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Ratzel E, Pretzell IM, Kindler T, Weber M, Gerlach C. Patient Reported Outcome Measurement (PROM) under real-life conditions of non-curable cancer outpatients with the Integrated Palliative Outcome Scale (IPOS) and NCCN- Distress Thermometer - A mixed methods study. PEC Innov 2024; 4:100264. [PMID: 38404931 PMCID: PMC10883829 DOI: 10.1016/j.pecinn.2024.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
Objective Prospective cohort study to test the real-life feasibility of longitudinal patient-reported outcome measurement PROM (Integrated Palliative Outcome Scale IPOS, and NCCN Distress Thermometer DT) required for outpatients with non-curable lung or prostate cancer in comprehensive cancer centers. Methods Assessment with paper-based IPOS and DT was observed for 15 months. We analyzed response to patients' distress (requests for supportive and palliative services) following PROM. Focus groups to comprehensively explore the user experience of patients, informal caregivers and health care professionals (HCP) supplemented the analysis. Results Ninety-seven percent (125/129) of the patients received a questionnaire once, but quarterly assessment as recommended by certification committees was achieved only in 50% and 31% of prostate and lung cancer patients. Although both instruments were well accepted, only IPOS showed a high content validity, because some patients had difficulties in understanding the DT. Patients felt comfortable with completing the PROM, and HCP found PROM helped to structure the patient encounter. Due to organizational deficiencies in the handling of the instruments and operationalization of reactions to identified distress, the referrals to supportive and palliative services were rare. Conclusion To facilitate consequences from PROM it should be a standardized intervention rather than assessment alone. Innovation The patient perspective improves the implementation of PROM under real-life clinical conditions.
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Affiliation(s)
- Eileen Ratzel
- Interdisciplinary Department of Palliative Care, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Geb. 407, 55131 Mainz, Germany
| | - Ina Maria Pretzell
- University Cancer Center Mainz (UCT Mainz), University Medical Center of the Johannes Gutenberg-University of Mainz, Germany
| | - Thomas Kindler
- University Cancer Center Mainz (UCT Mainz), University Medical Center of the Johannes Gutenberg-University of Mainz, Germany
| | - Martin Weber
- Interdisciplinary Department of Palliative Care, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Geb. 407, 55131 Mainz, Germany
| | - Christina Gerlach
- Interdisciplinary Department of Palliative Care, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Geb. 407, 55131 Mainz, Germany
- Department of Palliative Care, Heidelberg University Hospital, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
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Saiganesh H, Duffy C, Chrysanthopoulou SA, Dizon DS. Predictors and impact of survivorship care plans and survivorship care visits. J Cancer Surviv 2024; 18:836-843. [PMID: 36692704 PMCID: PMC9871419 DOI: 10.1007/s11764-023-01334-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/08/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE We performed this study to characterize the population at the Lifespan Cancer Institute (LCI) who received a survivorship care plan (SCP) with or without a survivorship care visit (SCV) to determine both the impact on specialty referrals and the demographic and clinical predictors of SCPs and SCVs. METHODS We retrospectively reviewed EMR records on 1960 patients at LCI between 2014 and 2017 for SCPs and SCVs and extracted demographics, distress thermometer (DT) scores collected at the time of initial presentation, and subsequent referrals. We evaluated the bivariate associations of SCP and SCV with continuous and categorical factors and assessed the adjusted effect of these factors on receipt of SCP and SCV independently. All analyses were performed in R v4.0.2. RESULTS SCPs were completed in 740 (37.8%) patients, and of those, 65.9% had a SCV. The mean age was 63.9, 67% were female, and 51.2% were married or partnered. Patients treated for breast, lung, and prostate cancers most received an SCP. Compared to SCP alone, the SCV was associated with more specialty referrals. Those who were younger and had breast cancer were more likely to receive a SCP, and those who were younger and female and had breast cancer were more likely to receive a SCV. CONCLUSIONS Gender, age, and type of cancer are significant predictors of receipt of SCP and SCV. Patients who received either SCP, SCV, or both were more likely to receive specialty referrals than those who received neither. IMPLICATIONS FOR CANCER SURVIVORS Identifying predictive factors of SCP and SCV can help facilitate earlier receipt of specialty services and specialty referrals as needed.
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Affiliation(s)
- Harish Saiganesh
- Brown University, 593 Eddy Street, George 302, Providence, RI, 02903, USA.
| | - Christine Duffy
- Lifespan Cancer Institute, 593 Eddy Street, George 302, Providence, RI, 02903, USA
| | | | - Don S Dizon
- Lifespan Cancer Institute, 593 Eddy Street, George 302, Providence, RI, 02903, USA
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Lee AY, Lyons AT, Makris V, Kamaraju S, Stolley MR, Neuner JM, Flynn KE. Adherence to adjuvant endocrine therapy for breast cancer: a qualitative exploration of attribution of symptoms among post-menopausal women. Support Care Cancer 2024; 32:265. [PMID: 38565669 DOI: 10.1007/s00520-024-08463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Oral adjuvant endocrine therapy (AET) is an effective treatment for hormone receptor positive breast cancer to decrease recurrence and mortality, but adherence is poor. This study explored post-menopausal women's experiences with AET, with a particular focus on adherence to AET as well as distress and symptoms experienced prior to and during AET treatment. METHODS Participants were recruited from a hospital registry, stratified by adherence to/discontinuation of AET. Telephone interviews followed a semi-structured interview guide and were recorded and transcribed verbatim. Transcripts were systematically coded using team-based coding, with analysis of themes using a grounded theory approach. RESULTS Thirty-three participants were interviewed; ages ranged from 57 to 86 years. Participants included 10 discontinued patients and 23 patients who completed their AET course or were adherent to AET at the time of interviewing. Both adherent and discontinued patients reported symptoms throughout their AET treatment course, and both attributed symptoms to factors other than AET (e.g., older age and pre-existing comorbidities). However, discontinued patients were more likely to attribute symptoms to AET and to describe difficulty managing their symptoms, with some directly citing symptoms as the reason for discontinuing AET therapy. Conversely, adherent patients were more likely to describe the necessity of taking AET, despite symptoms. CONCLUSIONS AET adherence was associated with beliefs about AET, symptom attribution, and symptom management. Routine symptom monitoring during AET and addressing both symptoms and patients' understanding of their symptoms may promote adherence to AET.
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Affiliation(s)
- Amy Y Lee
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 52336, USA
| | - Anna T Lyons
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 52336, USA
| | - Vaia Makris
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 52336, USA
| | - Sailaja Kamaraju
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 52336, USA
| | - Melinda R Stolley
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 52336, USA
| | - Joan M Neuner
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 52336, USA
| | - Kathryn E Flynn
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 52336, USA.
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Malaval CI, Cabanillas Stanchi KM, Werle D, Thiel S, Gansel M, Lang P, Handgretinger R, Svaldi J, Döring M. Application of the National Comprehensive Cancer Network- distress thermometer in pediatric patients during autologous and allogeneic hematopoietic stem cell transplantation and relationship to blood parameters of the stress axis. J Cancer Res Clin Oncol 2023; 149:15899-15909. [PMID: 37676266 PMCID: PMC10620269 DOI: 10.1007/s00432-023-05300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Hematopoietic stem cell transplantations (HSCT) are extremely stressful procedures for pediatric patients. The activation of the hypothalamic pituitary adrenocortical axis (HPA) can influence the immune system negatively and therefore the overall outcome. The distress thermometer (DT) is an easy to use tool for the self-assessment of perceived distress. METHODS In this prospective study, a DT with an attached problem list was used in 40 pediatric patients undergoing HSCT and in one parent of each patient. The patients were aged 10-18 years. The patients' cortisol, thyroid stimulating hormone, free triiodothyronine and thyroxine levels were measured regularly during the in-patient stay. RESULTS After admission to the hospital, the stress levels of the pediatric patients and their parents increased and reached their maximum on the day of HSCT. The overall stress values of the parents were higher than those of their children. There was a significant difference in the parents' stress levels on the day of HSCT, as compared to their stress levels on other days. The mean cortisol values of the pediatric patients also increased after admission, reaching significant elevated levels above the upper normal limit 1 week after HSCT and on discharge day. Although the pediatric patients experienced mainly exhaustion, especially on the day of transplantation, their parents mainly felt worry and anxiety. Interestingly, the rate of worry among children increased in the post-transplant period and reached its maximum on the day of discharge. CONCLUSIONS In summary, a significantly increased stress level is shown for both the patients and their parents. This is reflected for the patients both in the DT scores and in the increased cortisol values. For the parents, the focus is primarily on worry and anxiety, for the patients primarily on exhaustion and worry.
