DISTRESS AND PTSD IN PATIENTS WITH CANCER: COHORT STUDY CASE

Post-traumatic stress symptoms, post-traumatic stress disorder, and post-traumatic growth among cancer survivors: a systematic scoping review of interventions

The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors.

Post-Operative Care of the Cancer Patient: Emphasis on Functional Recovery, Rapid Rescue, and Survivorship

A cancer diagnosis and its subsequent treatments are life-changing events, impacting the patient and their family. Treatment options available for cancer care are developing at pace, with more patients now able to achieve a cancer cure. This is achieved through the development of novel cancer treatments, surgery, and modern imaging, but also as a result of better understanding treatment/surgical trauma, rescue after complications, perioperative care, and innovative interventions like pre-habilitation, enhanced recovery, and enhanced post-operative care. With more patients living with and beyond cancer, the role of survivorship and quality of life after cancer treatment is gaining importance. The impact cancer treatments can have on patients vary, and the "scars" treatments leave are not always visible. To adequately support patients through their cancer journeys, we need to look past the short-term interactions they have with medical professionals and encourage them to consider their lives after cancer, which often is not a reflection of life before a cancer diagnosis.

Cancer-related posttraumatic growth and posttraumatic stress: how are they connected and what are their correlates?

PURPOSE

Cancer is a stressful life event that can lead to specific posttraumatic reactions. Posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) are two main posttraumatic reactions that are related to each other, and both have different correlates.

METHODS

The linearity of the relationship between PTG and PTSS and the different socio-demographic, cancer-related, emotional, and psychological correlates were analyzed in patients with cancer (N = 126).

RESULTS

The relationship between PTG and PTSS was found to be more curvilinear than linear. PTSS was more strongly related to psychological factors (e.g., anxious preoccupation, hope-helplessness, and resilience) while PTG was strongly related to existential factors (e.g., self-transcendence and religiosity).

CONCLUSION

The results show that cancer-related PTSS and PTG are specifically related constructs which are related differently to particular correlates. Specifically, the greatest differences were observed in the psychological variables. In the early phases, therapeutic interventions focused on variables related to PTSS can lead to the reduction of PTSS. In follow-up phases, the therapeutic intervention focused on the increase of the level of variables related to PTG can help the development of PTG.

A clinical trial of cognitive behavior therapy for psychiatric comorbidity and quality of life with Cancer Patients during Chemotherapy (CPdC)

BACKGROUND

Cancer is a common worldwide illness; it evokes psychological distress at different stages, during chemotherapy patient perceives a variety of psychiatric symptoms due to various medication side-effects and psychological distress. Studies have shown a significant impact of cognitive behavior therapy (CBT) in the management of psychiatric symptoms during chemotherapy. This study aims to investigate the effectiveness of CBT for depression, anxiety, stress, death anxiety, satisfaction with life, and self-esteem among cancer patients during chemotherapy (CPdC).

METHODS

Place and duration of the study: Department of Applied Psychology, Government College University Faisalabad in collaboration with Department of Oncology, Allied Hospital Faisalabad from November 20, 2020 and July 31, 2021. A total of 90 cancer patients were enrolled. 70 out of 90 met the eligibility criteria and 60 participants fulfilled all requirements. Participants were randomly allocated to four different groups. The pre-assessment screening was started along with the first trial of chemotherapy. The CBT-based treatment plan was formulated and one session per week was given to each patient for 3 to 4 months. Participants' age range was 18-65 years (M ± SD = 47.51 ± 12.36. Demographic form, Depression Anxiety and Stress Scale (DASS), Death Anxiety Scale (DAS), Satisfaction with Life Scale (SWLS), and Rosenberg Self-Esteem Scale (RSES) were administered. Descriptive, t-test, and repeated measure ANOVA statistics were used to investigate the findings.

