Stress and coping strategies among allogeneic haematopoietic stem cell transplantation survivors: A qualitative study

OBJECTIVE

The aim of this qualitative study was to explore allogeneic haematopoietic stem cell transplantation (allo-HSCT) survivors' perspectives of stresses and their coping strategies, in order to attain a deeper understanding of their experience.

METHODS

We conducted semi-structured interviews with 20 Japanese allo-HSCT survivors about the stresses they experienced and how they coped. We then conducted a content-driven thematic analysis of the interview results. The interview questions probed stresses and coping strategies related to allo-HSCT.

RESULTS

We identified 74 stresses across 7 domains: symptoms after transplantation, limitations in daily life, appearance changes, relationship anxieties, work impairment and financial issues, uncertainty and disappointed expectations. In addition, 21 coping strategies were identified across 3 domains: direct efforts to manage problems, adaptive attitude, and seeking and using social support.

CONCLUSION

By identifying a broad range of stressors associated with allo-HSCT, insight was gained as to the impact of allo-HSCT on survivors' lives. These results provide a foundation for the future development of resources for survivors, their significant others and clinicians. Stressors and coping strategies among allo-HSCT survivors were comprehensively characterised, which will provide useful information for patients and enable healthcare practitioners to provide better care.

Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video-vignette study (J-SUPPORT1601)

BACKGROUND

Nondisclosure of a poor prognosis to patients with advanced cancer remains a typical practice in Asia. Although the importance of prognostic communication has increasingly been recognized worldwide, little is known about whether explicit prognostic disclosure positively affects Asian patients with advanced cancer. The objective of this study was to examine the effects of explicit prognostic communication on patients with cancer recurrence.

METHODS

In this randomized, video-vignette study, Japanese women with breast cancer who had undergone curative surgery viewed videos of prognostic communication between a patient with recurrent, incurable breast cancer and her oncologist. The videos differed only in the presence or absence of explicit prognostic disclosure. The primary outcome was participants' uncertainty (rated from 0 to 10), and the secondary outcomes included anxiety (measured on the State-Trait Anxiety Inventory-State: range, 20-80), satisfaction (Patient Satisfaction Questionnaire; range 0-10), self-efficacy (range, 0-10), and willingness to discuss advance care planning (range, 1-4).

RESULTS

In total, 105 women participated (mean ± SD age, 53.8 ± 8.2 years). After viewing the video with more versus less explicit disclosure, participants showed significantly lower uncertainty (mean ± SE scores, 5.3 ±0.2 vs 5.7 ± 0.2, respectively; P = .032) and higher satisfaction (5.6 ± 0.2 vs 5.2 ± 0.2, respectively; P = .010) without increasing anxiety (changes in scores on the State-Trait Anxiety Inventory-State: 0.06 ± 0.5 vs 0.6 ± 0.5, respectively; P = .198). No significant differences were observed in self-efficacy (5.2 ± 0.2 vs 5.0 ± 0.2, respectively; P = .277) or willingness to discuss advance care planning (2.7 ± 0.1 vs 2.7 ± 0.1, respectively; P = .240).

CONCLUSIONS

Explicit prognostic disclosure prompted better outcomes than nondisclosure in Japanese women with breast cancer. When asked about the prognosis by Asian patients with cancer, clinicians may be encouraged to respect their wishes and explicitly discuss the prognosis if deemed appropriate.

Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study

BACKGROUND

Postoperative delirium is a common and important complication in cancer patients. We need to identify patients at high risk of postoperative delirium such that it can be prevented preoperatively or in early postoperative phase. The aim of this study was to investigate whether preoperative anxiety predicted onset of postoperative delirium in cancer patients, not only in order to identify high-risk groups but also to help develop new preventive approaches.

METHODS

This was a prospective observational cohort study of cancer patients undergoing tumor resections. Postoperative delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Preoperative anxiety was evaluated with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and we defined HADS-A > 7 as clinical anxiety. We conducted multivariate logistic regression to determine which factors were predictors of delirium.

RESULTS

The final analysis included 91 patients, 29 of whom met the criteria for postoperative delirium. In multivariable logistic regression, age (5-year increments; odds ratio (OR) = 1.565, 95% confidence interval (CI) = 1.057-2.317, p = 0.025) and HADS-A > 7 (OR = 4.370, 95% CI = 1.051-18.178, p = 0.043) predicted delirium onset. These variables explained 74.2% of the variance.