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Affiliation(s)
- Carmen Isolde Malaval
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karin Melanie Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Stefanie Thiel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Melanie Gansel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
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Jan Ben S, Dörner M, Günther MP, von Känel R, Euler S. Proof of concept: Predicting distress in cancer patients using back propagation neural network (BPNN). Heliyon 2023; 9:e18328. [PMID: 37576295 PMCID: PMC10412887 DOI: 10.1016/j.heliyon.2023.e18328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Background Research findings suggest that a significant proportion of individuals diagnosed with cancer, ranging from 25% to 60%, experience distress and require access to psycho-oncological services. Until now, only contemporary approaches, such as logistic regression, have been used to determine predictors of distress in oncological patients. To improve individual prediction accuracy, novel approaches are required. We aimed to establish a prediction model for distress in cancer patients based on a back propagation neural network (BPNN). Methods Retrospective data was gathered from a cohort of 3063 oncological patients who received diagnoses and treatment spanning the years 2011-2019. The distress thermometer (DT) has been used as screening instrument. Potential predictors of distress were identified using logistic regression. Subsequently, a prediction model for distress was developed using BPNN. Results Logistic regression identified 13 significant independent variables as predictors of distress, including emotional, physical and practical problems. Through repetitive data simulation processes, it was determined that a 3-layer BPNN with 8 neurons in the hidden layer demonstrates the highest level of accuracy as a prediction model. This model exhibits a sensitivity of 79.0%, specificity of 71.8%, positive predictive value of 78.9%, negative predictive value of 71.9%, and an overall coincidence rate of 75.9%. Conclusion The final BPNN model serves as a compelling proof of concept for leveraging artificial intelligence in predicting distress and its associated risk factors in cancer patients. The final model exhibits a remarkable level of discrimination and feasibility, underscoring its potential for identifying patients vulnerable to distress.
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Affiliation(s)
- Schulze Jan Ben
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marc Dörner
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Götz A, Kröner A, Jenewein J, Spirig R. Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach. Palliat Support Care 2022:1-8. [PMID: 36367151 DOI: 10.1017/s1478951522001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To improve psychosocial care for oncology inpatients, we implemented screening for distress by means of distress thermometer (DT) at the Comprehensive Cancer Centre Zurich in 2011. Since then, several screening barriers have been reported regarding the application of the DT. This study aimed to evaluate the distress screening process between 2012 and 2016 to identify barriers preventing sustainability. METHODS In this sequential explanatory mixed methods study, we synthesized the results of 2 quantitative retrospective descriptive studies and 1 qualitative focus group study. To compare and analyze the data, we used thematic triangulation. RESULTS Nurses screened 32% (N = 7034) of all newly admitted inpatients with the DT, and 47% of the screenings showed a distress level ≥5. Of these cases, 9.7% were referred to psycho-oncological services and 44.7% to social services. In 15.7% of these cases, nurses generated a psychosocial nursing diagnosis. In focus group interviews, nurses attributed the low screening rate to the following barriers: adaptation to patients' individual needs, patient-related barriers and resistance, timing, communication challenges, established referral practice, and lack of integration in the nursing process. SIGNIFICANCE OF RESULTS To improve distress screening performance, the screening process should be tailored to patients' needs and to nurses' working conditions (e.g., timing, knowledge, and setting-specific factors). To gain more evidence on distress management as a basis for practical improvements, further evaluations of distress screening are required.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Anja Kröner
- Department of Oncology, Cantonal Hospital Glarus AG, Glarus, Switzerland
| | - Josef Jenewein
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, University Hospital Graz, Graz, Austria
- Private Clinic Hohenegg, Meilen, Switzerland and University of Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
- Institute of Nursing Science, University of Basel, Basel, Switzerland
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Park SY, Kim Y, Hong H. Patient-reported distress and problems among elderly patients with hematological malignancy in Korea. Support Care Cancer 2022; 30:9019-9027. [PMID: 35948847 DOI: 10.1007/s00520-022-07315-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Treatment for hematological malignancies (HMs) and functional decline associated with age can cause distress in elderly patients with HMs. However, information about the nature and effects of distress in this population is scarce. Therefore, this study examined the level of distress, its source, and the practical/familial/physical/emotional problems among elderly patients with HMs. METHODS We conducted a cross-sectional study of patients with HMs aged ≥ 65 years who visited an outpatient clinic at a tertiary medical center in Korea between November 2019 and March 2020. Patient-reported distress and problems were measured using the distress thermometer (DT) and 39-item Problem List by the National Comprehensive Cancer Network. Descriptive statistics, χ2 test or Fisher's exact test, and multivariate logistic regression analyses were conducted (N = 132). RESULTS In total, 62.1% of patients had moderate to severe distress (DT score ≥ 4), experiencing an average of nine problems. Significant sources of distress on multivariate logistic analysis included problems with transportation, depression, and constipation, accounting for 47% of distress variance. Most patients had physical (97.0%) or emotional problems (79.5%). Among these, fatigue (60.6%), worry (59.8%), tingling (59.8%), difficulty with mobility (47.0%), and memory/concentration (40.2%) were the most frequently reported problems. CONCLUSIONS Elderly patients with HMs have a high burden of distress, which is affected by different sources, compared with younger patients with solid tumors. Thus, in this population, assessment and management of distress need to be conducted considering the unique features of their source and burden. Further research on distress should consider the cancer type and population age.
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Affiliation(s)
- Sun-Young Park
- Graduate School, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.,Division of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, 400 Neungdong-ro, Gwangjin-gu, Seoul, 04554, Korea
| | - Yoonjoo Kim
- Department of Nursing, College of Healthcare Sciences, Far East University, Eumseong-gun, Chungcheongbuk-do, Seoul, South Korea, 27601
| | - Hyunju Hong
- National Cancer Center, 323 Ilsan-ro, Goyang-si, Gyeonggi-do, 10408, Korea.
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Abstract
Psychological distress scale is highly recommended for cancer patients’ care. Several psychological scales have been implemented in cancer outpatient clinics. However, the use of the psychological distress scale, particularly distress thermometer (DT), in the inpatient has not been reported. In this study, we report the efficacy of DT in the determination of cancer inpatients’ supporting needs. A total of 170 inpatients diagnosed with cancer have been enrolled in this study. Only 132 patients matched the inclusion criteria, while other cases were excluded because of other diseases associated with cancer. The standardized problem list (PL) and Hospital Anxiety and Depression Scale (HADS) were implemented in comparison with DT. Then, the cut-off score of DT was performed to identify clinically significant differences. The analysis of the receiver operating characteristic (ROC) curve revealed that a DT cut-off score of 4 displayed 0.76 under the ROC curve. Sensitivity showed 0.86 sensitivity for cut-off score 4 and a specificity of 0.56 relative to the HADS cut-off score (≥15). DT scores were found independent of medical variables such as cancer type and stage, recurrence, or metastasis. Clinical ECOG-SP showed a significant association with the DT cut-off score (P ≤ 0.05). Regarding PL, patients with scores above DT cut-off were suffering 21 of 40 problems in all categories. Furthermore, patients that scored above the DT cut-off significantly showed an association with high support needs. DT scale showed significant performance in the evaluation of psychological distress among cancer inpatients through the efficient determination of their support needs.