RESULTS

Results indicated significant mean difference on the variable of depression, anxiety and stress across four conditions (i.e. F(2, 56) = 39.55, p < .000, η² = .679; F(2,56) = 73.32, p < .000, η² = .797; F(2,56) = 119.77, p < .000, η² = .865 respectively). On death anxiety significant difference across four conditions was found (F(2,56) = 22.71, p < .000, η² = .549) with large effect size. Furthermore, findings indicated significant mean difference on the variable of satisfaction with life and self-esteem across four conditions was found (F(2,56) = 22.05, p < .000, η² = .542; F(2,56) = 36.19, p < .000, η² = .660) with large effect size.

CONCLUSION

It is concluded that CBT played a very effective role to reduce depression, anxiety, and stress-related psychiatric symptoms. CBT reduces the level of death anxiety and improving the quality of life and level of self-esteem among CPdC.

TRIAL REGISTRATION

The study trial was registered in the Thai Clinical Trial Registry-TCTR ( TCTR20201113002 ).

Effects of Drawing Therapy on Pediatric Oncology Patients: A Systematic Review

BACKGROUND

A small but significant number of children and adolescents with cancer experience severe physical and psychological distress. Previous studies have shown that drawing therapy positively affects relieving psychological problems. However, the effect of drawing therapy on pediatric oncology patients has not been established by systematic review.

OBJECTIVE

The aim of this study was to determine the effect of drawing therapy on the pediatric oncology population.

METHODS

PubMed, EMBASE, MEDLINE, Cochrane, PsycINFO, CINAHL, and Chinese databases including CNKI, Wanfang, VIP, and CBM were searched. Studies published in the English and Chinese languages up to December 2019 were screened, and randomized controlled trials and nonrandomized experimental studies of drawing therapy interventions for pediatric oncology patients were reviewed. Screening was undertaken independently by 2 reviewers. The review protocol was registered with PROSPERO (registration number: CRD42020178365).

RESULTS

Eight studies were included. Three studies were randomized controlled trials, and 5 studies were nonrandomized experimental studies. Seven studies showed that drawing therapy had positive effects on reducing depression and anxiety and improving quality of life. However, 1 study showed a contradictory result, that is, participants had an increased anxiety level after intervention.

CONCLUSIONS

Drawing therapy is effective in improving negative emotions, relieving somatic symptoms, and increasing social communication for pediatric oncology patients.

IMPLICATIONS FOR PRACTICE

Drawing therapy may be considered an adjuvant psychological intervention strategy for pediatric oncology patients. Meanwhile, more rigorous studies are needed to address the deficiencies of small number size and methodological weakness.

Quality of life and post-traumatic stress disorder among adult females with cancer in Palestine: a cross-sectional study

Background: Little research has been conducted on the quality of life (QoL), functional status, and traumatic symptoms related to the diagnosis and treatment of cancer in the Arab region, particularly in Palestine, where the psychological problems in patients with cancer are often neglected.Objective: The aim of the study was to assess QoL and post-traumatic stress disorder (PTSD) symptoms among adult female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem.Method: Participants were recruited from 4 April 2015 to the end of July 2015. The sample included 253 female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem. Data were collected using self-reported questionnaires, including a socio-demographic data sheet, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the post-traumatic stress disorder checklist for PTSD symptoms.Results: The current study showed poor global QoL (57.4%) and poor physical function (48.5%) for female patients with cancer. Insomnia, fatigue, and loss of appetite were the most troublesome symptoms that the participants complained about. The prevalence of PTSD symptoms was 3%. Regarding PTSD symptom severity, 2% reported severe symptoms, 23.3% reported moderate symptoms, and (68.8%) reported mild symptoms, based on a 1991 classification of PTSD symptom severity scores. Finally, Pearson's test revealed a strong, statistically significant, inverse relationship between QoL domains and PTSD.Conclusion: The study found that the overall QoL of female patients with cancer was low and strongly associated with PTSD symptoms, suggesting that early detection and treatment of these symptoms is critical.

Melanoma diagnosis: traumatic impact of the event on the patient

BACKGROUND

The aim of our study was to consider the distressing impact of the diagnosis in a group of patients with metastatic melanoma, and the effects it could have on the quality of life of the patients.

