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Abolfazli P, Apue Nchama CN, Lucke-Wold B. Optimizing chemotherapy outcomes: The role of mindfulness in Epirubicin treatment for urinary tumors. World J Psychiatry 2025; 15:102852. [DOI: 10.5498/wjp.v15.i4.102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 01/21/2025] [Accepted: 02/05/2025] [Indexed: 03/25/2025] Open
Abstract
This manuscript comments on the article published in a recent issue of World Journal of Psychology. We emphasize the potential of combining Epirubicin (EPI) chemotherapy with mindfulness-based interventions (MBIs) to optimize cancer care for urinary system tumors. The long-term use EPI is associated with depression and in short-term has shown side effects such as fatigue, nausea, and occasional abdominal pain, which can impact patient adherence. MBIs address the psychological burdens, such as depression and anxiety, that accompany cancer treatment, enhancing emotional well-being, immune function, and treatment adherence. Integration of MBIs alongside EPI offers improved clinical outcomes by lowering stress and reducing side effects, ultimately supporting both psychological and physical recovery. This comprehensive care model can potentially promote long-term health and quality of life for cancer patients.
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Affiliation(s)
- Pouria Abolfazli
- Health Science Center, Xi'an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | | | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32608, United States
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Anderson D, Vlachostergios PJ, Simpson L, Bruce SS, Fitzpatrick N, Connell J, Christodoulis E, Kamposioras K. A feasibility study of distress screening with psychometric evaluation and referral of cancer patients. Sci Rep 2025; 15:10397. [PMID: 40140408 PMCID: PMC11947445 DOI: 10.1038/s41598-025-94538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 03/14/2025] [Indexed: 03/28/2025] Open
Abstract
To assess for associations of known psychometric scales GAD-7, PHQ-9, pc-PTSD-5 with demographics and clinical characteristics of cancer patients as well as identify their value in screening for distress and in guiding Psycho-Oncology evaluation. This prospective feasibility study employed three psychological testing questionnaires, specifically the GAD-7, PHQ-9, and PC-PTSD-5, for the purpose of distress screening. Patients with a diagnosis of colorectal cancer who scored highly on at least one psychometric scale (defined in previous studies of non-cancer populations as a GAD-7 score of 10 or above, a PHQ-9 score of 10 or above, or a PC-PTSD-5 score of 4 or above) were offered a referral for further assessment in the Psycho-Oncology service and triaged via a semi-structured interview. The relationship between patients' demographics and clinical characteristics and scores and outcomes was evaluated using the chi-square test. Fifty-four patients (30 females) of median age 60 years (range 36-81) were evaluated in the study. Thirty-four patients (63%) scored high on GAD-7, 40 (74%) on PHQ-9, and 8 (15%) on PC-PTSD-5 scales, respectively. Twenty-nine out of the 54 patients who underwent initial assessment with the psychometric scales (53.7%) accepted to be referred to the Psycho-Oncology service and were triaged via semi-structured interview while the rest 25/54 (46.3%) patients declined further assessment. Twenty-two of the patients who were interviewed (76%) required further specialist Psycho-Oncology intervention and the rest were signposted to community services. Patients younger than 65 years of age were more likely to score high according to the GAD-7 tool (p = 0.036). White Caucasian patients tended to score higher in the PHQ-9 questionnaire compared to non-white ones (p = 0.07). Prior history of mental disorder was significantly associated with higher scores in both GAD-7 (p = 0.041) and PC-PTSD-5 tools (p = 0.016). Patients who accepted a referral for psycho-oncology intervention demonstrated statistically elevated levels of anxiety on GAD-7 (p = 0.007) and diminished levels of depression on PHQ-9 (p = 0.042) compared to those who declined the referral. A clinical pathway involving a stepwise approach of psychometric scale evaluation and semi-structured interview can appropriately identify cancer patients with distress requiring further psychological support.
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Affiliation(s)
- Daniel Anderson
- Department of Psycho-Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Panagiotis J Vlachostergios
- Department of Medical Oncology, IASO Thessalias Hospital, Larissa, Greece
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, USA
| | - Lilly Simpson
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Niall Fitzpatrick
- Department of Psycho-Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jacqueline Connell
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Konstantinos Kamposioras
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health The University of Manchester, Manchester, UK.
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Wang SJ, Feng X, Zhang W, Fang H, Jing H, Tang Y, Li T, Qi SN, Song YW, Zhang WW, Lu NN, Tang Y, Liu YP, Chen B, Liu X, Li YX, Zhai YR, Wang SL. Specific types of anxiety regarding radiation therapy in patients with breast cancer: a longitudinal study. Breast Cancer 2025:10.1007/s12282-025-01690-x. [PMID: 40121597 DOI: 10.1007/s12282-025-01690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 03/10/2025] [Indexed: 03/25/2025]
Abstract
PURPOSE The radiotherapy categorical anxiety scale (RCAS) was designed to evaluate the specific types of radiation therapy (RT)-related anxiety in cancer patients. We translated RCAS into Chinese, evaluated its reliability and validity in breast cancer (BC) patients, and used it to evaluate changes in specific types and levels of RT-related anxiety throughout RT. METHODS This was a prospective, longitudinal study enrolling 504 Chinese BC patients receiving RT. The patients completed questionnaires assessing the specific types of RT-related anxiety (our Chinese version of RCAS), depression [Patient Health Questionnaire-9 (PHQ-9)], and anxiety [Generalized Anxiety Disorder-7 (GAD-7)] before, during, and after RT. Emotional distress (ED) was defined as a PHQ-9 or GAD-7 score of > 4. Generalized estimating equation was performed to evaluate changes in total and subscale scores on RCAS. Multivariable general linear models were used to explore independent predictors of baseline RCAS scores. RESULTS Our Chinese version of RCAS demonstrated high internal consistency (Cronbach's α = 0.89-0.92). Our data demonstrated a Kaiser-Meyer-Olkin measure of 0.946 and P < 0.001 on the Bartlett sphericity test, indicating their suitability for subsequent confirmatory factor analysis (CFA). CFA further demonstrated its adequate convergent and discriminant validity. The levels of anxiety related to RT environment decreased over time, whereas those of anxiety related to RT treatment efficacy remained stable throughout the treatment. Patients demonstrated higher scores on items regarding side effects and treatment efficacy of RT than on other items. ED before RT independently predicted for higher baseline RCAS score. CONCLUSIONS Our Chinese version of the RCAS can be used to quantitatively evaluate specific types of RT-related anxiety in Chinese BC patients. Clinicians should pay more attention to anxiety regarding the side effects and treatment efficacy of RT reported by their patients, particularly those with baseline ED.