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Affiliation(s)
- Abdullah Al-Shaaobi
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, R. P. China
| | - Murad Alahdal
- Shenzhen Key Laboratory of Tissue Engineering, Shenzhen Laboratory of Digital Orthopedic Engineering, Guangdong Provincial Research Center for Artificial Intelligence and Digital Orthopedic Technology, Shenzhen Second People's Hospital (The First Hospital Affiliated to Shenzhen University, Health Science Center), Shenzhen, P. R. China.,Medical Laboratories Department, Faculty of Medicine and Health Sciences, Hodeidah University, Al Hudaydah, Yemen
| | - Shiying Yu
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongming Pan
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, R. P. China
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Erickson N, Schinkoethe T, Eckhardt C, Storck L, Joos A, Liu L, Ballmer PE, Mumm F, Fey T, Heinemann V. Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study). Support Care Cancer 2021. [PMID: 34159428 DOI: 10.1007/s00520-021-06351-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023]
Abstract
Abstract Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study) Background E-health based patient-reported outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors. Results Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR= 0.51, 95% CI=(0.27, 0.95), p = 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR=1.03, 95% CI=(1.01, 1.06), p = 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI=(-3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI=(−5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI=(2.27, 4.15), p < 0.001). As nutrition status declined, the distress score increased (95%CI=(0.88, 1.68), p < 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems. Conclusion Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.
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Kunz V, Wichmann G, Lehmann-Laue A, Mehnert-Theuerkauf A, Dietz A, Wiegand S. Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study. BMC Cancer 2021; 21:478. [PMID: 33926414 PMCID: PMC8086062 DOI: 10.1186/s12885-021-08236-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background In different cancer entities, several studies have shown the adverse effects of cancer on mental health, psychological well-being and the increased risk of high emotional distress in cancer patients. This study aims to analyze psychosocial distress levels and their relationship between sociodemographic parameters and selected items on the Distress Thermometer (DT) Problem List in head and neck squamous cell carcinoma (HNSCC) patients. Patients and methods We assessed a total of 120 HNSCC patients using the Distress Thermometer (DT) Problem List. Distress scores (DTS) of 90 patients were available. A DTS of ≥ 5 on the visual analogue scale represents clinically relevant distress. Data analysis consisted of descriptive statistics, comparison of mean values for different DTS subcategories and correlation between DTS scores and parameters of tumor classification, sociodemographic variables and selected problems. Results Distress was present in 57.7% of the sample, with a total of 52 patients with a DTS ≥ 5. The mean DTS was 4.7 (SD 2.4). Patients with newly diagnosed HNSCC had significantly higher DTS. Distress levels were significantly associated with sadness, general worries, anxiety, nervousness, sleeping disorders, mouth sores and fever. Out of the total sample, 6 patients and out of these 6 individuals, 5 patients with a DTS ≥ 5 requested referrals to psycho-oncological service. Conclusion High distress levels were common in HNSCC patients but only few patients desired psycho-oncological care. Addressing patients’ supportive care needs in routine clinical practice is essential to meet unmet needs of HNSCC patients and thus improve cancer care.
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Affiliation(s)
- V Kunz
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Leipzig, Leipzig, Germany.
| | - G Wichmann
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Leipzig, Leipzig, Germany
| | - A Lehmann-Laue
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - A Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - A Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Leipzig, Leipzig, Germany
| | - S Wiegand
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Leipzig, Leipzig, Germany
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Bartella AK, Kamal M, Gerwing D, Halama D, Kloss-Brandstätter A, Pausch N, Hölzle F, Lethaus B. Quality of life in patients with oral hard or soft tissue defects after reconstructive microsurgery. Br J Oral Maxillofac Surg 2020; 59:70-75. [PMID: 33229060 DOI: 10.1016/j.bjoms.2020.08.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
With current advances in medicine, many surgical methods have emerged for the reconstruction of soft and hard tissue defects of the head and neck. Current literature provides only a limited amount of evidence in studies addressing differences in quality of life for specific therapeutic measures in microvascular reconstruction. The validated University of Washington quality of life questionnaire version 4 (UW-QoL v4), a distress thermometer, and two questions addressing donor-site morbidity were sent to 134 patients at a tertiary care centre. All participants had undergone a type of microvascular reconstructive surgery of the head and neck. They were distributed into three groups according to the defect and type of treatment: defects reconstructed by soft-tissue microvascular tissue transfer, defects involving the hard tissue and treated by alloplastic reconstruction, and hard tissue defects receiving microvascular osseous reconstruction. A total of 82 patients completed the questionnaire in full and returned it. Patients from all the groups showed improved distress thermometer values postoperatively. Those who underwent osseous microvascular reconstruction had better functional items than those who had alloplastic reconstruction plates. Donor-site morbidity was rated low in all groups. Microvascular osseous reconstructive surgery might help to improve functional outcomes in patients with osseous defects more than alloplastic reconstruction.
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Affiliation(s)
- Alexander K Bartella
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany.
| | - Mohammad Kamal
- Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait
| | - Deborah Gerwing
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Dirk Halama
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany
| | | | - Niels Pausch
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany
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Ascencio-Huertas L, Allende-Pérez SR, Pastrana T. Associated factors of distress in patients with advanced cancer: A retrospective study. Palliat Support Care 2021; 19:447-56. [PMID: 33222720 DOI: 10.1017/S1478951520001066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to assess the psychosocial distress and associated factors in advanced cancer patients consulting at the outpatient Palliative Care Unit at the National Cancer Institute in Mexico City. DESIGN A retrospective study was conducted using electronic records (June 2015 to December 2016). SAMPLE A total of 646 patients with advanced cancer during their first visit to the outpatient palliative care unit at the National Cancer Institute in Mexico were evaluated using the Distress Thermometer (DT) and ECOG performance status scores. FINDINGS Overall, 62% were women, with a median age of 57 years, and married (54.8%). The most frequent diagnosis was gastrointestinal cancer (28.6%), and 38.9% had a functional performance status of ECOG 2. The median DT score was 4.0 (IQR = 2-6), with 56% reporting DT scores ≥4. The three most frequent problems ≥4 were sadness (82.6%), feeling weak (81.2%), worry (79.6%), and <4 were feeling weak (57.7%), fatigue (55.6%), and financial security (52.1%). The variables associated with distress according to the multiple logistic regression analysis were problems with housing (OR = 2.661, 95% CI = 1.538-4.602), sadness (OR = 2.533, 95% CI = 1.615-3.973), transportation (OR = 1.732, 95% CI = 1.157-2.591), eating (OR = 1.626, 95% CI = 1.093-2.417), nervousness (OR = 1.547, 95% CI = 1.014-2.360), and sleep (OR = 1.469, 95% CI = 1.980-2.203). CONCLUSION The principal factors were related to distress levels, housing problems, transportation issues, and emotional problems such as sadness, nervousness, lower functionality, and younger age. Therefore, psychosocial support is of considerable relevance in palliative care. These findings will help clinicians understand the distress of patients with advanced cancer in palliative care in Latin American countries.
