most newly diagnosed first-time cancer. Compared with patients with other types of cancer, those with breast cancer experience greater mental stress and more severe psychological impacts because of the life-threatening diagnosis, physical changes, treatment side effects, and family and social life dysfunctions. These usually manifest as anxiety, depression, nervousness, and insomnia, all of which elicit stress responses. Particularly under chronic stress, the continuous release of neurotransmitters from the neuroendocrine system can have a highly profound impact on the occurrence and prognosis of breast cancer. However, because of the complex mechanisms underlying chronic stress and the variability in individual tolerance, evidence of the role of chronic stress in the occurrence and evolution of breast cancer remains unclear. This article reviewed previous research on the correlation between chronic stress and the occurrence and development of breast cancer, particularly the molecular mechanism through which chronic stress promotes breast cancer via neurotransmitters secreted by the nervous system. We also review the progress in the development of potential drugs or blockers for the treatment of breast cancer by targeting the neuroendocrine system.

Relationship between spirituality and depression among patients with malignant cancer at a selected tertiary care Institute - A study from North India

Purpose: Depression is a major mental disorder and has drastic effects on people suffering from other terminal illnesses like cancer. Many patients struggling with chronic or fatal illnesses rely on spirituality to cope. Spirituality in Indian culture has always been a vital component in indigenous health systems.Objective: To determine the relationship between spirituality and depression among patients with cancer visiting a tertiary care institute of Uttarakhand State in northern India. Design: A descriptive cross-sectional survey.Sample: A total of 103 cancer patients visiting inpatient and outpatient departments of a selected tertiary care institute of Uttarakhand state of northern India. Methods: Participants were administered the socio-demographic proforma, Patient Health Questionnaire (PHQ-9) (Kroenke, Spitzer, and Williams, 2001), System of Belief Inventory (SBI-15R). Findings: The mean score of depression among cancer patients was 9.12±6.537 (CI, 7.84-10.39). Patients with high spirituality have minimal or no depression. We found a statistically significant negative correlation between depression and spirituality (r=-0.209, p=0.05).Conclusions: Health care professionals can incorporate spirituality in caring for cancer patients to develop a positive outlook on living despite the illness. Implications for Psychosocial Providers Or Policy: Establishing a spiritual support program as an integral part of a multidisciplinary approach can better cancer treatment in the Indian setting.

Mechanisms Supporting the Use of Beta-Blockers for the Management of Breast Cancer Bone Metastasis

Simple Summary

Bone represents the most common site of metastasis for breast cancer and the establishment and growth of metastatic cancer cells within the skeleton significantly reduces the quality of life of patients and their survival. The interplay between sympathetic nerves and bone cells, and its influence on the process of breast cancer bone metastasis is increasingly being recognized. Several mechanisms, all dependent on β-adrenergic receptor signaling in stromal bone cells, were shown to promote the establishment of disseminated cancer cells into the skeleton. This review provides a summary of these mechanisms in support of the therapeutic potential of β-blockers for the early management of breast cancer metastasis.

Abstract

The skeleton is heavily innervated by sympathetic nerves and represents a common site for breast cancer metastases, the latter being the main cause of morbidity and mortality in breast cancer patients. Progression and recurrence of breast cancer, as well as decreased overall survival in breast cancer patients, are associated with chronic stress, a condition known to stimulate sympathetic nerve outflow. Preclinical studies have demonstrated that sympathetic stimulation of β-adrenergic receptors in osteoblasts increases bone vascular density, adhesion of metastatic cancer cells to blood vessels, and their colonization of the bone microenvironment, whereas β-blockade prevented these events in mice with high endogenous sympathetic activity. These findings in preclinical models, along with clinical data from breast cancer patients receiving β-blockers, support the pathophysiological role of excess sympathetic nervous system activity in the formation of bone metastases, and the potential of commonly used, safe, and low-cost β-blockers as adjuvant therapy to improve the prognosis of bone metastases.

The effect of targeted nursing on the quality of sleep and life in lung cancer patients undergoing chemotherapy

OBJECTIVE

To explore the effect of targeted nursing on the quality of sleep and life in lung cancer patients undergoing chemotherapy.