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Affiliation(s)
- Shi-Jia Wang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xin Feng
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Zhang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hui Fang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hao Jing
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yu Tang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shu-Nan Qi
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yong-Wen Song
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wen-Wen Zhang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning-Ning Lu
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuan Tang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yue-Ping Liu
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bo Chen
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xin Liu
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ye-Xiong Li
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yi-Rui Zhai
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Shu-Lian Wang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Schwartz LF, Shubeck SP, Danielson EC. Young People with Cancer: A Growing Population in Need of United Attention. Curr Oncol Rep 2025:10.1007/s11912-025-01661-7. [PMID: 40106216 DOI: 10.1007/s11912-025-01661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2025] [Indexed: 03/22/2025]
Abstract
Each year, over 84,000 young people in the United States are diagnosed with cancer. These patients face unique burdens that defy historical "adolescent and young adult" and "early-onset cancer" silos. These groups share common vulnerabilities, including financial toxicity, disruptions to education and career development, and inadequate survivorship care. Research efforts to address these shared challenges remain inefficient due to parallel and uncoordinated investigations. Health policy decisions are similarly impacted, with the lack of a unified framework potentially leading to gaps in insurance coverage, disparities in resource allocation, and incomplete data collection on young people diagnosed with cancer. To address these challenges, a collaborative and integrated strategy across clinical care, research, and health policy is urgently needed. By unifying efforts and recognizing the shared experiences of young people with cancer, we can develop more effective support systems, optimize outcomes, and reduce the long-term burden of cancer for this fast-growing and vulnerable population.
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Affiliation(s)
- Lindsay F Schwartz
- Department of Pediatrics, Division of Hematology/Oncology and Stem Cell Transplantation, University of Chicago, 5841 S. Maryland Ave., MC 4060, Chicago, IL, 60637, USA.
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
| | - Sarah P Shubeck
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Elizabeth C Danielson
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
- Department of Surgery, University of Chicago, Chicago, IL, USA
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Jang M, Park J, Han J. Psychosocial programs to alleviate fertility-related distress in patients with cancer: A mixed-methods systematic review. Eur J Oncol Nurs 2025; 74:102787. [PMID: 39826406 DOI: 10.1016/j.ejon.2025.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Revised: 12/22/2024] [Accepted: 01/07/2025] [Indexed: 01/22/2025]
Abstract
PURPOSE This mixed-methods systematic review aimed to identify the key components of psychosocial programs for fertility-related distress in patients with cancer and integrate the findings from quantitative and qualitative studies. METHODS A search for relevant studies published between January 2012 and March 2024 was conducted in the PubMed, EMBASE, CINAHL, MEDLINE, PsycINFO, and Cochrane Review Library databases. Data were synthesized using a sequential descriptive design. RESULTS Eight studies were included: six randomized controlled trials (two of which also included qualitative data) and two qualitative studies. The quantitative data found direct effects such as increased fertility-related knowledge, although the results on psychological outcomes such as anxiety and depression were inconsistent. The qualitative findings confirmed patients' ambivalence about facing their fertility issues, increased knowledge for decision-making, and unmet needs such as information overload and a lack of psychological support. For the cognitive-behavioral outcomes, fertility-related concerns were examined in greater depth in the quantitative studies, whereas the qualitative studies focused more on empowerment. CONCLUSION This review emphasizes the need for the careful design of psychosocial interventions to prevent negative emotional impacts while supporting the long-term self-management of fertility-related issues. Tailoring these interventions to meet the specific needs of patients is essential for improving psychosocial outcomes.
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Affiliation(s)
- Mina Jang
- Chung-Ang University, Red Cross College of Nursing, 84, Heukseok-ro, Dongjak-gu, Seoul, 06974, South Korea
| | - Jinyoung Park
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Jeehee Han
- Chung-Ang University, Red Cross College of Nursing, 84, Heukseok-ro, Dongjak-gu, Seoul, 06974, South Korea.
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Langballe R, Mertz B, Kroman N, Maltesen T, Rosthøj S, Envold Bidstrup P. Are breast cancer patients with low distress at diagnosis at risk of psychological symptoms later in their disease trajectory? Considerations for when to screen for distress. Acta Oncol 2025; 64:105-113. [PMID: 39863933 PMCID: PMC11788679 DOI: 10.2340/1651-226x.2025.42367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 01/09/2025] [Indexed: 01/27/2025]
Abstract
INTRODUCTION To target psychological support to cancer patients most in need of support, screening for psychological distress has been advocated and, in some settings, also implemented. Still, no prior studies have examined the appropriate 'dosage' and whether screening for distress before cancer treatment may be sufficient or if further screenings during treatment are necessary. We examined the development in symptom trajectories for breast cancer patients with low distress before surgery and explored potential risk factors for developing burdensome symptoms at a later point in time. METHODS In total, 299 patients newly diagnosed with breast cancer who scored < 7 on the distress thermometer were included between August 2017 and October 2019 at the Department of Breast Surgery, Rigshospitalet, Copenhagen. Patients were followed through electronic questionnaires at baseline before surgery and after 6, 12, and 18 months. We used latent class mixed models to identify sub-groups of patients with similar development in distress, anxiety, depression, breast cancer-specific health-related quality of life, self-efficacy, and fear of recurrence over time. Logistic and multinomial regression analyses were applied to examine clinical and sociodemographic factors associated with specific symptom trajectories. RESULTS We did not identify any sub-groups of women with low distress at diagnosis who developed disabling psychological symptoms up to 18 months after diagnosis. However, we did identify a sub-group of 52% of the women who experienced persistent mild anxiety (Generalised Anxiety Disorder [GAD]-7 score 5-9). Adjusted for baseline treatment modalities and sociodemographic characteristics, women having low social support (odds ratio [OR]: 2.90; 95% confidence interval [CI]: 1.07-7.87) or living with a partner (OR: 3.18; 95% CI: 1.38-7.34) were more likely to experience persistent mild anxiety. INTERPRETATION The results show that the majority of women with low distress at breast cancer diagnosis do not experience an increase in psychological symptoms over time. Screening for distress at cancer diagnosis may be an essential step to identify most breast cancer patients in need of professional support for psychological symptoms.
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Affiliation(s)
- Rikke Langballe
- Psychological Aspects of Cancer, Cancer Survivorship, The Danish Cancer Institute, Copenhagen, Denmark; Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark.
