NCCN Guidelines® Insights: Distress Management, Version 2.2023

Predictors of significant distress in cervical cancer patients: a cross sectional study

PURPOSE

This cross-sectional study aims to investigate parameters that predict relevant levels of distress in women in a perioperative setting undergoing treatment for cervical cancer.

MATERIALS AND METHODS

Data from 495 patients with cervical cancer that were treated at the university hospital Aachen between 2010 and 2022 were analysed based on their respective National Comprehensive Cancer Network (NCCN) Distress Thermometer score (DT) and Problem List (PL) and their clinical history. 105 patients were enrolled in the study. 18 medical and demographic variables were analysed using multivariate logistic regression.

RESULTS

Three variables contributed significantly to the prediction of a DT score ≥ 5. Significant distress was defined as a DT score of ≥ 5, which was observed in 70.5% of the participants (mean: 5.58 ± 2.892). Women who chose to receive psycho-oncological counselling were more likely to have a DT score ≥ 5 (Odds Ratio(OR) = 3.323; Confidence Interval (CI95%): 1.241-8.900; p-value: 0.017). In addition, women who did not receive chemoradiation had significantly higher DT scores (OR = 3.807; CI 95%:1.185-12.236; p-value: 0.025), as did women whose Distress Thermometer was assessed in the first month after their initial diagnosis (OR = 3.967; CI 95%:1.167-13.486; p-value: 0.027).

CONCLUSION

Increased distress in women with cervical cancer is common especially in the first month after diagnosis, in patients who do not receive chemoradiation and in patients who seek psycho-oncological counselling. Surgical factors do not play a major role in patient distress.

Supportive Care Needs in Chinese, Vietnamese, and Korean Americans With Metastatic Cancer: Mixed Methods Protocol for the DAWN Study

BACKGROUND

Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer.

OBJECTIVE

This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals).

METHODS

CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs.

RESULTS

Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024.

CONCLUSIONS

Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50032.

The Emotional Impact of a Cancer Diagnosis: A Qualitative Study of Adolescent and Young Adult Experience

The biographical disruption that occurs in adolescents and young adults following a cancer diagnosis can affect various important psychosocial domains including relationships with family and friends, sexual development, vocational and educational trajectories, and physical and emotional wellbeing. While there is evidence of the physical impact of cancer during this period, less is known about the impact on emotional wellbeing and especially on the barriers for young people accessing help and support. We aimed to obtain a more in-depth understanding of young people's experiences of their diagnosis, treatment, psychological impact, and range of resources they could or wanted to access for their mental health. We conducted an in-depth qualitative study using semi-structured interviews with 43 young people who had developed cancer aged 16 to 39 years and were either within 6 months of diagnosis or 3-5 years after treatment had ended. Framework analysis identified three themes: the emotional impact of cancer (expressed through anxiety, anger, and fear of recurrence); personal barriers to support through avoidance; and support to improve mental health through mental health services or adolescent and young adult treatment teams. We showed the barriers young people have to access care, particularly participant avoidance of support. Interrupting this process to better support young people and provide them with flexible, adaptable, consistent, long-term psychological support has the potential to improve their quality of life and wellbeing.

The effects of art-making intervention on mind-body and quality of life in adults with cancer: a systematic review and meta-analysis

PURPOSE

To investigate the effectiveness of art-making interventions on physical and psychological outcomes, as well as quality of life (QOL), in adult patients with cancer.

METHODS

Seven English-language databases (PubMed, Academic Search Premier, EMBASE, CINAHL, PsycINFO, The Cochrane Library, and Web of Science) and three Chinese-language databases (CNKI, WanFang, and VIP) were searched up to and including May 1, 2023. We used the Cochrane Risk of Bias tool 2.0 and the Risk of Bias in Non-Randomized Studies-of Interventions to evaluate the certainty of evidence. The data were analyzed using Review Manager software 5.4. The study protocol was registered with PROSPERO (CRD42022321471).