METHODS

We proposed an Impact Event Scale (IES-R) to a group of 31 patients. The patients were positive to the distress thermometer (DS) and accepted the psychological support. After six months from the start of the treatment we made a semi-structured interview of 10 multiple choice questions.

RESULTS

Sixty-five per cent of women and 50% of men report that all the event related to the disease, cause emotions that recall the disease. Eighty-two per cent of women compared to 50% of men, report that the thought of their medical condition tends to affect their quality of sleep; the patients report feelings of anger and irritation (41% of the women and 78% of the men).

CONCLUSIONS

The traumatic aspects following the diagnosis of melanoma burst powerfully into the life of these patients, who show different reactions, also according to gender.

Evaluation of Distress and Religious Coping Among Cancer Patients in Turkey

The purpose of this study was to determine distress levels and religious coping styles of cancer patients and the relationship between religious coping styles and distress. This study was conducted as descriptive design. It was determined that 60.7% of the patients experienced distress related to the disease. The field of problem from which the patients mostly experienced distress was physical problems. It was observed that positive coping scores of the patients were higher. There was a negative correlation between their mean scores for positive religious styles and distress total scores.

Are we missing PTSD in our patients with cancer? Part I

Posttraumatic Stress Disorder (PTSD) can be defined by the inability to recover from a traumatic event. A common misconception is that PTSD can only develop in circumstances of war or acute physical trauma. However, the diagnostic criteria of PTSD were adjusted in the Diagnostic Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) to include the diagnosis and treatment of a life-threatening illness, such as cancer, as a traumatic stressor that can result in PTSD. The word 'cancer' is so strongly linked to fear, stigma, and mortality, that some patients are fearful to even say 'the C word'. Therefore, it is not surprising that patients may experience a diagnosis of cancer as sudden, catastrophic, and/or life-threatening. Cancer-related PTSD (CR-PTSD) can negatively affect a patient's psychosocial and physical well-being during treatment and into survivorship. Unfortunately, CR-PTSD often goes undiagnosed and, consequentially, untreated. This article provides a general overview of PTSD with cancer as the traumatic event in order to define CR-PTSD, and reviews the growing pool of literature on this topic, including prevalence, risk factors, characterization, and treatment of CR-PTSD. The purpose of this article is to spread awareness of this relatively newly defined and commonly missed disorder among patients with cancer to clinicians and patients alike.

Serotonin transporter-linked polymorphic region genotypes in relation to stress conditions among patients with papillary thyroid carcinoma

The serotonin-transporter-linked polymorphic region (5-HTTLPR) gene has been reported to predispose individuals experiencing trauma to affective disorders such as anxiety and depression. We hypothesized that SS genotype of 5-HTTLPR gene would induce stress conditions and poor prognosis of papillary thyroid carcinoma (PTC). The study enrolled 287 patients with or without post-traumatic stress disorder (PTSD) following surgical treatment of PTC with their baseline characteristics collected. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was conducted to detect genotype frequency. Five self-rating scales, including Impact of Event Scale-Revised Edition (IES-R), MedicaI Coping Modes Questionnaire (MCMO), Hamilton Depression Scale (HAMD), Social Support Rating Scale (SSRS) and Stressful Life Events (SLEs), were used for depressive state assessment. Survival situations were observed through 15-year follow-up visits one time every six months. Survival rate was calculated using Life Table. Logistic regression analysis was used to analyze factors related to prognosis of PTC. Increased SS genotype and decreased LL genotypes were found in patients with PTSD. PTSD is associated with high stress, and inter-group analysis revealed that patients carrying SS genotype exhibited a high stress condition. PTSD and SS genotype correlated to large tumor size, advanced clinical stage, lymph node metastasis, and decreased 10-year and 15-year survival rate. As for patients carrying the same genotype, those suffering from PTSD showed poorer survival. Also, 5-HTTPRL, MCMQ score (confrontation/avoidance/surrender), HAMD score, SSRS total score, SLEs score, tumor size, clinical stage, and lymph node metastasis were relevant factors for prognosis of PTC. The results demonstrate SS genotype of the 5-HTTPRL gene as a contributor of high stress among patients with PTC. Thus, 5-HTTPRL and stress conditions represent potential investigative focus targets for prognosis of PTC.