| | - Birgitte Mertz
- Department of Breast Cancer Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Cancer Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Maltesen
- Statistics and Data Analysis, The Danish Cancer Institute, Copenhagen, Denmark
| | - Susanne Rosthøj
- Statistics and Data Analysis, The Danish Cancer Institute, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Cancer Survivorship, The Danish Cancer Institute, Copenhagen, Denmark
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Luo D, Foster K, White K. Conceptualisation and Measurement of Resilience of Adults With Cancer: An Umbrella Review. J Adv Nurs 2025. [PMID: 39812117 DOI: 10.1111/jan.16724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 12/11/2024] [Accepted: 12/17/2024] [Indexed: 01/16/2025]
Abstract
AIMS To (1) clarify the key components of resilience of adults with cancer; (2) summarise and analyse the resilience measures used in this population; and (3) discuss future evaluation directions. DESIGN An umbrella review. DATA SOURCES MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Cochrane library and Epistemonikos were searched in December 2023. METHODS The Joanna Briggs Institute (JBI) guidelines were followed for undertaking this umbrella review. Systematic and narrative reviews that defined resilience of adults with cancer and reported resilience measures, published in English, were included. The methodological quality was assessed using the JBI appraisal tool. RESULTS Fourteen eligible reviews were included. Four key resilience components from various resilience conceptualisations were identified. Twenty resilience measures were used among cancer patients, with the 25-item Connor-Davidson Resilience Scale providing a relatively comprehensive assessment of individual resilience. Recommended future research with cancer patients includes assessing these resilience components: (1) available individual resources-key psychological factors that enhance individual resilience; (2) access to social resources-close interpersonal relationships, family cohesion and social support; (3) adaptive coping ability-problem-solving skills, emotional management strategies and experiences in managing adversity; (4) ability to regain mental health and well-being-the capacity to recover a relatively stable psychological state and promote positive psychological functioning. CONCLUSION The findings provide evidence for refining future resilience measurement in the adult cancer population. Examining the four key components of resilience with this population across cultures is warranted. IMPACT Understanding the key components of resilience of cancer patients can help healthcare professionals identify individuals who may need further support and facilitate early intervention or referral to psychosocial support services. The 25-item Connor-Davidson Resilience Scale is recommended over other tools for use in the cancer population. PATIENT OR PUBLIC CONTRIBUTION Patient or public involvement is not applicable in this study.
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Affiliation(s)
- Dan Luo
- The Daffodil Centre, Sydney, New South Wales, Australia
- Cancer Care Research Unit, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia
| | - Kim Foster
- National School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kate White
- The Daffodil Centre, Sydney, New South Wales, Australia
- Cancer Care Research Unit, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia
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LePore L, Kronfli D, Baker K, Eggleston C, Schotz K, Kleckner AS, Bentzen SM, Mohindra P, Vyfhuis MA. Identifying Nutritional Inequities of Patients with Cancer Residing in Food Deserts. Adv Radiat Oncol 2025; 10:101641. [PMID: 40017914 PMCID: PMC11867131 DOI: 10.1016/j.adro.2024.101641] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/21/2024] [Indexed: 03/01/2025] Open
Abstract
Purpose Nutrition is essential for cancer care, and patients who reside in food priority areas (FPAs) may experience limited access to healthy meals. There are few data evaluating the consequence of residing in FPAs because it relates to perceived food insecurity, psychosocial needs, or nutritional status of patients with cancer. This study aimed to determine the nutritional and psychosocial needs of patients with cancer who do and do not reside in FPAs. Methods and Materials From May 2019 to December 2022, a cross-sectional analysis was conducted using a validated questionnaire, offered at various time points before and after therapy, evaluating the psychosocial needs of patients with curable cancers. Groups were compared using X2 and Mann-Whitney U tests as appropriate. Binary logistic regression was used to identify predictors of food insecurity. Results Survey compliance was 74% (n = 320 of 434 patients). Patients who resided in FPAs (26%; n = 114) were more likely to self-identify as Black (60.5% vs 39.5%; P < .001), single (70% vs 37%; P < .001), and have a lower median income ($47,225 vs $91,305; P < .001) when compared with non-FPA residents. Residents of FPAs had a higher unmet nutritional needs index (median nutritional unmet needs score: 2.42 vs 2.00; P = .003), which included higher demands for healthier food choices (67.6% vs 54.4; P = .047) and greater food insecurity (44.4% vs 19.9%; P = .002). FPA residence was associated with a 3-fold increased risk of food insecurity (odds ratio [OR], 3.23; 95% confidence interval [CI], 1.59-6.57; P < .001). On multivariate analysis, predictors for food insecurity included Black race (OR, 9.46; 95% CI, 3.93-22.76; P < .001), stage (stage IV vs l OR, 4.27; 95% CI, 1.12-16.34; P = .034), and recurrent disease (OR, 10.26; 95% CI, 2.29-46.09; P = .002). Conclusions Inequities were identified in patients residing in FPAs, where race and higher stage were important predictors of food insecurity. Demographics can be readily used by clinicians to identify high-risk patients early in their cancer care in order to provide continuous nutritional resources to improve food insecurity perceptions. Future prospective studies are needed to confirm if such interventions improve cancer outcomes.
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Affiliation(s)
- Lara LePore
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Dahlia Kronfli
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Kaysee Baker
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Caitlin Eggleston
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - Kaitlin Schotz
- University of Maryland, Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Amber S. Kleckner
- University of Maryland, Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland
| | - Søren M. Bentzen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Epidemiology and Public Health, Biostatistics and Bioinformatics Division, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Pranshu Mohindra
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Melissa A.L. Vyfhuis
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
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Bergerot C, Jacobsen PB, Rosa WE, Lam WWT, Dunn J, Fernández-González L, Mehnert-Theuerkauf A, Veeraiah S, Li M. Global unmet psychosocial needs in cancer care: health policy. EClinicalMedicine 2024; 78:102942. [PMID: 39634034 PMCID: PMC11615525 DOI: 10.1016/j.eclinm.2024.102942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 10/23/2024] [Accepted: 11/01/2024] [Indexed: 12/07/2024] Open
Abstract
Preventable psychosocial suffering is an unmet need in patients with cancer around the world, significantly compromising quality of life and impairing cancer health outcomes. This narrative review overviews the global prevalence of emotional distress and cancer-related needs and the access barriers to psychosocial care. The COVID-19 pandemic has served only to amplify the need for psychosocial care, exacerbating the inadequacy of available psychosocial resources, particularly in low- and middle-income countries. Proposed solutions include implementing routine screening for emotional distress, addressing stigma related to mental health needs, and increased attention to the psychosocial dimensions of cancer care in oncology training and interprofessional models of care. There is an urgent need to address health policy issues such as resource allocation in cancer control plans and to embrace technological innovation in order to fill the universal gaps to providing more equitable psychosocial cancer care. Funding None.
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Affiliation(s)
- Cristiane Bergerot
- Oncoclinicas&Co - Medica Scientia Innovation Research (MEDSIR), Sao Paulo, Brazil
| | - Paul B. Jacobsen
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy Wing Tak Lam
- LKS Faculty of Medicine, School of Public Health, Centre for Psycho-Oncology Research and Training, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jeff Dunn
- Centre for Health Research University of Southern Queensland, Australia
| | | | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, Comprehensive Cancer Center Central Germany (CCCG), University Medical Center Leipzig, Leipzig, Germany
| | - Surendran Veeraiah
- Department of Psycho-Oncology & Resource Centre for Tobacco Control. Cancer Institute, Adyar, Chennai, India
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
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Zebrack B, Schapmire T, Damaskos P, Grignon M, Smith SK. The essential and evolving nature of oncology social work: Accomplishments and impact, 2010-present. J Psychosoc Oncol 2024; 42:739-768. [PMID: 39373332 DOI: 10.1080/07347332.2024.2404577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
This paper demonstrates the essential nature of oncology social work and the critical role that oncology social workers (OSWs) play in the achievement of high-quality cancer care that improves patient outcomes, contains cost, advances population health, reduces provider burn-out among healthcare providers, and does it in a manner that addresses disparities and achieves equity. To this end, this paper's purpose is two-fold: (1) to review and demonstrate OSW contributions to the advancement of comprehensive cancer care over the last 15 years, and (2) to consider next steps for the Association of Oncology Social Work (AOSW) and the Oncology Social Work profession to achieve its mission and calling. To enhance the viability and security of OSWs and the professional organizations that support them, this report summarizes a breadth and depth of work and includes recommendations for the profession.