METHODS

This study was conducted in 88 lung cancer patients who underwent chemotherapy. According to the random number table, these patients were assigned to the control group (n=44) and the experimental group (n=44). In the control group, patients received routine nursing. Meanwhile, patients in the experimental group received both routine nursing and targeted nursing. The quality of sleep score, quality of life score, psychological state-related score, and visual analogue scale (VAS) score on admission and 1 week after discharge were compared between the two groups.

RESULTS

There were no differences in the quality of sleep score, quality of life score, psychological state-related score, and VAS score between the two groups of patients on admission (all P>0.05). Compared with those on admission, the quality of sleep score, quality of life score, psychological state-related score, and VAS score in both groups 1 week after discharge were declined (all P<0.05). Additionally, the changes in the experimental group were much bigger than those in the control group (all P<0.001). Satisfaction in nursing in the experimental group was higher than that in the control group (P<0.05).

CONCLUSION

Targeted nursing can improve the quality of sleep, quality of life, psychological state, and satisfaction in nursing in lung cancer patients undergoing chemotherapy.

Coping Strategies, Locus of Control, and Quality of Life in Patients with Early-Stage Breast Cancer

Patients with cancer are included in vulnerable groups with a low quality of life. Accordingly, this study aimed to explore the relationship between coping strategies and locus of control with the quality of life in women with early-stage breast cancer. A total of 224 women with breast cancer (M_age = 36.82; SD_age = 11.21) were selected using convenience sampling from general hospitals and cancer treatment centers in Tehran, Iran, and completed measures included Multidimensional Coping Inventory, Locus of Control of Behavior Scale, and World Health Organization Quality of Life. The results of the current study showed significant relationships between coping strategies and locus of control with the quality of life in women suffering from breast cancer. Moreover, the results of hierarchical multiple regression analysis indicated that the locus of control (β = - .47), task-focused coping style (β = .27), and emotion-focused coping strategy (β = - .19) were significant predictors of the patients' quality of life. Quality of life of the women with early-stage breast cancer may be improved by helping them to adopt more task-focused coping strategies and internal locus of control.

Onco-Esthetics Dilemma: Is There a Role for Electrocosmetic-Medical Devices?

Objective

The primary aim of this review is to verify whether the warning against the use of electromedical instruments in the cosmetic professional or medical cancer patient settings is consistent with evident oncological risks supported by experimental in vitro/in vivo studies or anecdotal clinical reports, or any other reasonable statement.

Methods

MEDLINE, PubMed, Embase, AMED, Ovid, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched. Data relating to research design, sample population, type of electro-cosmetic devices used, were extracted.

Results

The search strategy identified 50 studies, 30 of which were potentially relevant.

Conclusions

Our research is in favor of moderate periodical use of cosmetic medical devices in patients bearing tumors, in any stage, like in healthy people. Special consideration is dedicated to massage, manipulation, and pressure delivery upon the cytoskeleton of cancer cells that has proven to be sensitive to mechanical stress at least in some specific locally relapsing cancers such as osteosarcoma.

[A Review of Chronic Stress and the Initiation and Evolution of Cancer]

Chronic stress activates the typical neuroendocrine system, hypothalamus pituitary adrenal axis and sympathetic nervous system, and leads to a sustained non-specific adaptive response. It has been proved that chronic stress can promote tumor initiation and induce tumor evolution, especially in immune function and remodeling of tumor microenvironment. However, due to the complex mechanism of chronic stress and the great difference in individual tolerance, the research evidence of chronic stress in tumor genesis and progression is still unclear. Therefore, in this paper, we review the research on the relationship between chronic stress and tumor initiation and evolution, focusing on the molecular mechanism of chronic stress promoting tumor occurrence and development, inhibiting immune response and remodeling tumor immune microenvironment, and exploring the stress management program of healthy people and cancer patients, so as to provide clues for exploring new strategies of cancer prevention and treatment. In our opinion, targeting the cAMP/PKA/CREB signaling pathway to reverse tumor treatment strategy, the relationship between the tumor and stress, inflammation, immunity, the suppressor activity of β receptor antagonist and its mechanism as well as associated with different treatment options, still need to be further explored. A healthy lifestyle, positive life attitudes and professional stress management guidance are essential for the prevention and treatment of cancer.