RESULTS

The studies predominantly focused on visual art (n = 21), two specifically used performing art (n = 2), and five integrated both forms of art-making (n = 5). The pooled results showed that art-making significantly improved anxiety (SMD =  - 1.12, 95% CI [- 1.43, - 0.81], p < 0.01), depression (SMD =  - 0.91, 95% CI [- 1.16, - 0.65], p < 0.01), distress (SMD =  - 1.19, 95% CI [- 1.43, - 0.95], p < 0.01), psychological well-being (SMD = 0.41, 95% CI [0.02, 0.80], p = 0.04), societal well-being (SMD = 0.29, 95% CI [0.04, 0.54], p = 0.03), nausea (SMD =  - 1.81, 95% CI [- 2.84, - 0.78], p < 0.01), physical well-being (SMD = 0.11, 95% CI [0.02, 0.20], p = 0.02), and QOL (SMD = 0.81, 95% CI [0.29, 1.33], p < 0.01). However, it did not significantly improve fatigue (SMD =  - 0.28, 95% CI [- 0.75, 0.19], p = 0.24) and pain (SMD =  - 0.18, 95% CI [- 1.97, 1.60], p = 0.84) in patients with cancer.

CONCLUSIONS

Art-making interventions may boost psychological well-being, physical symptoms, and QOL among patients with cancer. More robust studies are necessary to overcome methodological limitations and promote wider adoption of these interventions.

TRIAL REGISTRATION

Prospero registration number: CRD42022321471.

Distress and Psycho-Oncological Support for Patients With Advanced Breast Cancer

OBJECTIVES

Patients with advanced breast cancer (ABC) face an incurable disease that brings along many challenges. Health care professionals, and nurses in particular, have a main role in supporting these patients to adapt and adjust to their condition. In this study, we discuss how good communication skills can be the first level of emotional support to patients and families; and how the high prevalence of distress in this population makes it of great importance to screen for distress regularly and treat it when needed.

DATA SOURCES

We present our research study on the impact of negative effects on biobehavioral processes that contribute to disease progression, and comment on the psychological interventions that may reduce it, with a particular focus on the CALM therapy model we validated for the Portuguese ABC patients. We also report on the added human value of a retreat for couples and professionals that our team has tested with ABC patients and their partners.

CONCLUSION

It is critical to screen for distress in ABC patients who have a higher prevalence of distress. There are available evidence-based interventions to assist clinicians in reducing their suffering. CALM therapy and a retreat format may be options to consider with ABC patients.

IMPLICATIONS FOR NURSING PRACTICE

As front-line clinicians, nurses have an important role in providing provide emotional support to patients using good communication skills, but also in identifying patients at risk for distress, screening for it regularly, and referring patients for specialized psychosocial care when needed.

Metabolite Biomarkers of Prolonged and Intensified Pain and Distress in Head and Neck Cancer Patients Undergoing Radio- or Chemoradiotherapy by Means of NMR-Based Metabolomics-A Preliminary Study

Treatment of head and neck squamous cell carcinoma (HNSCC) has a detrimental impact on patient quality of life. The rate of recognized distress/depression among HNSCC patients ranges from 9.8% to 83.8%, and the estimated prevalence of depression among patients receiving radiotherapy is 63%. Shorter overall survival also occurs in preexisting depression or depressive conditions. The present study analyzes the nuclear magnetic resonance (NMR) blood serum metabolic profiles during radio-/chemoradiotherapy and correlates the detected alterations with pain and/or distress accumulated with the disease and its treatment. NMR spectra were acquired on a Bruker 400 MHz spectrometer and analyzed using multivariate methods. The results indicate that distress and/or pain primarily affect the serum lipids and metabolites of energy (glutamine, glucose, lactate, acetate) and one-carbon (glycine, choline, betaine, methanol, threonine, serine, histidine, formate) metabolism. Sparse disturbances in the branched-chain amino acids (BCAA) and in the metabolites involved in protein metabolism (lysine, tyrosine, phenylalanine) are also observed. Depending on the treatment modality-radiotherapy or concurrent chemoradiotherapy-there are some differences in the altered metabolites.

Analysis of distress in patients undergoing radical prostatectomy: A multicenter prospective study

PURPOSE

To analyze the degree of psychological distress experienced pre- and postoperatively in patients who underwent radical prostatectomy after being diagnosed with prostate cancer.

MATERIALS AND METHODS

Patients diagnosed with prostate cancer who underwent radical prostatectomy without history of psychiatric disorders were included in this study. The degree of psychological distress was evaluated using hospital anxiety and depression scale (HADS) and distress thermometer (DT) questionnaires preoperatively and at 1, 3, 6, and 12 months postoperatively.