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Affiliation(s)
- Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Tara Schapmire
- School of Medicine, Division of Palliative Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Penny Damaskos
- Sliver School of Social Work, New York University, New York, New York, USA
- Wurzweiler School of Social Work, Yeshiva University, New York, New York, USA
| | | | - Sophia K Smith
- Duke School of Nursing, Faculty Member, Duke Cancer Institute, Durham, North Carolina, USA
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Pozzar RA, Enzinger AC, Howard C, Tavormina A, Matulonis UA, Campos S, Liu JF, Horowitz N, Konstantinopoulos PA, Krasner C, Wall JA, Sciacca K, Meyer LA, Lindvall C, Wright AA. Feasibility and acceptability of a nurse-led telehealth intervention (BOLSTER) to support patients with peritoneal carcinomatosis and their caregivers: A pilot randomized clinical trial. Gynecol Oncol 2024; 188:1-7. [PMID: 38851039 PMCID: PMC11368606 DOI: 10.1016/j.ygyno.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Patients with advanced gynecologic (GYN) and gastrointestinal (GI) cancers frequently develop peritoneal carcinomatosis (PC), which limits prognosis and diminishes health-related quality of life (HRQoL). Palliative procedures may improve PC symptoms, yet patients and caregivers report feeling unprepared to manage ostomies, catheters, and other complex needs. Our objectives were to (1) assess the feasibility of an efficacy trial of a nurse-led telehealth intervention (BOLSTER) for patients with PC and their caregivers; and (2) assess BOLSTER's acceptability, potential to improve patients' HRQoL and self-efficacy, and potential impact on advance care planning (ACP). METHODS Pilot feasibility RCT. Recently hospitalized adults with advanced GYN and GI cancers, PC, and a new complex care need and their caregivers were randomized 1:1 to BOLSTER or enhanced discharge planning (EDP). We defined feasibility as a ≥ 50% approach-to-consent ratio and acceptability as ≥70% satisfaction with BOLSTER. We assessed patients' HRQoL and self-efficacy at baseline and six weeks, then compared the proportion experiencing meaningful improvements by arm. ACP documentation was identified using natural language processing. RESULTS We consented 77% of approached patients. In the BOLSTER arm, 91.0% of patients and 100.0% of caregivers were satisfied. Compared to EDP, more patients receiving BOLSTER experienced improvements in HRQoL (68.4% vs. 40.0%) and self-efficacy for managing symptoms (78.9% vs. 35.0%) and treatment (52.9% vs. 42.9%). The BOLSTER arm had more ACP documentation. CONCLUSIONS BOLSTER is a feasible and acceptable intervention with the potential to improve patients' HRQoL and promote ACP. An efficacy trial comparing BOLSTER to usual care is underway. TRIAL REGISTRATION ClinicalTrials.gov: NCT03367247; PI: Wright.
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Affiliation(s)
- Rachel A Pozzar
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Andrea C Enzinger
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | | | - Ursula A Matulonis
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Susana Campos
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Joyce F Liu
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Neil Horowitz
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | - Carolyn Krasner
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jaclyn A Wall
- University of Alabama, Birmingham, AL, United States
| | - Kate Sciacca
- Dana Farber Cancer Institute, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States
| | - Larissa A Meyer
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Charlotta Lindvall
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States
| | - Alexi A Wright
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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12
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Baik SH, Clark K, Sanchez M, Loscalzo M, Celis A, Razavi M, Yang D, Dale W, Haas N. Usability and Preliminary Efficacy of an Adaptive Supportive Care System for Patients With Cancer: Pilot Randomized Controlled Trial. JMIR Cancer 2024; 10:e49703. [PMID: 38986134 PMCID: PMC11269963 DOI: 10.2196/49703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/22/2023] [Accepted: 03/21/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Using an iterative user-centered design process, our team developed a patient-centered adaptive supportive care system, PatientCareAnywhere, that provides comprehensive biopsychosocial screening and supportive cancer care to patients across the continuum of care adaptively. The overarching goal of PatientCareAnywhere is to improve health-related quality of life (HRQOL) and self-efficacy of patients with cancer by empowering them with self-management skills and bringing cancer care support directly to them at home. Such support is adaptive to the patient's needs and health status and coordinated across multiple sources in the forms of referrals, education, engagement of community resources, and secure social communication. OBJECTIVE This study aims to assess the usability of the new web-based PatientCareAnywhere system and examine the preliminary efficacy of PatientCareAnywhere to improve patient-reported outcomes compared with usual care. METHODS For phase 1, usability testing participants included patients with cancer (n=4) and caregivers (n=7) who evaluated the software prototype and provided qualitative (eg, interviews) and quantitative (eg, System Usability Scale) feedback. For phase 2, participants in the 3-month pilot randomized controlled trial were randomized to receive the PatientCareAnywhere intervention (n=36) or usual care control condition (n=36). HRQOL and cancer-relevant self-efficacy were assessed at baseline (preintervention assessment) and 12 weeks from baseline (postintervention assessment); mean differences between pre- and postintervention scores were compared between the 2 groups. RESULTS Participants were highly satisfied with the prototype and reported above-average acceptable usability, with a mean System Usability Scale score of 84.09 (SD 10.02). Qualitative data supported the overall usability and perceived usefulness of the intervention, with a few design features (eg, "help request" function) added based on participant feedback. With regard to the randomized controlled trial, patients in the intervention group reported significant improvements in HRQOL from pre- to postintervention scores (mean difference 6.08, SD 15.26) compared with the control group (mean difference -2.95, SD 10.63; P=.01). In contrast, there was no significant between-group difference in self-efficacy (P=.09). CONCLUSIONS Overall, PatientCareAnywhere represents a user-friendly, functional, and acceptable supportive care intervention with preliminary efficacy to improve HRQOL among patients diagnosed with cancer. Future studies are needed to further establish the efficacy of PatientCareAnywhere as well as explore strategies to enhance user engagement and investigate the optimal intensity, frequency, and use of the intervention to improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02408406; https://clinicaltrials.gov/study/NCT02408406.