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Lugtenberg RT, de Groot S, Kaptein AA, Fischer MJ, Kranenbarg EM, Carpentier MD, Cohen D, de Graaf H, Heijns JB, Portielje JEA, van de Wouw AJ, Imholz ALT, Kessels LW, Vrijaldenhoven S, Baars A, Fiocco M, van der Hoeven JJM, Gelderblom H, Longo VD, Pijl H, Kroep JR; Dutch Breast Cancer Research Group (BOOG). Quality of life and illness perceptions in patients with breast cancer using a fasting mimicking diet as an adjunct to neoadjuvant chemotherapy in the phase 2 DIRECT (BOOG 2013-14) trial. Breast Cancer Res Treat 2021; 185:741-58. [PMID: 33179154 DOI: 10.1007/s10549-020-05991-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Purpose In the phase II DIRECT study a fasting mimicking diet (FMD) improved the clinical response to neoadjuvant chemotherapy as compared to a regular diet. Quality of Life (QoL) and illness perceptions regarding the possible side effects of chemotherapy and the FMD were secondary outcomes of the trial. Methods 131 patients with HER2-negative stage II/III breast cancer were recruited, of whom 129 were randomly assigned (1:1) to receive either a fasting mimicking diet (FMD) or their regular diet for 3 days prior to and the day of neoadjuvant chemotherapy. The European Organisation for Research and Treatment of Cancer (EORTC) questionnaires EORTC-QLQ-C30 and EORTC-QLQ-BR23; the Brief Illness Perception Questionnaire (BIPQ) and the Distress Thermometer were used to assess these outcomes at baseline, halfway chemotherapy, before the last cycle of chemotherapy and 6 months after surgery. Results Overall QoL and distress scores declined during treatment in both arms and returned to baseline values 6 months after surgery. However, patients’ perceptions differed slightly over time. In particular, patients receiving the FMD were less concerned and had better understanding of the possible adverse effects of their treatment in comparison with patients on a regular diet. Per-protocol analyses yielded better emotional, physical, role, cognitive and social functioning scores as well as lower fatigue, nausea and insomnia symptom scores for patients adherent to the FMD in comparison with non-adherent patients and patients on their regular diet. Conclusions FMD as an adjunct to neoadjuvant chemotherapy appears to improve certain QoL and illness perception domains in patients with HER2-negative breast cancer. Trialregister ClinicalTrials.gov Identifier: NCT02126449. Electronic supplementary material The online version of this article (10.1007/s10549-020-05991-x) contains supplementary material, which is available to authorized users.
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Abd El-Aziz N, Khallaf S, Abozaid W, Elgohary G, Abd El-Fattah O, Alhawari M, Khaled S, AbdelHaffez A, Kamel E, Mohamed S. Is it the time to implement the routine use of distress thermometer among Egyptian patients with newly diagnosed cancer? BMC Cancer 2020; 20:1033. [PMID: 33109093 PMCID: PMC7592584 DOI: 10.1186/s12885-020-07451-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/22/2020] [Indexed: 01/30/2023] Open
Abstract
Background The distress thermometer (DT) is an effective tool for identifying distress among cancer patients worldwide. However, DT has not been studied in Egyptian patients. We aimed to study the prevalence of distress among Egyptian patients with different types of cancers using DT. Methods A total of 550 patients with newly diagnosed hematological and solid cancers who were followed up at 3 Oncology Centers in Egypt were enrolled. They completed a sociodemographic and clinical status questionnaire, the DT and the Problem List (PL) scale. Results At a DT cut-off score of ≥4, 46% of patients had significant distress, which was related to the tumor site and stage. The most frequent problems reported were treatment decision (64.4%), worry (47%), and fears (44.5%). In univariate logistic regression analysis, participants who had significant distress described 23 out of 36 problems in the practical, family, emotional, and physical areas. After adjustment to sociodemographic and clinical characteristics, multivariable analysis confirmed that insurance, depression, fear, sadness, worry, loss of interest in usual activity, and sleep were independent factors associated with significant distress in cancer patients. Conclusions Almost half of Egyptian patients newly diagnosed with cancer reported significant distress. Those who had significant distress described extra problems in the practical, family, emotional, and physical areas. We recommend the routine use of DT for screening Egyptian patients with cancer, as well as the involvement of the psycho-oncology and social services, at the time of their initial diagnosis.
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Affiliation(s)
- Nashwa Abd El-Aziz
- Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.,Hematology-Oncology Department, King Khaled University hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Salah Khallaf
- Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Waleed Abozaid
- Department of Clinical Oncology, Faculty of Medicine, Mansura University, Mansura, Egypt
| | - Ghada Elgohary
- Hematology-Oncology Department, King Khaled University hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Department of Adult Hematology/Internal Medicine, Ain Shams University, College of Medicine, Cairo, Egypt
| | - Ola Abd El-Fattah
- Department of Adult Hematology/Internal Medicine, Ain Shams University, College of Medicine, Cairo, Egypt.,Department of Clinical Oncology, Faculty of medicine, Assiut University, Assiut, Egypt
| | - Mai Alhawari
- Hematology-Oncology Department, King Khaled University hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Safaa Khaled
- Department of Internal Medicine, Clinical Hematology Unit/Unit of Bone Marrow Transplantation, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Azza AbdelHaffez
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ehab Kamel
- Department of Pyschiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sherif Mohamed
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Obiajulu VO, Abiola T, Izehinosen CO, Obiako RO, Aveka IA, Adam BY, Lateef TS. Psychometric validity of the distress thermometer and problem check list in ART-naïve HIV infected patients in Northern Nigeria. Afr Health Sci 2019; 19:3172-3180. [PMID: 32127894 PMCID: PMC7040331 DOI: 10.4314/ahs.v19i4.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND HIV diagnosis comes with a lot of worry and distress. Ability to objectively estimate this distress by non-psychiatrist will enhance early detection of psychological distress for intervention. OBJECTIVES To investigate the validity of the Distress Thermometer (DT) and its problem checklist in achieving early detection of mental distress among ART-naïve HIV infected patient. MATERIALS AND METHODS A total of 90 ART-naïve HIV infected patients completed the DT and its problem check list, Hospital Anxiety Depression Scale (HADS), Oslo Social Support Scale and the 14-item Resilience Scale. RESULTS The DT was positively correlated with all the measures of distress and reversely correlated with all the positive wellness in this study. The correlations were only significant for the negative measures of psychological wellness. The internal consistency of the DT's problem list overall and sub-categories were within acceptable range (i.e. α > 0.50). The Receiver Operating Characteristic (ROC) curves and Area Under the Curves (AUC) analysis were significant and found the DT and Problem List to respectively differentiate between cases of distress, anxiety and depression. The DT's cut-off was >5.0 with AUC range (0.754 - 0.709); sensitivity range (81.0% - 70.4%); specificity range (68.3% - 65.2%) for distress, anxiety and depression as determined by HADS. And the Problem List cut-off was >6.0 with AUC range (0.854 - 0.821); sensitivity range (90.5% - 85.7%); specificity range (68.3% - 65.2%) for distress, anxiety and depression as measured by HADS. CONCLUSION The DT and Problem List were found to be valid measures of distress in ART-naïve HIV infected patients.
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Affiliation(s)
| | - Tajudeen Abiola
- Medical Services Unit, Federal Neuropsychiatric Hospital Barnawa-Kaduna
| | | | | | | | - Bashir Yakasai Adam
- Department of Internal Medicine, Kaduna State University, Kaduna State, Nigeria
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Van Lander A, Tarot A, Savanovitch C, Pereira B, Vennat B, Guastella V. Assessing the validity of the clinician-rated distress thermometer in palliative care. Palliat Care 2019; 18:81. [PMID: 31623591 PMCID: PMC6798346 DOI: 10.1186/s12904-019-0466-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background The distress of patients suffering from a terminal illness can lead to a state of despair and requests for euthanasia and assisted suicide. It is a major challenge for palliative care workers. The Distress Thermometer (DT) is recommended by the National Comprehensive Cancer Network as a means of more easily assessing distress. It is available as a Self-assessment reported Distress Thermometer, but for a wider use in palliative care it should also be implemented in the form of a clinician-reported outcome (clinRO). Clinicians need to rate patient’s distress when the patient is not able to do so (subject that cannot be addressed, defensive patient…). The primary aim of the quantitative study was to assess the validity of the Clinician-Rated Distress Thermometer in palliative care. Method The assessments were performed by teams working in three palliative care centres. The primary endpoint was concordance between the patient and clinicians’ responses via Lin’s concordance coefficient. Eligible patients were aged 18 years or older, suffering from a severe disease in the palliative phase, and with a sufficient level of awareness to consent to participate in the study. A total of 51 patients were recruited, 55% were male, with a mean age of 65.8 years [39–90 years]. Results Three hundred sixty-four clinician-Rated Distress Thermometer and 467 Self-Reported Distress Thermometer were performed. Only 364 of the 467 Self-Reported Distress Thermometer were used for the study, as investigators did not systematically ask the patient to give an account of his distress. Concordance between patient and clinician responses: The Lin’s concordance coefficient with a threshold (alpha) of 5% was 0.46 [0.38; 0.54]. At the first assessment, it was 0.61 [0.44; 0.79]. The Cohen’s kappa coefficient was 0.52, with a concordance rate of 79.6%. The sensitivity was 82.9% [66.4–93.4] and the specificity 71.4% [41.9–91.6]. Conclusion The first assessment gave the best results in terms of concordance between Clinician-Rated DT and Self-Reported DT. In the next assessments, the Clinician-Rated DT were less consistent with the patients’ Self-Reported DT.