CONCLUSIONS

Preoperative anxiety strongly predicted postoperative delirium in cancer patients. Our findings suggest that preoperative anxiety may be a new target for prevention of postoperative delirium. Trial registration number This study was registered at UMIN000018980.

Fan Therapy Is Effective in Relieving Dyspnea in Patients With Terminally Ill Cancer: A Parallel-Arm, Randomized Controlled Trial

CONTEXT

Dyspnea is a common distressing symptom among patients with advanced cancer.

OBJECTIVE

The objective of this study was to determine the effect of fan therapy on dyspnea in patients with terminally ill cancer.

METHODS

This parallel-arm, randomized controlled trial included 40 patients with advanced cancer from a palliative care unit at the National Cancer Center Hospital in Japan. All patients experienced dyspnea at rest with a score of at least three points on a subjective 0- to 10-point Numerical Rating Scale (NRS), showed peripheral oxygen saturation levels of ≥90%, had an Eastern Cooperative Oncology Group grade of 3 or 4, and were aged 20 years or more. In one group, a fan was directed to blow air on the patient's face for five minutes. This group was compared to a control group wherein air was blown to the patient's legs. Patients were randomly assigned to each group. The main outcome measure was the difference in dyspnea NRS scores between fan-to-face and fan-to-legs groups.

RESULTS

No significant differences were seen in baseline dyspnea NRS between groups (mean score, 5.3 vs. 5.1, P = 0.665). Mean dyspnea changed by -1.35 points (95% CI, -1.86 to -0.84) in patients assigned to receive fan-to-face and by -0.1 points (-0.53 to 0.33) in patients assigned to receive fan-to-legs (P < 0.001). The proportion of patients with a one-point reduction in dyspnea NRS was significantly higher in the fan-to-face arm than in the fan-to-legs arm (80% [n = 16] vs. 25% [n = 5], P = 0.001).

CONCLUSION

Fan-to-face is effective in alleviating dyspnea in patients with terminally ill cancer.

Efficacy of an educational program for patients with pancreatic and biliary cancers, and their caregivers

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Background: We first introduced an educational program delivered in a classroom environment for patients with pancreatic and biliary cancers and their caregivers in 2007. Physicians, pharmacists, nurses, clinical psychotherapists, dietitians, and medical social workers attended and talked about their specialties. We conducted a prospective observational study from Jan. 2016 through Dec. 2016 to assess the efficacy of this educational program. Methods: This study was approved by our institutional review board and informed consent was obtained from all the participants. The 2-hour program included an overview of disease and information about treatment and management. The participants completed a questionnaire assessing their knowledge and including the Distress Thermometer both before and after the program. In addition, the participants completed a questionnaire regarding their satisfaction with the program to assess their informational needs. Results: Thirty-three patients and 50 caregivers were enrolled. Although no significant differences were seen in the mean baseline knowledge levels of the patients and caregivers, the mean baseline distress level was greater for the caregiver than for the patients. After attending the program, both the knowledge and distress levels were significantly improved for both the two groups. Regarding the satisfaction questionnaire, more than 90% of the participants reported being satisfied with the contents of the program and responded that the program was useful for their life. However, the percentage of respondents who reported being satisfied with hearing other participants’ stories was less than 40%. Conclusions: This study suggests that an educational program can improve knowledge and distress levels in patients and caregivers. We are planning to improve our program to further satisfy the needs of patients and caregivers, such as providing an opportunity to communicate with other participants, and to perform further evaluations.

Evaluation of the Appropriate Washout Period Following Fan Therapy for Dyspnea in Patients With Advanced Cancer: A Pilot Study

Objectives:

To clarify the duration required for dyspnea to return to baseline severity after fan therapy, to evaluate whether fan-to-legs therapy or no fan therapy would be a suitable control therapy, and to investigate changes in patients’ face surface temperature after fan therapy.

Methods:

In this pilot study, all participants received 3 interventions in the following order: no fan, fan to legs, and fan to face. Participants used a fan for 5 minutes, and they scored their dyspnea at 10-minute intervals for 60 minutes or until the score had returned to its baseline value, whichever occurred first. Nine patients with advanced cancer admitted to a palliative care unit were included; they had dyspnea at rest and rated its severity as at least 3 points on a 0- to 10-point numerical rating scale. Descriptive statistics and the Wilcoxon signed rank test were used to analyze the data.