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Affiliation(s)
- Sharon H Baik
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Karen Clark
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Marisol Sanchez
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Ashley Celis
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Marianne Razavi
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | | | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Niina Haas
- BrightOutcome, Buffalo Grove, IL, United States
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13
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Stevens JM, Montgomery K, Miller M, Saeidzadeh S, Kwekkeboom KL. Common patient-reported sources of cancer-related distress in adults with cancer: A systematic review. Cancer Med 2024; 13:e7450. [PMID: 38989923 PMCID: PMC11238242 DOI: 10.1002/cam4.7450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Cancer-related distress (CRD) is widely experienced by people with cancer and is associated with poor outcomes. CRD screening is a recommended practice; however, CRD remains under-treated due to limited resources targeting unique sources (problems) contributing to CRD. Understanding which sources of CRD are most commonly reported will allow allocation of resources including equipping healthcare providers for intervention. METHODS We conducted a systematic review to describe the frequency of patient-reported sources of CRD and to identify relationships with CRD severity, demographics, and clinical characteristics. We included empirical studies that screened adults with cancer using the NCCN or similar problem list. Most and least common sources of CRD were identified using weighted proportions computed across studies. Relationships between sources of CRD and CRD severity, demographics, and clinical characteristics were summarized narratively. RESULTS Forty-eight studies were included. The most frequent sources of CRD were worry (55%), fatigue (54%), fears (45%), sadness (44%), pain (41%), and sleep disturbance (40%). Having enough food (0%), substance abuse (3%), childbearing ability (5%), fevers (5%), and spiritual concerns (5%) were infrequently reported. Sources of CRD were related to CRD severity, sex, age, race, marital status, income, education, rurality, treatment type, cancer grade, performance status, and timing of screening. CONCLUSIONS Sources of CRD were most frequently emotional and physical, and resources should be targeted to these sources. Relationships between sources of CRD and demographic and clinical variables may suggest profiles of patient subgroups that share similar sources of CRD. Further investigation is necessary to direct intervention development and testing.
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Affiliation(s)
- Jennifer M Stevens
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Megan Miller
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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14
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Negahdary M. Role of miRNA-21 in cancer and its application in electrochemical bioanalysis. Bioanalysis 2024; 16:997-1000. [PMID: 38949192 PMCID: PMC11581167 DOI: 10.1080/17576180.2024.2368340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- Masoud Negahdary
- Department of Biomedical Engineering, Texas A&M University, 600 Discovery Drive, College Station, TX77840-3006, USA
- Center for Remote Health Technologies & Systems, Texas A&M Engineering Experiment Station, 600 Discovery Drive, College Station, TX77840-3006, USA
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15
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Zeng Y, Hu CH, Li YZ, Zhou JS, Wang SX, Liu MD, Qiu ZH, Deng C, Ma F, Xia CF, Liang F, Peng YR, Liang AX, Shi SH, Yao SJ, Liu JQ, Xiao WJ, Lin XQ, Tian XY, Zhang YZ, Tian ZY, Zou JA, Li YS, Xiao CY, Xu T, Zhang XJ, Wang XP, Liu XL, Wu F. Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer. Nat Med 2024; 30:1680-1688. [PMID: 38740994 PMCID: PMC11186781 DOI: 10.1038/s41591-024-02929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/18/2024] [Indexed: 05/16/2024]
Abstract
Emotional distress (ED), commonly characterized by symptoms of depression and/or anxiety, is prevalent in patients with cancer. Preclinical studies suggest that ED can impair antitumor immune responses, but few clinical studies have explored its relationship with response to immune checkpoint inhibitors (ICIs). Here we report results from cohort 1 of the prospective observational STRESS-LUNG study, which investigated the association between ED and clinical efficacy of first-line treatment of ICIs in patients with advanced non-small-cell lung cancer. ED was assessed by Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scale. The study included 227 patients with 111 (48.9%) exhibiting ED who presented depression (Patient Health Questionnaire-9 score ≥5) and/or anxiety (Generalized Anxiety Disorder 7-item score ≥5) symptoms at baseline. On the primary endpoint analysis, patients with baseline ED exhibited a significantly shorter median progression-free survival compared with those without ED (7.9 months versus 15.5 months, hazard ratio 1.73, 95% confidence interval 1.23 to 2.43, P = 0.002). On the secondary endpoint analysis, ED was associated with lower objective response rate (46.8% versus 62.1%, odds ratio 0.54, P = 0.022), reduced 2-year overall survival rate of 46.5% versus 64.9% (hazard ratio for death 1.82, 95% confidence interval 1.12 to 2.97, P = 0.016) and detriments in quality of life. The exploratory analysis indicated that the ED group showed elevated blood cortisol levels, which was associated with adverse survival outcomes. This study suggests that there is an association between ED and worse clinical outcomes in patients with advanced non-small-cell lung cancer treated with ICIs, highlighting the potential significance of addressing ED in cancer management. ClinicalTrials.gov registration: NCT05477979 .
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Affiliation(s)
- Yue Zeng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chun-Hong Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Cancer Mega-Data Intelligent Application and Engineering Research Centre, Changsha, China
| | - Yi-Zheng Li
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Molecular Radiation Oncology Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Jian-Song Zhou
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shu-Xing Wang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Meng-Dong Liu
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Zhen-Hua Qiu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao Deng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Ma
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chun-Fang Xia
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu-Rong Peng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ao-Xi Liang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sheng-Hao Shi
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shi-Jiao Yao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun-Qi Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Jie Xiao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiao-Qiao Lin
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Xin-Yu Tian
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Ying-Zhe Zhang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhuo-Ying Tian
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ji-An Zou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yun-Shu Li
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Chao-Yue Xiao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tian Xu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Jie Zhang
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiao-Ping Wang
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xian-Ling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.
- Hunan Cancer Mega-Data Intelligent Application and Engineering Research Centre, Changsha, China.
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
- Hunan Key Laboratory of Early Diagnosis and Precision Therapy in Lung Cancer, The Second Xiangya Hospital, Central South University, Changsha, China.
- FuRong Laboratory, Changsha, China.
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16
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Kang D, Kim N, Kim H, Lee AY, Park J, Kim S, Ahn JS, Shim YM, Cho J. Emulating trial to evaluate the effectiveness of routine supportive care on mortality among cancer patients experiencing distress at the time of diagnosis. J Affect Disord 2024; 354:519-525. [PMID: 38484885 DOI: 10.1016/j.jad.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Few studies have evaluated the effectiveness of interventions for distress during cancer diagnosis on clinical outcomes in a real-world setting. We aimed to evaluate whether routine information and psychosocial support to patients experiencing distress at the time of diagnosis could decrease the risk of mortality within 1 and 3 years after diagnosis. MATERIAL AND METHODS We conducted a retrospective cohort study of 4880 newly diagnosed cancer patients who reported distress scores of ≥4 using the tablet or kiosk-based screening between July 2014 and December 2017 at a university-affiliated cancer center in Seoul, South Korea. We performed an emulated target trial with two groups: those that received information and psychosocial support and those that did not. Cox proportional hazards models were used to identify the associations between information and psychosocial support and all-cause mortality. RESULTS Of all the patients, 16.6 % had routine information and psychosocial support. The hazard ratio (HR) for one-year mortality comparing participants with information and psychosocial support to those without it were 0.73 (95 % confidence interval (CI) = 0.54, 0.99). Age < 50 and 50 - <60 group had a stronger effect of information and psychosocial support on reducing mortality within one-year than these in age ≥ 60 (p for interaction = 0.03). In terms of three-year mortality, the HR comparing participants with information and psychosocial support to those without it was 0.93 (95 % CI = 0.76, 1.14). CONCLUSION This large-scale real-world study suggests that timely psychosocial care benefits newly diagnosed cancer patients who had distress during pre-treatment period.