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Affiliation(s)
- A Van Lander
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France. .,University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France.
| | - A Tarot
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France
| | - C Savanovitch
- University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France
| | - B Pereira
- CHU Clermont-Ferrand, DRCI, 63000, Clermont-Ferrand, France
| | - B Vennat
- University Clermont Auvergne, ACCePPT, Place Henri Dunand, 63000, Clermont-Ferrand, France
| | - V Guastella
- CHU Clermont-Ferrand, Unit of palliative care, Hôpital Louise Michel, 63118, cébazat, France
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Geerse OP, Brandenbarg D, Kerstjens HAM, Berendsen AJ, Duijts SFA, Burger H, Holtman GA, Hoekstra-Weebers JEHM, Hiltermann TJN. The distress thermometer as a prognostic tool for one-year survival among patients with lung cancer. Lung Cancer 2019; 130:101-107. [PMID: 30885329 PMCID: PMC7026622 DOI: 10.1016/j.lungcan.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The use of patient-reported outcome measures is increasingly advocated to support high-quality cancer care. We therefore investigated the added value of the Distress Thermometer (DT) when combined with known predictors to assess one-year survival in patients with lung cancer. METHODS All patients had newly diagnosed or recurrent lung cancer, started systemic treatment, and participated in the intervention arm of a previously published randomised controlled trial. A Cox proportional hazards model was fitted based on five selected known predictors for survival. The DT-score was added to this model and contrasted to models including the EORTC-QLQ-C30 global QoL score (quality of life) or the HADS total score (symptoms of anxiety and depression). Model performance was evaluated through improvement in the -2 log likelihood, Harrell's C-statistic, and a risk classification. RESULTS In total, 110 patients were included in the analysis of whom 97 patients accurately completed the DT. Patients with a DT score ≥5 (N = 51) had a lower QoL, more symptoms of anxiety and depression, and a shorter median survival time (7.6 months vs 10.0 months; P = 0.02) than patients with a DT score <5 (N = 46). Addition of the DT resulted in a significant improvement in the accuracy of the model to predict one-year survival (P < 0.001) and the discriminatory value (C-statistic) marginally improved from 0.69 to 0.71. The proportion of patients correctly classified as high risk (≥85% risk of dying within one year) increased from 8% to 28%. Similar model performance was observed when combining the selected predictors with QoL and symptoms of anxiety or depression. CONCLUSIONS Use of the DT allows clinicians to better identify patients with lung cancer at risk for poor outcomes, to further explore sources of distress, and subsequently personalize care accordingly.
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Affiliation(s)
- O P Geerse
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands.
| | - D Brandenbarg
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - H A M Kerstjens
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
| | - A J Berendsen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - S F A Duijts
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - H Burger
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands; Amsterdam University Medical Center, Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
| | - G A Holtman
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, the Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, the Netherlands; Netherlands Comprehensive Cancer Organization (IKNL), The Netherlands
| | - T J N Hiltermann
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands
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Götz A, Kröner A, Jenewein J, Spirig R. Evaluation of the adherence of distress screening with the distress thermometer in cancer patients 4 years after implementation. Support Care Cancer 2019; 27:2799-807. [PMID: 30539312 DOI: 10.1007/s00520-018-4579-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Identifying and assessing psychosocial distress with an appropriate screening instrument is essential when caring for cancer patients. Since 2012, the distress thermometer (DT) has been used by nurses for all cancer inpatients at the Comprehensive Cancer Center Zurich. We wanted to identify nurses' adherence to the screening protocol, differences between screened and not screened patients and the relationship between screening rate and productivity. METHODS This retrospective descriptive study used screening and referral data as well as socioeconomic and disease-related data of inpatients at the Comprehensive Cancer Center Zurich. This was collected from the electronic patient documentation system. Additionally, data showing the productivity of all wards was used. All data were analyzed descriptive. RESULTS Since 2012, 40.6% (4541) of the 11,184 patients have been screened. The screening rate was initially significantly lower but settled at 40% after 2 years. There was a higher screening rate among Swiss, married, male, and emergency patients and patients with hematology diseases, brain tumors, or head and neck cancer (p < 0.001). Every fourth patient with a moderate to severe distress level requested referral to a psychosocial service. Significantly more screened patients were referred to the social service (44.7%) than to the psycho-oncology service (9.4%). Only 22.9% of all referrals were made on the day of screening or a day later. There were only two wards of 15 with a significant relationship between productivity and screening rate. CONCLUSIONS Screening is useful in recognizing distress among patients, but screening practice needs to be reconsidered.
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Schell JT, Petermann-Meyer A, Kloss-Brandstätter A, Bartella AK, Kamal M, Hölzle F, Lethaus B, Teichmann J. Distress thermometer for preoperative screening of patients with oral squamous cell carcinoma. J Craniomaxillofac Surg 2018; 46:1111-1116. [PMID: 29789211 DOI: 10.1016/j.jcms.2018.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 12/15/2022] Open
Abstract
In this study, we evaluate the association between distress, various demographic and medical variables, and the prevalence of psychosocial distress in preoperative patients with oral squamous cell carcinoma. A total of 100 consecutive patients were recruited into the study and asked to complete the Distress Thermometer (DT) form with the Problem List questionnaire prior to surgical intervention; the average distress score was 5.7 ± 2.7. The distress score was neither correlated with age (r = -0.025; p = 0.804) nor with tumor size (r = 0.028; p = 0.785). General worries, anxiety, sadness, depression, pain, exhaustion, sleeping disorders, or problems with nutrition resulted in significantly higher distress scores compared to patients without these complaints. Individuals with a DT score of 5 or higher (p = 0.006) were advised to seek out psychological support. There is a strong correlation between a high DT score and emotional disorders, as well as physical problems.