Results:

All patients completed the study. Of the 9 participants, 6 experienced a clinical benefit from using a fan to their faces. Of these patients, only 2 participants’ (2 of 6) dyspnea scores returned to baseline by the end of the 60-minute assessment period after exposure to fan-to-face therapy. In fan-to-legs and no fan settings, there was no change in the dyspnea scores. There were significant differences between the baseline face surface temperature and that after fan-to-face and fan-to-legs settings.

Conclusion:

When using a crossover design to investigate the effect of fan therapy on dyspnea, 1 hour is an insufficient washout period.

The Association Between Depressive Symptoms and Age in Cancer Patients: A Multicenter Cross-Sectional Study

CONTEXT

There is controversy around the association between depressive symptoms and age in adult cancer patients.

OBJECTIVES

The aim of this study was to evaluate the following hypotheses: 1) cancer patients' depressive symptoms decrease with age, and 2) in individuals aged 65 years or older, depressive symptoms increase because of the effect of somatic symptoms.

METHODS

We retrospectively analyzed a database of 356 cancer patients who were consecutively recruited in a previous multicenter cross-sectional study. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9), and correlations with age and other factors were assessed by hierarchical multivariate regression analysis. Age was entered as the dependent variable in the first step, patient characteristics and cancer-related variables were entered in the second step, and somatic symptoms were entered in the last step. We analyzed this model for both the total sample and the subpopulation aged 65 years or older.

RESULTS

In the total sample, the PHQ-9 score was significantly associated with lower age, fatigue, and shortness of breath (adjusted R(2) 14.2%). In the subpopulation aged 65 years or older, no factor was associated with the PHQ-9 score (adjusted R(2) 7.3%).

CONCLUSION

The finding that depressive symptoms in cancer patients decreased with age was concordant with our first hypothesis, but the second hypothesis was not supported. Younger cancer patients were vulnerable to depressive symptoms and should be monitored carefully. Further studies using more representative samples are needed to examine in detail the association between depressive symptoms and age in older cancer patients.

Prevalence and predictive factors of depression and anxiety in patients with pancreatic cancer: a longitudinal study

OBJECTIVE

It is known that depression and anxiety occur more frequently in pancreatic cancer patients than in those with other malignancies. However, few studies have assessed depression and anxiety using reliable psychiatric diagnostic tools. The purpose of this study was to determine the prevalence of depression and anxiety among pancreatic cancer patients before and 1 month after the start of anticancer treatment using reliable psychiatric diagnostic tools, and to identify factors that predict their occurrence.

METHODS

Pancreatic cancer patients were consecutively recruited. Structured clinical interviews were used to determine the presence of affective disorders, anxiety disorders and adjustment disorders. Baseline interviews were performed prior to initiation of anticancer treatment, while follow-up interviews were performed 1 month after treatment was started. Medical, demographic and psychosocial backgrounds were also assessed as predictive factors.

RESULTS

One hundred and ten patients participated in the baseline interview and 91 in the follow-up interview. Depression and anxiety were observed in 15 patients (13.6%) at the baseline, and 15 patients (16.5%) at the follow-up. Lack of confidants was associated with depression and anxiety at the baseline. At the baseline, sadness, lower Karnofsky Performance Status and prior experience with the death of a family member due to cancer predicted newly diagnosed depression and anxiety at the follow-up.

CONCLUSION

A considerable percentage of pancreatic cancer patients experienced depression and anxiety. Multidimensional psychosocial predictive factors were found and optimal psychological care should incorporate early detection of sadness.

Impact of depression on health utility value in cancer patients

OBJECTIVE

The quality-adjusted life year, which is usually calculated from the health utility value, is now a standard measurement used in political decision-making in health. Although depression is the leading cause of decrement in health utility in general population, impact of comorbid depression among cancer patients has not been studied sufficiently. Therefore, this study aimed to measure the impact of depression on cancer patients' health utility score, according to the severity of depression.