Differences in depressive and anxiety symptoms between cancer and noncancer patients with psychological distress

BACKGROUND

Cancer patients are particularly vulnerable to psychological problems. The purpose of the present study was to compare differences in psychological difficulties, including depression and anxiety, between cancer patients and noncancer patients. This study assessed the differences in depressive and anxiety symptoms between patients with and without cancer.

MATERIALS AND METHODS

Participants included 219 patients at The Cancer Center, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea, who reported depressive or anxiety symptoms between April 2014 and April 2016. Patients were categorized into cancer and noncancer groups based on medical histories showing a diagnosis of any type of cancer. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to evaluate psychological distress at each patient's first visit. Patients' charts were reviewed for clinical data, including BDI and BAI scores and duration of cancer treatment, and for demographic data such as age and sex.

RESULTS

The results showed that patients in the cancer group experienced greater discomfort related to somatic symptoms; higher BDI subscale scores were related to work difficulties, insomnia, loss of appetite, somatic worries (fatigue), and loss of libido compared with patients in the noncancer group. The BAI subscale scores for fear of the worst happening, feeling unsteady, feeling terrified or afraid, a sense of choking, fear of dying, and feeling scared were higher in patients with than in those without cancer.

CONCLUSION

High levels of depressive symptoms related to somatic discomfort and anxiety symptoms related to fear of cancer were associated with considerable psychological distress in patients with cancer diagnosis and treatment.

Confidence in communicating with patients with cancer mediates the relationship between rehabilitation therapists' autistic-like traits and perceived difficulty in communication

OBJECTIVE

Recently, rehabilitation therapists have become involved in cancer rehabilitation; however, no communication skills training that increases the ability to provide emotional support for cancer patients has been developed for rehabilitation therapists. In addition, no study has examined associations between rehabilitation therapists' communication skills and their level of autistic-like traits (ALT), which are in-born characteristics including specific communication styles and difficulty communicating with patients. In this study, we aimed to investigate whether confidence in communicating with patients mitigates communication difficulties experienced by rehabilitation therapists who have high levels of ALT.

METHOD

Rehabilitation therapists who treat patients with cancer completed self-administered postal questionnaires anonymously. Scores were obtained on the Autism-Spectrum Quotient short form, confidence in communication, and communication difficulties. We used covariance structure analyses to test hypothetical models, and confirmed that confidence in communication mediates the relationship between ALT and perceived communication difficulties.

RESULTS

Participants included 1,343 respondents (49.6%). Autism-Spectrum Quotient scores were positively correlated with communication difficulties (r = 0.16, p < 0.001). The correlation was mitigated by confidence in communication in the fit model. However, higher confidence in creating a supportive atmosphere was associated with more difficulty in communication (r = 0.16, p < 0.001).

SIGNIFICANCE OF RESULTS

Communication difficulty was linked to rehabilitation therapists' ALTs. By increasing confidence in areas of communication other than creation of a supportive atmosphere, ALT-related difficulties in communication may be ameliorated. Confidence to create supportive environments correlated positively with difficulty. Communication skills training to increase confidence in communication for rehabilitation therapists should be developed with vigilance regarding ALT levels.

Prevalence and its associated psychological variables of symptoms of depression and anxiety among ovarian cancer patients in China: a cross-sectional study

Background

It is well known that cancer patients tend to have high levels of perceived stress and symptoms of depression and anxiety. However, there is less study on the association between perceived stress and symptoms of depression and anxiety among ovarian cancer patients in China. And the mediating effect of hope and resilience needs to be further studied. In this study, we aim to examine the prevalence of depression and anxiety symptoms, to analyze the association between perceived stress and symptoms of depression and anxiety, and to test whether hope and resilience mediate the association of perceived stress with symptoms of depression and anxiety among Chinese patients with ovarian cancer.