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Affiliation(s)
- Juliana-Theresa Schell
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. F. W. Hölzle), RWTH Aachen University, Pauwelstr 30, 52054, Aachen, Germany
| | - Andrea Petermann-Meyer
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Section Psychooncology, Euregionales Comprehensive Cancer Center, RWTH Aachen University, Pauwelstr 30, 52054, Aachen, Germany
| | - Anita Kloss-Brandstätter
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. F. W. Hölzle), RWTH Aachen University, Pauwelstr 30, 52054, Aachen, Germany
| | - Alexander K Bartella
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. F. W. Hölzle), RWTH Aachen University, Pauwelstr 30, 52054, Aachen, Germany
| | - Mohammad Kamal
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. F. W. Hölzle), RWTH Aachen University, Pauwelstr 30, 52054, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. F. W. Hölzle), RWTH Aachen University, Pauwelstr 30, 52054, Aachen, Germany
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. F. W. Hölzle), RWTH Aachen University, Pauwelstr 30, 52054, Aachen, Germany.
| | - Jan Teichmann
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. F. W. Hölzle), RWTH Aachen University, Pauwelstr 30, 52054, Aachen, Germany
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van der Geest I, van Dorp W, Pluijm S, van den Heuvel-Eibrink M. The distress thermometer provides a simple screening tool for selecting distressed childhood cancer survivors. Acta Paediatr 2018; 107:871-874. [PMID: 29385290 DOI: 10.1111/apa.14251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/02/2017] [Accepted: 01/25/2018] [Indexed: 11/27/2022]
Abstract
AIM We investigated the value of the distress thermometer, a one-item screening tool, in childhood cancer survivors. METHODS The participants were 286 childhood cancer survivors who visited an outpatient clinic at Erasmus MC University-Sophia Children's Hospital, Rotterdam, The Netherlands, for the first time from 2001 to 2008 and completed the distress thermometer and Hospital Anxiety and Depression Scale (HADS). Higher scores reflected more distress. A HADS score ≥15 was used as the cut-off point for emotional distress. We calculated the correlation between the HADS and distress thermometer, the relationship between the HADS anxiety and the HADS depression ratings, and the distress score and the sensitivity and specificity for different cut-off scores of the distress thermometer. RESULTS A moderate correlation was found between the HADS score and the distress thermometer (r: 0.56, p < 0.01, interclass correlation 0.40, p < 0.01). In total, 39% of the variability of distress, as measured by the distress thermometer, could be explained by the HADS anxiety and HADS depression ratings. A cut-off score of at least three on the distress thermometer resulted in a sensitivity of 92% and specificity of 79%. CONCLUSION The distress thermometer provided a rapid screening tool for identifying distressed childhood cancer survivors who needed further psychological support.
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Affiliation(s)
- I.M.M. van der Geest
- Department of Paediatric Oncology/Haematology; Erasmus MC University-Sophia Children's Hospital; Rotterdam The Netherlands
- Princess Màxima Center for Paediatric Oncology; Utrecht The Netherlands
| | - W. van Dorp
- Department of Paediatric Oncology/Haematology; Erasmus MC University-Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Obstetrics and Gynaecology; Division of Reproductive Medicine; Erasmus MC University-Medical Center; Rotterdam The Netherlands
| | - S.M.F. Pluijm
- Department of Paediatric Oncology/Haematology; Erasmus MC University-Sophia Children's Hospital; Rotterdam The Netherlands
- Princess Màxima Center for Paediatric Oncology; Utrecht The Netherlands
| | - M.M. van den Heuvel-Eibrink
- Department of Paediatric Oncology/Haematology; Erasmus MC University-Sophia Children's Hospital; Rotterdam The Netherlands
- Princess Màxima Center for Paediatric Oncology; Utrecht The Netherlands
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Biji MS, Dessai S, Sindhu N, Aravind S, Satheesan B. Validation of Malayalam Version of National Comprehensive Cancer Network Distress Thermometer and its Feasibility in Oncology Patients. Indian J Palliat Care 2018; 24:67-71. [PMID: 29440810 PMCID: PMC5801633 DOI: 10.4103/ijpc.ijpc_160_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context This study was designed to translate and validate the National Comprehensive Cancer Network (NCCN) distress thermometer (DT) in regional language " Malayalam" and to see the feasibility of using it in our patients. Aims (1) To translate and validate the NCCN DT. (2) To study the feasibility of using validated Malayalam translated DT in Malabar Cancer center. Settings and Design This is a single-arm prospective observational study. The study was conducted at author's institution between December 8, 2015, and January 20, 2016 in the Department of Cancer Palliative Medicine. Materials and Methods This was a prospective observational study carried out in two phases. In Phase 1, the linguistic validation of the NCCN DT was done. In Phase 2, the feasibility, face validity, and utility of the translated of NCCN DT in accordance with QQ-10 too was done. Statistical Analysis Used SPSS version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.) was used for analysis. Results Ten patients were enrolled in Phase 2. The median age was 51.5 years and 40% of patients were male. All patients had completed at least basic education up to the primary level. The primary site of cancer was heterogeneous. The NCCN DT completion rate was 100%. The face validity, utility, reliability, and feasibility were 100%, 100%, 100%, and 90%, respectively. Conclusion It can be concluded that the Malayalam validated DT has high face validity, utility, and it is feasible for its use.
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Affiliation(s)
- M S Biji
- Department of Palliative Medicine, Malabar Cancer Centre, Kannur, Kerala, India
| | - Sampada Dessai
- Department of Gynecological Oncology, Malabar Cancer Centre, Kannur, Kerala, India
| | - N Sindhu
- Department of Palliative Medicine, Malabar Cancer Centre, Kannur, Kerala, India
| | - Sithara Aravind
- Department of Pathology, Malabar Cancer Centre, Kannur, Kerala, India
| | - B Satheesan
- Department of Surgical Oncology, Malabar Cancer Centre, Kannur, Kerala, India
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22
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Liu F, Huang J, Zhang L, Fan F, Chen J, Xia K, Liu Z. Screening for distress in patients with primary brain tumor using distress thermometer: a systematic review and meta-analysis. BMC Cancer 2018; 18:124. [PMID: 29394923 PMCID: PMC5797347 DOI: 10.1186/s12885-018-3990-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/16/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with primary brain tumors are reported to have an elevated level of distress prevalence, due to the functional sequelae and the unfavorable prognosis, but the estimated prevalence of this disorder varies among studies. The Distress Thermometer (DT) is widely used distress screening tools to identify patients suffering from elevated psychosocial distress. The objective of this meta-analysis is to get a summarized estimate of distress prevalence in adult primary brain tumor patients screened by the DT instrument to identify distress in brain tumor patients. METHOD We searched studies published in PubMed, PsycINFO, and Cochrane library through August 2017 and checked related reviews and meta-analyses for eligible studies. Studies were eligible if they were published in the peer-reviewed literature and evaluated distress level by Distress Thermometer. The prevalence of distress symptoms in patients with the intracranial tumor was estimated by study-level characteristics using stratified meta-analysis. The prevalence of distress level or symptoms during the follow-up examination at different time points was detected by secondary analysis of the longitudinal studies included. RESULTS Twelve studies including a total of 2145 brain tumor patients were included in this analysis. Eight used a cross-sectional design and four were longitudinal. The pooled prevalence of distress was 38.2% (95% confidence interval (CI) 28.7%-47.7%) for the overall sample. The pooled prevalence of distress DT ≥4 was 41.1% (642/1686, 95% CI 28.6%-53.5%) and the pooled prevalence of distress by DT ≥6 was 29.7% (137/459, 95% CI 19.5%-39.9%). The distress symptom did not decrease in follow-up studies (Relative Increase Ratio:1.02, 95% CI, (0.78, 1.35)). A huge heterogeneity in different studies was detected, and different screening scales were not compared. CONCLUSION The high prevalence of distress becomes an enormous challenge for primary brain tumor patients. Routine screening and evaluation of distress in brain tumor patients may assist medical workers to develop proper interventions, which may lead to better quality of life and oncology management.
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Affiliation(s)
- Fangkun Liu
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Jing Huang
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.,Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (xiangya), Changsha, Hunan, 410011, China
| | - Liyang Zhang
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Fan Fan
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China
| | - Jindong Chen
- Department of Psychiatry, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.,Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (xiangya), Changsha, Hunan, 410011, China
| | - Kun Xia
- The State Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Zhixiong Liu
- Department of neurosurgery, Xiangya Hospital, Central South University (CSU), Changsha, China.