RESULTS

Distress was high preoperatively and decreased over the entire period. In addition, HADS-anxiety and HADS-depression scores showed an improved severity, shifting from an abnormal state to a borderline state in some patients. However, the DT score, including emotional problems, spiritual concerns, physical problems, family problems, and practical problems, was slightly higher at 1 month postoperatively compared to preoperatively. Furthermore, even at 12 months postoperatively, about one fifth of patients surveyed had a DT score of 4 or higher, requiring psychiatric intervention.

CONCLUSIONS

Before and after radical prostatectomy, a significant number of patients complained of distress such as anxiety, depression, and insomnia, and they needed help from a specialist because of psychological distress even 12 months postoperatively. Therefore, a close evaluation of the patient's psychological distress and supportive treatment are needed during the entire pre- and postoperative period.

Change in alcohol consumption during the Covid-19 pandemic and associations with mental health and financial hardship: results from a survey of Wisconsin patients with cancer

PURPOSE

Alcohol consumption increases health risks for patients with cancer. The Covid-19 pandemic may have affected drinking habits for these individuals. We surveyed patients with cancer to examine whether changes in drinking habits were related to mental health or financial effects of the pandemic.

METHODS

From October 2020 to April 2021, adult patients (age 18-80 years at diagnosis) treated for cancer in southcentral Wisconsin were invited to complete a survey. Age-adjusted percentages for history of anxiety or depression, emotional distress, and financial impacts of Covid-19 overall and by change in alcohol consumption (non-drinker, stable, decreased, or increased) were obtained via logistic regression.

RESULTS

In total, 1,875 patients were included in the analysis (median age 64, range 19-87 years), including 9% who increased and 23% who decreased drinking. Compared to stable drinkers (32% of sample), a higher proportion of participants who increased drinking alcohol also reported anxiety or depression (45% vs. 26%), moderate to severe emotional distress (61% vs. 37%) and viewing Covid-19 as a threat to their community (67% vs. 55%). Decreased (vs. stable) drinking was associated with higher prevalence of depression or anxiety diagnosis, emotional distress, and negative financial impacts of the pandemic. Compared to non-drinkers (36% of sample), participants who increased drinking were more likely to report emotional distress (61% vs. 48%).

CONCLUSIONS

Patients with cancer from Wisconsin who changed their alcohol consumption during the Covid-19 pandemic were more likely to report poor mental health including anxiety, depression, and emotional distress than persons whose alcohol consumption was stable.

IMPLICATIONS FOR CANCER SURVIVORS

Clinicians working with cancer survivors should be aware of the link between poor mental health and increased alcohol consumption and be prepared to offer guidance or referrals to counseling, as needed.

Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: SIO-ASCO Guideline Summary and Q&A

This SIO-ASCO guideline Q&A provides guidance on integrative oncology care of symptoms of anxiety and depression in adult patients with cancer

Efficacy of meaning-centered group psychotherapy in Chinese patients with cancer: A randomized controlled trial

OBJECTIVES

Meaninglessness is one of the most common psychological problems in cancer patients, which can lead to anxiety, depression and psychological distress, and diminished quality of life. Recent evidence indicates that meaning-centered group psychotherapy (MCGP) effectively enhances the meaning in life among cancer patients. This study aimed to evaluate the impact of MCGP on the meaning in life, post-traumatic growth, psychological distress, and fear of recurrence among Chinese cancer patients with a favorable prognosis.

METHODS

Sixty-six cancer patients were randomly assigned to either the MCGP group (n = 33) or the control group (n = 33). Participants in the MCGP group underwent a 4-week, 8-session MCGP, while those in the control group received usual care. Meaning in life, post-traumatic growth, psychological distress, and fear of recurrence were assessed at both baseline and postintervention to evaluate the impact of the intervention. The intervention outcomes were analyzed using paired t-tests or analysis of covariance, as appropriate.

RESULTS

Patients in the MCGP group demonstrated significant improvements in meaning in life, post-traumatic growth, and fear of recurrence from baseline to postintervention. In comparison to the control group, the MCGP group displayed positive effects on meaning in life and post-traumatic growth following the intervention. However, no significant effects were observed in terms of psychological distress and fear of recurrence.

SIGNIFICANCE OF RESULTS

Our research offers evidence supporting the effectiveness of MCGP in enhancing meaning in life and post-traumatic growth among Chinese cancer patients with a favorable prognosis.