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Affiliation(s)
- Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Nayoen Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hoyoung Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - A Young Lee
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Joungwon Park
- Division of Social Work, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sooyeon Kim
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jin Seok Ahn
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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17
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Gudenkauf LM, Fox RS, Gonzalez BD, Jim HSL, Salsman JM, Victorson DE, Sanford SD, Oswald LB. Need for Behavioral Interventions for Young Adults Living with Advanced Cancer in the U.S. Cancers (Basel) 2024; 16:1910. [PMID: 38791988 PMCID: PMC11120301 DOI: 10.3390/cancers16101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
The population of young adults (YAs) aged 18-39 living with advanced cancer is growing and faces a compounded set of challenges at the intersection of age and disease. Despite these substantial challenges, behavioral interventions tailored to YAs living with advanced cancer remain scarce. This commentary aims to (1) discuss the unmet psychological, social, and behavioral needs of YAs living with advanced cancer; (2) highlight the paucity of behavioral interventions tailored to this growing population; (3) offer recommendations for the development of behavioral interventions targeting the unique needs of YAs living with advanced cancer; and (4) describe potential far-reaching public health benefits of these targeted behavioral interventions.
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Affiliation(s)
- Lisa M. Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33216, USA
| | - Rina S. Fox
- Division of Advanced Nursing Practice and Science, University of Arizona College of Nursing, Tucson, AZ 85721, USA
- Cancer Prevention and Control Program, University of Arizona Cancer Center, Tucson, AZ 85719, USA
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33216, USA
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33216, USA
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - David E. Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Cancer Control and Survivorship Program, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Stacy D. Sanford
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Cancer Control and Survivorship Program, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33216, USA
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18
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Quaidoo TG, Adu B, Iddrisu M, Osei-Tutu F, Baaba C, Quiadoo Y, Poku CA. Unlocking timely palliative care: assessing referral practices and barriers at a ghanaian teaching hospital. BMC Palliat Care 2024; 23:90. [PMID: 38575917 PMCID: PMC10996152 DOI: 10.1186/s12904-024-01411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The need for primary care physicians to be heavily involved in the provision of palliative care is growing. International agencies and practice standards advocate for early palliative care and the use of specialized palliative care services for patients with life-threatening illnesses. This study was conducted to investigate physicians' referral practices and perceived barriers to timely referral at the Korle Bu Teaching Hospital. METHODS A cross-sectional study design was employed using a convenience sampling technique to recruit 153 physicians for the study. Data on socio-demography, referral practices, timing and perceived barriers were collected using a structured questionnaire. Binary Logistic regression using crude and adjusted odds was performed to determine the factors associated with late referral. Significance was set at p < 0.05. RESULTS The prevalence of late referral was reported to be 68.0%. There were poor referral practices among physicians to palliative care services, and the major barriers to late referral were attributed to the perception that referring to a palliative care specialist means that the physician has abandoned his patient and family members' decisions and physicians' personnel choices or opinions on palliative care. CONCLUSION The healthcare system needs tailored interventions targeted at improving physicians' knowledge and communication strategies, as well as tackling systemic deficiencies to facilitate early and appropriate palliative care referrals. It is recommended that educational programs be implemented, palliative care training be integrated into medical curricula and culturally sensitive approaches be developed to address misconceptions surrounding end-of-life care.
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Affiliation(s)
| | - Barbara Adu
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Merri Iddrisu
- School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | | | | | - Yekua Quiadoo
- Department of Humanity, University of Ghana, Legon, Ghana
| | - Collins Atta Poku
- School of Nursing and Midwifery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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19
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Russell KB, Forbes C, Qi S, Link C, Watson L, Deiure A, Lu S, Silvius J, Kelly B, Bultz BD, Schulte F. End-of-Life Symptom Burden among Patients with Cancer Who Were Provided Medical Assistance in Dying (MAID): A Longitudinal Propensity-Score-Matched Cohort Study. Cancers (Basel) 2024; 16:1294. [PMID: 38610971 PMCID: PMC11011194 DOI: 10.3390/cancers16071294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer is the primary underlying condition for most Canadians who are provided Medical Assistance in Dying (MAID). However, it is unknown whether cancer patients who are provided MAID experience disproportionally higher symptom burden compared to those who are not provided MAID. Thus, we used a propensity-score-matched cohort design to evaluate longitudinal symptom trajectories over the last 12 months of patients' lives, comparing cancer patients in Alberta who were and were not provided MAID. We utilized routinely collected retrospective Patient-Reported Outcomes (PROs) data from the Edmonton Symptom Assessment System (ESAS-r) reported by Albertans with cancer who died between July 2017 and January 2019. The data were analyzed using mixed-effect models for repeated measures to compare differences in symptom trajectories between the cohorts over time. Both cohorts experienced increasing severity in all symptoms in the year prior to death (β from 0.086 to 0.231, p ≤ .001 to .002). Those in the MAID cohort reported significantly greater anxiety (β = -0.831, p = .044) and greater lack of appetite (β = -0.934, p = .039) compared to those in the non-MAID cohort. The majority (65.8%) of patients who received MAID submitted their request for MAID within one month of their death. Overall, the MAID patients did not experience disproportionally higher symptom burden. These results emphasize opportunities to address patient suffering for all patients with cancer through routine collection of PROs as well as targeted and early palliative approaches to care.
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Affiliation(s)
- K. Brooke Russell
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Caitlin Forbes
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.F.); (B.K.); (B.D.B.)
| | - Siwei Qi
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C1, Canada; (S.Q.); (C.L.); (L.W.); (A.D.)
| | - Claire Link
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C1, Canada; (S.Q.); (C.L.); (L.W.); (A.D.)
| | - Linda Watson
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C1, Canada; (S.Q.); (C.L.); (L.W.); (A.D.)
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Andrea Deiure
- Applied Research and Patient Experience, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C1, Canada; (S.Q.); (C.L.); (L.W.); (A.D.)
| | - Shuang Lu
- Surveillance and Reporting, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
| | - James Silvius
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Provincial Seniors Health and Continuing Care, Alberta Health Services, Calgary, Alberta T2W 1S7, Canada
| | - Brian Kelly
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.F.); (B.K.); (B.D.B.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Barry D. Bultz
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.F.); (B.K.); (B.D.B.)
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.F.); (B.K.); (B.D.B.)