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23
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Ghazali N, Roe B, Lowe D, Tandon S, Jones T, Brown J, Shaw R, Risk J, Rogers SN. Screening for distress using the distress thermometer and the University of Washington Quality of Life in post-treatment head and neck cancer survivors. Eur Arch Otorhinolaryngol 2017; 274:2253-2260. [PMID: 28168421 DOI: 10.1007/s00405-017-4474-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/18/2017] [Indexed: 03/04/2023]
Abstract
The primary aim was to determine the efficacy of the Distress Thermometer (DT) in screening for anxiety and mood problems against the University of Washington Quality of Life, version 4 (UWQOL). Secondary aims were to evaluate the association between demographic, clinical and health-related QOL variables with significant distress. Two hundred and sixty one disease-free HNC ambulatory patients attending routine follow-up clinics were prospectively recruited. Both DT and UWQOL were completed pre-consultation. Receiver operating characteristic (ROC) curve analyses of DT score for anxiety dysfunction yielded an area under the curve (AUC) of 0.877, with a sensitivity of 84% (43/51) and specificity of 76% (159/210) for a DT cut-off of ≥4; with a corresponding AUC of 0.825 for mood with sensitivity 78% (28/36) and specificity 71% (159/225). Treatment with radiotherapy and a longer consultation time were associated with significant distress (DT ≥4). Significant distress was also reported in two third of those reporting less than "Good" overall QOL. Distress levels were particularly associated with poor Social-Emotional function, more so than the association seen with poor physical function. DT is a reasonable screening tool for distress in the HNC population. The DT cut-off score ≥4 was effective in identifying those with significant distress. Significant distress is associated in survivors with poor health-related quality of life, those who received radiotherapy and patients who have longer consultation times in clinic.
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Affiliation(s)
- Naseem Ghazali
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. .,Regional Maxillofacial Unit, Aintree University Hospitals NHS Trust, Lower Lane, Liverpool, L9 7AL, UK.
| | - Brenda Roe
- Faculty of Health and Social Care, Evidence-Based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Derek Lowe
- Regional Maxillofacial Unit, Aintree University Hospitals NHS Trust, Lower Lane, Liverpool, L9 7AL, UK.,Faculty of Health and Social Care, Evidence-Based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Sank Tandon
- ENT Unit, Aintree University Hospitals NHS Trust, Liverpool, UK
| | - Terry Jones
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,ENT Unit, Aintree University Hospitals NHS Trust, Liverpool, UK
| | - James Brown
- Regional Maxillofacial Unit, Aintree University Hospitals NHS Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Richard Shaw
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Regional Maxillofacial Unit, Aintree University Hospitals NHS Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Janet Risk
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Simon N Rogers
- Regional Maxillofacial Unit, Aintree University Hospitals NHS Trust, Lower Lane, Liverpool, L9 7AL, UK.,Faculty of Health and Social Care, Evidence-Based Practice Research Centre, Edge Hill University, Ormskirk, UK
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24
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Musiello T, Dixon G, O'Connor M, Cook D, Miller L, Petterson A, Saunders C, Joske D, Johnson C. A pilot study of routine screening for distress by a nurse and psychologist in an outpatient haematological oncology clinic. Appl Nurs Res 2016; 33:15-18. [PMID: 28096010 DOI: 10.1016/j.apnr.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/28/2016] [Accepted: 09/22/2016] [Indexed: 10/21/2022]
Abstract
AIM To explore the: 1) prevalence of distress, type of problems experienced by haematological patients, and referrals for supportive care; 2) effect of demographic and clinical variables on distress, and 3) effect on the time of health professionals conducting the screening in the ambulatory chemotherapy setting. METHODS Participants completed the National Comprehensive Cancer Network Distress Thermometer and Problem List and had a follow-up screening discussion with a health professional. RESULTS Of 68 participants, 40% reported significant distress (≥4) on the Distress Thermometer (mean 3.2, SD 2.4). All patients reported physical problems and 72% reported emotional problems-the major contributors to distress and to time spent with the health professional. Distress was unrelated to age, gender or cancer type. Patients were less likely to have significant distress at the end of treatment than at the beginning (OR=0.15, 95% CI: 0.03; 0.72,). Forty patients (59%) were referred to supportive services. The psychologist spent less time with patients compared to the nurse (18 vs 48min, p<0.001). The more emotional problems reported, the greater the time spent with the patient (rs=0.34, p=0.009). CONCLUSIONS Nurses can appropriately screen for distress and address significant distress reported by haematology patients undergoing chemotherapy without over burdening the nurse or patient.
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Affiliation(s)
- Toni Musiello
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Glenys Dixon
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Kent St, Bentley, Western Australia 6102, Australia
| | - Deb Cook
- Department of Haematology, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Lisa Miller
- Department of Psychiatry, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Anna Petterson
- SolarisCare, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Christobel Saunders
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - David Joske
- Department of Haematology, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia; SolarisCare, Sir Charles Gairdner Hospital, 1 Hospital Ave, Nedlands, Western Australia 6009, Australia
| | - Claire Johnson
- School of Surgery, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
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25
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Lo-Fo-Wong DNN, de Haes HCJM, Aaronson NK, van Abbema DL, den Boer MD, van Hezewijk M, Immink M, Kaptein AA, Menke-Pluijmers MBE, Reyners AKL, Russell NS, Schriek M, Sijtsema S, van Tienhoven G, Sprangers MAG. Predictors of enduring clinical distress in women with breast cancer. Breast Cancer Res Treat 2016; 158:563-72. [PMID: 27417105 PMCID: PMC4963436 DOI: 10.1007/s10549-016-3896-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/02/2016] [Indexed: 10/25/2022]
Abstract
To date, little is known about enduring clinical distress as measured with the commonly used distress thermometer. We therefore used the distress thermometer to examine: (a) the prevalence of enduring clinical distress, distress-related problems, and subsequent wish for referral of women with breast cancer, and (b) sociodemographic, clinical, and psychosocial predictors of enduring clinical distress. The study had a multicenter, prospective, observational design. Patients with primary breast cancer completed a questionnaire at 6 and 15 months postdiagnosis. Medical data were retrieved from chart reviews. Enduring clinical distress was defined as heightened distress levels over time. The prevalence of enduring clinical distress, problems, and wish for referral was examined with descriptive analyses. Associations between predictors and enduring clinical distress were examined with multivariate analyses. One hundred sixty-four of 746 patients (22 %) reported having enduring clinical distress at 6 and 15 months postdiagnosis. Of these, 10 % wanted to be referred for care. Fatigue was the most frequently reported problem by patients with and without clinical distress, at both time points. Lack of muscle strength (OR = 1.82, 95 % CI 1.12-2.98), experience of a low level of life satisfaction (OR = 0.77, 95 % CI 0.67-0.89), more frequent cancer worry (OR = 1.40, 95 % CI 1.05-1.89), and neuroticism (OR = 1.09, 95 % CI 1.00-1.18) were predictors of enduring clinical distress. In conclusion, one in five women with breast cancer develops enduring clinical distress. Oncologists, nurse practitioners, and cancer nurses are advised to use single-item questions about distress and distress-related problems to ensure timely detection of high-risk patients. Providers should also routinely assess fatigue and its causes, as fatigue is the most frequently reported distress-related problem over time.
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Affiliation(s)
- Deborah N N Lo-Fo-Wong
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands.