Highlighting the Potential for Chronic Stress to Minimize Therapeutic Responses to Radiotherapy through Increased Immunosuppression and Radiation Resistance

Ionizing radiation has been used in the treatment of cancer for more than 100 years. While often very effective, there is still a great effort in place to improve the efficacy of radiation therapy for controlling the progression and recurrence of tumors. Recent research has revealed the close interaction between nerves and tumor progression, especially nerves of the autonomic nervous system that are activated by a variety of stressful stimuli including anxiety, pain, sleep loss or depression, each of which is likely to be increased in cancer patients. A growing literature now points to a negative effect of chronic stressful stimuli in tumor progression. In this review article, we present data on the potential for adrenergic stress to influence the efficacy of radiation and in particular, its potential to influence the anti-tumor immune response, and the frequency of an "abscopal effect" or the shrinkage of tumors which are outside an irradiated field. We conclude that chronic stress can be a major impediment to more effective radiation therapy through mechanisms involving immunosuppression and increased resistance to radiation-induced tumor cell death. Overall, these data highlight the potential value of stress reduction strategies to improve the outcome of radiation therapy. At the same time, objective biomarkers that can accurately and objectively reflect the degree of stress in patients over prolonged periods of time, and whether it is influencing immunosuppression and radiation resistance, are also critically needed.

Effect of the solution-focused brief therapy on cancer-related fatigue in breast cancer patients under adjuvant chemotherapy: a randomized trial

Background

Cancer-related fatigue (CRF) is a severe symptom in breast cancer survivors. We aimed to explore the effects of the solution-focused brief therapy (SFBT) on CRF in breast cancer patients after lumpectomy or mastectomy under adjuvant chemotherapy.

Methods

First, 196 patients with primarily diagnosed breast cancer were recruited, screened, and the qualified 160 patients were randomly assigned into the control (routine nursing interventions), and intervention (routine nursing interventions and SFBT) groups. CRF was evaluated using the Chinese version of revised Piper Fatigue Scale. Data were collected at baseline (T1), post-intervention (T2), and post-follow-up (T3).

Results

Mild to severe fatigue existed in all qualified participants at T1 and the fatigue symptom went worse with the chemotherapy in control group. In intervention group, the fatigue level decreased at T2 (P<0.05), and went to the similar level at T3 as that at T1. The levels of behavioral, affective, and sensory fatigues in the control group significantly increased at T3 (P<0.05), while no difference was found in the intervention group. This study showed that SFBT effectively decreased CRF in breast cancer survivors after surgery under adjuvant chemotherapy.

Conclusions

Hence, SFBT might be a beneficial non-pharmacological intervention alone or in combination with other interventions to improve patients’ quality of life.

The Relation of Readiness for Return to Work and Return to Work Among Iranian Cancer Survivors

Return to work after completion of cancer treatments has many benefits for patients, families, and society. Readiness for return to work (RRTW) seems to be an effective factor for return to work in cancer survivors. Therefore, the present study was to investigate return to work and its relation to RRTW among Iranian survivors of cancer. This descriptive-correlational study examined a total of 227 survived cancer patients with completed primary treatments and without active cancer symptoms. Data were collected by the return to work and RRTW questionnaires and analyzed with descriptive statistics and inferential statistics using SPSS software. Upon completion of initial treatment, 166 (73.2%) of survivor participants returned to work, of which 78 (34.4%) and 88 (38.4%) participants returned to full-time and part-time works, respectively. ANOVA test showed a significant difference between RRTW and the type of return to work. In addition, results of regression analysis revealed that there was a positive significant relationship between RRTW and the rate of return to work before and after the adjustment of variables (p ≤ 0.05). Considering the findings of the study, there is a necessary need planning for rehabilitation programs by nursing managers concerning these patients to facilitate their return to work.

Beta-Adrenergic Signaling in Tumor Immunology and Immunotherapy

Communication between the nervous and immune systems is required for the body to regulate physiological homeostasis. Beta-adrenergic receptors expressed on immune cells mediate the modulation of immune response by neural activity. Activation of beta-adrenergic signaling results in suppression of antitumor immune response and limits the efficacy of cancer immunotherapy. Beta-adrenergic signaling is also involved in regulation of hematopoietic reconstitution, which is critical to the graft-versus-tumor (GVT) effect and to graft-versus-host disease (GVHD) following allogeneic hematopoietic cell transplantation (HCT). In this review, the function of beta-adrenergic signaling in mediating tumor immunosuppression will be highlighted. We will also discuss the implication of targeting beta-adrenergic signaling to improve the efficacy of cancer immunotherapy including the GVT effect, and to diminish the adverse effects including GVHD.