METHODS

Impact of depression severity (measured by the Patient Health Questionnaire) on health utility score (measured by the EuroQoL-5 scale) was evaluated in a sample of 328 Japanese cancer patients, controlling for performance status, symptom burden, and demographic variables.

RESULTS

The patients with depression had significantly lower health utility value than those without depression (mean decrement = 0.14). Decrements in health utility of 0.13, 0.18, and 0.19 were observed for mild, moderate, and moderately severe to severe level of depression, respectively. The difference was significant between groups. Depression severity was a significant predictor for health utility (standardized coefficient beta = -0.25), which was comparable with physical symptom burden and performance status. Participants' age, gender, cancer stage, and comorbid illness were not significant. The model explained 37.9% of the variance.

CONCLUSIONS

Even mild level of depression caused clinically meaningful decrement in health utility value in cancer patients, which was comparable with decrements due to major physical complications of cancer. Influence of depression should be carefully investigated when interpreting the quality-adjusted life year among cancer patients. Copyright © 2015 John Wiley & Sons, Ltd.

Intrahepatic pseudoaneurysm after surgical hemostasis for a delayed hemorrhage due to blunt liver injury: report of a case

We report herein a case of delayed hemorrhage occurring after blunt hepatic trauma which was further complicated by an intrahepatic pseudoaneurysm. The delayed hemorrhage with free rupture occurred 2 weeks after the injury and the pseudoaneurysm developed 8 weeks after surgical hemostatic intervention for the delayed hemorrhage. The pseudoaneurysm was successfully treated by transcatheter arterial embolization. This rare case is reported to demonstrate the possibility of delayed catastrophic complications occurring after blunt liver injury and to point out the necessity of continued surveillance until the liver has completely healed.

Critical limb ischemia in a patient with von Recklinghausen's neurofibromatosis. Report of a case

A 42-year-old woman complicated with neurofibromatosis underwent both balloon percutaneous transluminal angioplasty (PTA) of the iliac artery and femoropopliteal (FP) bypass grafting for critical lower limb ischemia. Seven months after the initial intervention, a recurrence of stenosis in the iliac artery and at the anastomoses of the FP bypass necessitated both PTA and a repeat thrombectomy and finally resulted in the amputation of her left thigh. This is a rarely documented case of chronic arterial occlusion associated with neurofibromatosis, in which the prognosis of arterial reconstruction for such patients is suggested to be poor.

[Regulation of progesterone accumulation in dissociated luteal cells on day 15 of pregnancy in rats]

Luteal cells from the corpora lutea of rats on day 15 of pregnancy were suspended in DMEM-F12 and progesterone accumulation was measured by radioimmunoassay. Progesterone accumulation increased steadily over eight hours and then gradually decreased. Progesterone accumulation was seen to increase with the addition of BSA and 25-hydroxycholesterol. At doses of 12 ng/ml and 600 ng/ml hCG, progesterone accumulation increased, but was seen to decrease at a dose of 30 micrograms/ml hCG. However, the addition of cyclohexamide alone had no effect on progesterone accumulation, but the simultaneous addition of cyclohexamide and hCG blocked the effects of hCG in a dose related manner. These data indicate that progesterone production by rat luteal cells depends on cholesterol availability. The results reveal that hCG stimulates progesterone production by a process requiring new protein synthesis.

Inhibitory effects of adrenocorticotrophin or corticosterone on progesterone secretion during mid-pregnancy in rats

Conceptus number was reduced to one on Day 7 of pregnancy in rats by aspirating all but a single conceptus (Group E) or left at greater than or equal to 8 conceptuses (Group C). In Group E rats, serum progesterone concentrations remained low from Day 12 until autopsy at Day 21. Hypophysectomy on Day 12 significantly increased serum progesterone values after Day 17 of pregnancy, and these increases were blocked by treatment with ACTH (10 U/day, i.p., Days 12-17). Adrenalectomy on Day 12 also induced slight, but statistically significant, increases in serum progesterone concentration after Day 17, and these were overcome by implantation of a 10 mg capsule of corticosterone. In Group C rats, hypophysectomy or adrenalectomy on Day 12 did not change serum progesterone concentrations, but 40 U ACTH/day inhibited progesterone secretion. We conclude from these results that the pituitary-adrenal system exerts inhibitory effects on progesterone secretion during mid-pregnancy in rats.