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
| | - Neil K Aaronson
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Doris L van Abbema
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Mathilda D den Boer
- Erasmus MC - Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - Marjan van Hezewijk
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Marcelle Immink
- Reinier de Graaf Hospital, Reinier de Graafweg 3-11, 2625 AD, Delft, The Netherlands
| | - Ad A Kaptein
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | | | - Anna K L Reyners
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Nicola S Russell
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Manon Schriek
- St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Sieta Sijtsema
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Geertjan van Tienhoven
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, The Netherlands
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26
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Ploos van Amstel FK, Prins JB, van der Graaf WTA, Peters MEWJ, Ottevanger PB. The effectiveness of a nurse-led intervention with the distress thermometer for patients treated with curative intent for breast cancer: design of a randomized controlled trial. BMC Cancer 2016; 16:520. [PMID: 27455960 PMCID: PMC4960715 DOI: 10.1186/s12885-016-2565-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 07/14/2016] [Indexed: 12/14/2022] Open
Abstract
Background Distress in patients with cancer influences their quality of life. Worldwide, screening on distress with the Distress Thermometer (DT) in patients with cancer is recommended. However, the effects of the use of the DT on the psychosocial wellbeing of the patient are unknown. A study to assess the psychosocial consequences of the systematic use of the DT and its discussion by a nurse as compared to the usual care provided to outpatients who are treated for primary breast cancer is needed. Methods/design The effectiveness of a nurse-led intervention with the DT will be tested in a non-blinded randomized controlled trial. Patients treated with curative intent for breast cancer will be recruited from the Radboud University Medical Center. The intervention consists of the DT together with discussion of the results with the patient by a trained oncology nurse added to the usual care. Patients will be randomly allocated (1:1) to either receive usual care or the usual care plus the intervention. Primary outcome measure is global quality of life measured with the EORTC QLQ-C30. The functional and symptom scales of the EORTC QLQ-C30 and BR23, Hospital Anxiety and Depression Scale, Impact of Event Scale, Illness Cognition Questionnaire and DT (baseline and final measurement only) will be used to measure secondary outcomes. Questionnaires are obtained in both arms at baseline, after completion of each type of cancer treatment modality and during follow up, with a three and six months’ interval during the first and second year respectively. Discussion This study will be the first randomized controlled longitudinal study about the effectiveness of the DT as nurse led-intervention. In case of proven effectiveness, future implementation and standardization of use of the DT as part of routine care will be recommended. Trial registration This study is registered at clinicaltrial.gov march 17, 2010 (NCT01091584).
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Affiliation(s)
- Floortje K Ploos van Amstel
- Department of Medical Oncology, Radboud University Medical Center, P.O. Box 9101, 6500, Nijmegen, The Netherlands.
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, P.O. Box 9101, 6500, Nijmegen, The Netherlands.,Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Marlies E W J Peters
- Department of Medical Oncology, Radboud University Medical Center, P.O. Box 9101, 6500, Nijmegen, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, P.O. Box 9101, 6500, Nijmegen, The Netherlands
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27
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Saeedi-Saedi H, Shahidsales S, Koochak-Pour M, Sabahi E, Moridi I. Evaluation of emotional distress in breast cancer patients. Iran J Cancer Prev 2015; 8:36-41. [PMID: 25821569 PMCID: PMC4360349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cancer has been known as a class of dangerous diseases which cause tremendous physical and emotional problems to both patients and their families. In spite of medical advances, cancer is still considered to be equal with death and pain. This study aims to analyze the emotional distress and the causes in breast cancer patients. METHODS This study was a quantitative study which tries to analyze the emotional distress in 82 breast cancer patients referred to the Radiotherapy and Oncology Department of Razi Hospital in Rasht, northern Iran. In this study, the emotional distress is analyzed based on a standard questionnaire which contains demographic information, distress thermometer, and a section devoted to the probable causes. RESULTS Among the 82 patients that participated in this study, 32 patients (39%) suffered from severe emotional distress which had a statistically significant relationship (p<0.009) with the functional status of the patients. Taking care of children, fear, anxiety, difficulties of taking bath and wearing clothes, family problems, fever and nasal dryness are the most common issued related to emotional distress. CONCLUSION Emotional distress can affect the quality of life of breast cancer patients. Therefore, oncology specialists should utilize mental health services to improve their patients' mental health as well as to control the consequences of the disease.
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Affiliation(s)
- Hamid Saeedi-Saedi
- Dept. of Radiation Oncology, Cancer Research Center, Gilan University of Medical Sciences, Gilan, Iran
| | - Soodabeh Shahidsales
- Cancer Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Corresponding Author:
Soodabeh Shahidsales, PhD;
Assistant professor of Radiation Oncology
Tel: (+98) 9153160721
| | - Mona Koochak-Pour
- Dept. of Internal Medicine, Gilan University of Medical Sciences, Gilan, Iran
| | - Emad Sabahi
- Dept. of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Irene Moridi
- Cancer Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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28
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Badr H, Gupta V, Sikora A, Posner M. Psychological distress in patients and caregivers over the course of radiotherapy for head and neck cancer. Oral Oncol 2014; 50:1005-11. [PMID: 25091150 DOI: 10.1016/j.oraloncology.2014.07.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Head and neck cancer patients and their caregivers report high rates of psychological distress. High rates of physical symptom burden and the increased need for family members to provide caregiving during treatment may contribute to this distress. METHODS This study examined trajectories of patient and caregiver distress over the course of radiotherapy for head and neck cancer as well as how patients and caregivers influence each other's distress. Forty-nine head and neck cancer patient-caregiver dyads completed 6 weekly assessments of physical symptoms (MDASI-HN) and distress (e.g., NCCN distress thermometer) over the course of radiotherapy. RESULTS Patient and caregiver distress increased steadily over the course of treatment, peaking at week 5; patients (82% male; 69% Stage 4) and caregivers (90% female) reported significant distress in 77% of cases. Linear mixed models with the patient-caregiver dyad as the unit of analysis showed that increases in patient-rated head and neck specific physical symptoms had a significant (p<.05) time-varying effect on both patient and caregiver distress. Increases in one dyad member's distress levels were also significantly associated with decreases in the other's distress levels over time. CONCLUSION Findings highlight the adverse impact of patient physical symptoms during radiotherapy on both patient and caregiver distress. They also support a dyadic coping model whereby patients and caregivers manage their distress together as a unit. Overall, dyadic supportive care interventions that focus on controlling patient physical symptoms and that address both patient and caregiver distress are sorely needed in head and neck cancer.
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Affiliation(s)
- Hoda Badr
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew Sikora
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marshall Posner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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29
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Tang LL, Zhang YN, Pang Y, Zhang HW, Song LL. Validation and reliability of distress thermometer in chinese cancer patients. Chin J Cancer Res 2011; 23:54-8. [PMID: 23467708 PMCID: PMC3587535 DOI: 10.1007/s11670-011-0054-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To examine the validation and reliability of the distress thermometer (DT) recommended by National Comprehensive Cancer Network (NCCN) in Chinese cancer patients. METHODS A total of 574 Chinese cancer patients from Beijing Cancer Hospital completed the detection of DT, the Hospital Anxiety and Depression Scale (HADS) and Symptom Checklist 90 (SCL-90), Receiver Operating Characteristic (ROC) curve and Area Under the Curve (AUC) were used to analyze the validation relative to HADS and SCL-90. The patients with DT≥4 and whose distress caused by emotional problems were interviewed with the MiNi International Neuro-psychiatric Interview (MINI) (Chinese Version 5.0). This version was used to analyze cancer patients' psychological and Psychiatric symptoms during the cancer process; 3. Another 106 cancer patients in rehabilitation stage and stable condition were asked to fill in DT two times, at the base time and after 7-10 days. RESULTS Data of ROC indicates that a DT cutoff score of 4 yielded AUC of 0.80 with a optimal sensitivity (0.80) and specificity (0.70) relative to HADS, and AUC of 0.83 with the greatest sensitivity (0.87) and specificity (0.72) against SCL-90. The DT also has acceptable test-retest reliability (r=0.800, P=0.000); According to the interview results, the most common psychiatric problems cancer patients have adjustment disorder, depression, and anxiety. CONCLUSION The data suggest that DT has acceptable overall accuracy and reliability as a screening tool for testing distress severity and specific problems causing distress in Chinese cancer patients. It is worth being used in oncology clinic, the rapid screening and interview could help caregivers to identify psychological and psychiatric problems of cancer patients and provide useful information for further treatment.
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Affiliation(s)
- Li-Li Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing 100142, China
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