Method

A total of 220 questionnaires were distributed and collected from the First Affiliated Hospital of China Medical University and Shengjing Hospital of China Medical University. All participants in this study were ovarian cancer inpatients. After excluding the incomplete questionnaires, 198 questionnaires were valid for the analysis. Qualified patients were asked to response to the questionnaires including Hospital anxiety and depression scale (HADS), perceived stress scale (PSS-10), and the Herth hope scale and the resilience scale. Hierarchical regression analyses were used to test the associations among perceived stress, symptoms of depression and anxiety, and hope and resilience. Bootstrapping method was conducted to examine whether the indirect effect of hope and resilience was significant respectively.

Results

The prevalence of symptoms of depression and anxiety in ovarian cancer patients was 47.0% and 51.5% respectively. Perceived stress correlated significantly with symptoms of depression (r = 0.709, P < 0.01) and anxiety (r = 0.660, P < 0.01). Hope (a*b = 0.155, BCa 95% CI: 0.094, 0.223) partly mediated the association between perceived stress and symptoms of depression; similarly, hope (a*b = 0.129, BCa 95% CI: 0.048, 0.205) partly mediated the effect of perceived stress on symptoms of anxiety. However, resilience (a*b = 0.004, BCa 95% CI: -0.030, 0.040) did not mediate the association between perceived stress and symptoms of depression. And resilience (a*b = 0.041,BCa 95% CI: -0.013, 0.098) did not mediate the association between perceived stress and symptoms of anxiety.

Conclusions

The present study suggests that perceived stress might be one of the impact factors of symptoms of depression and anxiety, while hope might ease symptoms of depression and anxiety. In view of the role of hope, medical workers and patient caregivers should pay more attention to hope, and then to intervene perceived stress among patients with ovarian cancer.

Hyperlipidemia and statins use for the risk of new-onset anxiety/depression in patients with head and neck cancer: A population-based study

Objective

Anxiety/depression is common among patients with head and neck cancer (HNC), and can negatively affect treatment compliance and outcome. The aim of this study was to assess the association between hyperlipidemia and the risk of new-onset anxiety/depression after the diagnosis of HNC and the influence of administering statins.

Methods

A matched longitudinal cohort study of 1632 subjects (408 HNC patients with preexisting hyperlipidemia and 1224 age- and sex-matched HNC patients without hyperlipidemia) was included and analyzed by using data from Taiwan’s National Health Insurance Research Database from January 1996 to December 2012. The incidence and hazard ratios (HRs) for the development of new-onset anxiety/depression were examined between the two groups. Cox proportional hazard regression was applied to estimate the relative risks of anxiety/depressive disorders adjusted for potential confounding factors. To estimate the risks of anxiety/depression in different sub-groups, a stratified analysis was also used.

Results

HNC patients with preexisting hyperlipidemia had a higher risk for comorbidities such as hypertension, diabetes mellitus, and cardiovascular disease (P <0.001). The incidence rate of anxiety/depression in the HNC patients with preexisting hyperlipidemia was also significantly higher than that among patients without hyperlipidemia (10.78% vs 7.27%, respectively; P = 0.03). A Cox regression model revealed that preexisting hyperlipidemia was an independent risk factor for anxiety/depression (aHR, 1.96; 95% CI, 1.30–2.94). Statins use was protective against anxiety/depression among HNC patients with hyperlipidemia (aHR, 0.85; 95% CI, 0.46–1.57), especially for individuals older than 65 years and for females.

Conclusions

Preexisting hyperlipidemia was associated with increased risk of new-onset anxiety/depression in the HNC patients. Statins use for HNC patients with hyperlipidemia could decrease the risk of anxiety/depression, especially for those older than 65 years and for female patients.