A population-based study of the humanistic burden among cancer patients in Japan

Aims: Understanding the burden of cancer in Japan is becoming increasingly important to address the socio-economic consequences of the disease. This study broadly examined the cancer burden in terms of: Health-Related Quality of Life (HRQoL), work productivity and activity impairment (WPAI), stress-related comorbidities, and indirect costs in patients diagnosed with (i) any type of cancer, (ii) breast cancer, (iii) colorectal cancer, compared to controls without cancer.Materials and methods: This cross-sectional study used data from the 2017 Japan National Health and Wellness Survey (NHWS). Patient outcomes included self-reported stress-related comorbidities, HRQoL assessed by Short Form 12-item Health Survey and EuroQoL 5-dimension scale (EQ-5D), and work productivity and indirect costs assessed by WPAI questionnaire. Multivariate analysis was performed to compare outcomes across groups. An ad-hoc analysis compared respondents currently and currently not receiving prescription medication (Rx).Results: A total of 1,540 patients with any type of cancer, 254 with breast cancer, 144 with colorectal cancer were included in the analyses and compared to 28,070 controls without cancer. After adjusting for potential confounding effects patients with any type of cancer had significantly lower mental component summary scores (45.70 vs. 46.45, p = .003), physical component summary scores (48.95 vs. 50.02, p < .001) and EQ-5D index (0.77 vs. 0.79, p < .001), and significantly increased absenteeism (5.13% vs. 2.68% p < .001) compared to controls. No significant differences were detected for indirect costs. Breast cancer patients had significantly increased odds of anxiety and migraine. Colorectal cancer patients had significantly increased odds of insomnia. Patients currently receiving Rx had significantly lower HRQoL and higher WPAI than both controls and cancer patients not receiving Rx.Conclusions: Japanese cancer patients experience a significantly decreased HRQoL, increased absenteeism and higher odds ratio for stress-related comorbidities. This has implications for future policy making and Health Technology Assessment in Japan.

Effect of Psychological Intervention on Quality of Life and Psychological Outcomes of Colorectal Cancer Patients

Objective: This study was undertaken to evaluate the effect of psychological interventions on quality of life (QOL) and psychological outcomes in colorectal cancer patients. Methods: Three components-the Hospital Anxiety and Depression Scale (HADS), cancer-related distress, and QOL-were assessed at admission (T0/baseline), three-month follow-up (T1), and six-month follow-up (T2). Results: The general characteristics of participants were well balanced between the psychological intervention group and control group. Psychological intervention significantly improved the anxiety measured by HADS in the psychological intervention group at T1 and T2 compared with the control group (T1 = -2.83 versus 0.33, p = .002; T2 = -2.64 versus 0.13, p = .045). Both total and avoidance scores of cancer-related distress decreased significantly in the psychological intervention group at T1, and the amelioration maintained until T2. However, the psychological intervention group and the control group did not show any significant differences between global QOL and cognitive function. While the psychological intervention greatly improved physical function at T1 (4.30 versus -4.28, p = .012), the difference was not significant at T2 (3.36 versus -3.41, p = .116). However, the fatigue score in the psychological intervention group was reduced significantly compared with that in control group at T2 (-4.94 versus 3.61, p = .027). Conclusion: Our results suggest that psychological intervention benefits QOL and psychological outcomes of patients with colorectal cancer.

Psychological intervention based on psychoneuroimmunology improves clinical evolution, quality of life, and immunity of children with leukemia: A preliminary study

We conducted a non-randomized, open-label clinical trial to assess whether a psychoneuroimmunology-based intervention enhanced immunity in children with acute lymphoblastic leukemia undergoing chemotherapy. In total, 16 children (44% female) received psychoneuroimmunology-based intervention, whereas 12 (50% female) received health psychoeducation (controls). The primary outcome was immunity markers, being clinical conditions the secondary outcome. Psychoneuroimmunology-based intervention increased immune markers (CD8+ T, B, and natural killer cells, serum immunoglobulin A, and immunoglobulin M) and quality of life, whereas it shortens the duration of fever and use of antipyretics, antibiotics, analgesics, and respiratory therapy. Immunity markers correlated with clinical conditions. Thus, psychoneuroimmunology-based intervention could reduce hospital cost and increase patient well-being.