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20
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Seib C, Harbeck E, Anderson D, Porter-Steele J, Nehill C, Sanmugarajah J, Perrin L, Shannon C, Cabraal N, Jennings B, Otton G, Adams C, Mellon A, Chambers S. Establishing the sensitivity and specificity of the gynaecological cancer distress screen. Psychooncology 2024; 33:e6328. [PMID: 38504431 DOI: 10.1002/pon.6328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/08/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Nuanced distress screening tools can help cancer care services manage specific cancer groups' concerns more efficiently. This study examines the sensitivity and specificity of a tool specifically for women with gynaecological cancers (called the Gynaecological Cancer Distress Screen or DT-Gyn). METHODS This paper presents cross-sectional data from individuals recently treated for gynaecological cancer recruited through Australian cancer care services, partner organisations, and support/advocacy services. Receiver operating characteristics analyses were used to evaluate the diagnostic accuracy of the DT-Gyn against criterion measures for anxiety (GAD-7), depression (patient health questionnaire), and distress (IES-R and K10). RESULTS Overall, 373 individuals aged 19-91 provided complete data for the study. Using the recognised distress thermometer (DT) cut-off of 4, 47% of participants were classified as distressed, while a cut-off of 5 suggested that 40% had clinically relevant distress. The DT-Gyn showed good discriminant ability across all measures (IES-R: area under the curve (AUC) = 0.86, 95% CI = 0.82-0.90; GAD-7: AUC = 0.89, 95% CI = 0.85-0.93; K10: AUC = 0.88, 95% CI = 0.85-0.92; PHQ-9: AUC = 0.85, 95% CI = 0.81-0.89) and the Youden Index suggested an optimum DT cut-point of 5. CONCLUSIONS This study established the psychometric properties of the DT-Gyn, a tool designed to identify and manage the common sources of distress in women with gynaecological cancers. We suggest a DT cut point ≥5 is optimal in detecting 'clinically relevant' distress, anxiety, and depression in this population.
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Affiliation(s)
- Charrlotte Seib
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Emma Harbeck
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Debra Anderson
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Janine Porter-Steele
- The Wesley Hospital Choices Cancer Support Centre (Choices), Wesley Hospital, Auchenflower, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Caroline Nehill
- Cancer Australia, Strawberry Hills, New South Wales, Australia
| | - Jasotha Sanmugarajah
- Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Lewis Perrin
- Mater Hospital and Mater Cancer Care Centre, South Brisbane, Queensland, Australia
| | - Catherine Shannon
- Mater Hospital and Mater Cancer Care Centre, South Brisbane, Queensland, Australia
| | - Nimithri Cabraal
- Mater Hospital and Mater Cancer Care Centre, South Brisbane, Queensland, Australia
| | - Bronwyn Jennings
- Mater Hospital and Mater Cancer Care Centre, South Brisbane, Queensland, Australia
| | - Geoffrey Otton
- Lambton Women's Health, Lambton, New South Wales, Australia
| | | | - Anne Mellon
- Hunter New England Centre for Gynaecological Cancer, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Suzanne Chambers
- Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
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21
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Alghamdi M, Masharqa F, Alsultan A, Sewaralthahab S, Abdelwahab O, Mohamed S, Abd El-Aziz N, Alosaimi FD. Utility and Implementation of the Distress Thermometer for Cancer Patients: A Cross-Sectional Study From Saudi Arabia. Cureus 2024; 16:e57187. [PMID: 38681302 PMCID: PMC11056099 DOI: 10.7759/cureus.57187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background Cancer patients suffer from variable degrees of distress. The distress thermometer (DT) is a valuable tool for screening those patients for distress. Few studies have addressed the utility of DT in screening cancer patients in Saudi Arabia. We aimed to measure the distress level of adult cancer patients utilizing the DT and identify the appropriate measures and interventions required to improve this population's well-being. Methods This cross-sectional study was carried out at the oncology center of King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Enrollment criteria were Saudi adults (≥14 years old), with a diagnosis of cancer, who gave informed consent. They were screened for distress using the DT and its associated problem list (PL). A workflow for a psycho-oncology supportive program was suggested. Results Using DT at a cut-off score of ≥4, 22% of patients had significant distress. The most frequent problems reported were loss/change of physical activity, swelling/edema, change in eating, family health problems, and child care. The multivariable binary regression analysis showed that sadness, depression, worry/anxiety, fear, loss of interest, change in appearance, taking care of myself, swelling/edema, and memory/concentration problems were independent factors for significant distress in our cohort. The suggested workflow could effectively be implemented among cancer patients. Conclusion The current study's findings support previous reports concerning the utility of DT in screening cancer patients for distress. A considerable number of Saudi cancer patients suffered from significant distress, which was significantly related to the emotional, spiritual, social, and religious aspects of their problems. We suggested a workflow by which cancer centers can implement DT screening after developing a plan for timely distress evaluation, with further proper management and referrals accordingly. Additional studies are warranted.
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Affiliation(s)
- Mohammed Alghamdi
- Department of Medical Oncology, King Saud University Medical City, King Saud University, Riyadh, SAU
| | - Fadi Masharqa
- Department of Hematology/Oncology, King Saud University Medical City, King Saud University, Riyadh, SAU
| | - Abdulrahman Alsultan
- Department of Pediatric Oncology, King Saud University Medical City, King Saud University, Riyadh, SAU
| | - Sarah Sewaralthahab
- Department of Hematology and Medical Oncology, King Saud University Medical City, King Saud University, Riyadh, SAU
| | | | - Sherif Mohamed
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, EGY
- Department of Internal Medicine, Sultan Bin Abdulaziz Humanitarian City, Riyadh, SAU
| | - Nashwa Abd El-Aziz
- Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, EGY
- Department of Medical Oncology, National Blood and Cancer Center, Riyadh, SAU
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22
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Boguszewicz Ł, Heyda A, Ciszek M, Bieleń A, Skorupa A, Mrochem-Kwarciak J, Składowski K, Sokół M. Metabolite Biomarkers of Prolonged and Intensified Pain and Distress in Head and Neck Cancer Patients Undergoing Radio- or Chemoradiotherapy by Means of NMR-Based Metabolomics-A Preliminary Study. Metabolites 2024; 14:60. [PMID: 38248863 PMCID: PMC10819132 DOI: 10.3390/metabo14010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Treatment of head and neck squamous cell carcinoma (HNSCC) has a detrimental impact on patient quality of life. The rate of recognized distress/depression among HNSCC patients ranges from 9.8% to 83.8%, and the estimated prevalence of depression among patients receiving radiotherapy is 63%. Shorter overall survival also occurs in preexisting depression or depressive conditions. The present study analyzes the nuclear magnetic resonance (NMR) blood serum metabolic profiles during radio-/chemoradiotherapy and correlates the detected alterations with pain and/or distress accumulated with the disease and its treatment. NMR spectra were acquired on a Bruker 400 MHz spectrometer and analyzed using multivariate methods. The results indicate that distress and/or pain primarily affect the serum lipids and metabolites of energy (glutamine, glucose, lactate, acetate) and one-carbon (glycine, choline, betaine, methanol, threonine, serine, histidine, formate) metabolism. Sparse disturbances in the branched-chain amino acids (BCAA) and in the metabolites involved in protein metabolism (lysine, tyrosine, phenylalanine) are also observed. Depending on the treatment modality-radiotherapy or concurrent chemoradiotherapy-there are some differences in the altered metabolites.
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Affiliation(s)
- Łukasz Boguszewicz
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.C.); (A.S.); (M.S.)
| | - Alicja Heyda
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (A.H.); (A.B.)
| | - Mateusz Ciszek
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.C.); (A.S.); (M.S.)
| | - Agata Bieleń
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (A.H.); (A.B.)
| | - Agnieszka Skorupa
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.C.); (A.S.); (M.S.)
| | - Jolanta Mrochem-Kwarciak
- Analytics and Clinical Biochemistry Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Krzysztof Składowski
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (A.H.); (A.B.)
| | - Maria Sokół
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.C.); (A.S.); (M.S.)
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (A.H.); (A.B.)
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Zion SR, Taub CJ, Heathcote LC, Ramiller A, Tinianov S, McKinley M, Eich G, Penedo FJ, Ganz PA, Antoni M, Shumay DM. Effects of a Cognitive Behavioral Digital Therapeutic on Anxiety and Depression Symptoms in Patients With Cancer: A Randomized Controlled Trial. JCO Oncol Pract 2023; 19:1179-1189. [PMID: 37862670 PMCID: PMC10732510 DOI: 10.1200/op.23.00210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 10/22/2023] Open
Abstract
PURPOSE Patients with cancer often experience elevated levels of distress. This double-blind, randomized controlled trial compared the impact of an app-based version of cognitive behavioral stress management (CBSM) versus a health education sham app on anxiety and depression symptoms. METHODS Patients with nonmetastatic (stage I-III) cancer who were receiving or recently completed (≤6 months) systemic treatment were recruited nationwide. The primary outcome of change in anxiety symptoms (PROMIS-Anxiety) over 12 weeks and the top secondary outcome of change in depression symptoms (PROMIS-Depression) over 12 weeks were analyzed using mixed-effects modeling with repeated measures (weeks 0, 4, 8, 12). Patient global impressions of change in anxiety and depression were reported at weeks 4, 8, and 12. In addition, self-reported adverse events were collected throughout the study and adjudicated by the site principal investigator. RESULTS Four hundred forty-nine patients were enrolled in the trial (age M [standard deviation] = 52.44 [11.46]; 81% female; 76% White; 53% breast cancer). Patients randomly assigned to digitized CBSM showed significantly greater reductions in anxiety (B = -0.03; P = .019) and depression (B = -0.02; P = .042) symptoms over 12 weeks. Patients who received digitized CBSM were also significantly more likely to perceive much or very much improvement (v no/minimal change or much/very much worse) in their symptoms of anxiety (χ2 = 31.76; P < .001) and depression (χ2 = 19.70; P < .001) compared with the control. CONCLUSION The use of digitized CBSM led to significant improvements in anxiety and depression outcomes compared with the sham app.
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Affiliation(s)
| | | | | | | | | | | | - Geoff Eich
- Blue Note Therapeutics, San Francisco, CA
| | | | | | | | - Dianne M. Shumay
- Blue Note Therapeutics, San Francisco, CA
- University of California San Francisco, San Francisco, CA
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24
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Gao L, Cao Y, Cao X, Shi X, Lei M, Su X, Liu Y. Machine learning-based algorithms to predict severe psychological distress among cancer patients with spinal metastatic disease. Spine J 2023; 23:1255-1269. [PMID: 37182703 DOI: 10.1016/j.spinee.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND CONTEXT Metastatic spinal disease is an advanced stage of cancer patients and often suffer from terrible psychological health status; however, the ability to estimate the risk probability of this adverse outcome using current available data is very limited. PURPOSE The goal of this study was to propose a precise model based on machine learning techniques to predict psychological status among cancer patients with spinal metastatic disease. STUDY DESIGN/SETTING A prospective cohort study. PATIENT SAMPLE A total of 1043 cancer patients with spinal metastatic disease were included. OUTCOME MEASURES The main outcome was severe psychological distress. METHODS The total of patients was randomly divided into a training dataset and a testing dataset on a ratio of 9:1. Patients' demographics, lifestyle choices, cancer-related features, clinical manifestations, and treatments were collected as potential model predictors in the study. Five machine learning algorithms, including XGBoosting machine, random forest, gradient boosting machine, support vector machine, and ensemble prediction model, as well as a logistic regression model were employed to train and optimize models in the training set, and their predictive performance was assessed in the testing set. RESULTS Up to 21.48% of all patients who were recruited had severe psychological distress. Elderly patients (p<0.001), female (p =0.045), current smoking (p=0.002) or drinking (p=0.003), a lower level of education (p<0.001), a stronger spiritual desire (p<0.001), visceral metastasis (p=0.005), and a higher Eastern Cooperative Oncology Group (ECOG) score (p<0.001) were significantly associated with worse psychological health. With an area under the curve (AUC) of 0.865 (95% CI: 0.788-0.941) and an accuracy of up to 0.843, the gradient boosting machine algorithm performed best in the prediction of the outcome, followed by the XGBooting machine algorithm (AUC: 0.851, 95% CI: 0.768-0.934; Accuracy: 0.826) and ensemble prediction (AUC: 0.851, 95% CI: 0.770-0.932; Accuracy: 0.809) in the testing set. In contrast, the AUC of the logistic regression model was only 0.836 (95% CI: 0.756-0.916; Accuracy: 0.783). CONCLUSIONS Machine learning models have greater predictive power and can offer useful tools to identify individuals with spinal metastatic disease who are experiencing severe psychological distress.
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Affiliation(s)
- Le Gao
- Department of Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, No. 8 Dongdajie Street, Fengtai District, Beijing, China
| | - Yuncen Cao
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Xuyong Cao
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Xiaolin Shi
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Hangzhou, 310005, China
| | - Mingxing Lei
- Department of Orthopedic Surgery, Hainan Hospital of PLA General Hospital, No. 80 Jianglin Road, Haitang District, Sanya, 572022, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, 100039, China.
| | - Xiuyun Su
- Intelligent Medical Innovation Institute, Southern University of Science and Technology Hospital, No. 6019 Xili Liuxian Avenue, Nanshan District, Shenzhen, 518071, China.
| | - Yaosheng Liu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, 100039, China.
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25
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Bergerot CD, Wang AWT, Serpentini S, Borgese C, Kim Y. Healthcare providers' perceptions about the unmet needs of their patients with cancer across healthcare systems: results of the International Psycho-Oncology Society survivorship survey. Support Care Cancer 2023; 31:538. [PMID: 37632538 DOI: 10.1007/s00520-023-07998-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Systematic understanding of patients' unmet needs is essential for providing effective supportive care. This study sought to compare the unmet needs of patients with cancer identified by health care providers (HCPs) among four major healthcare systems. METHODS HCPs (n = 247) participated in the International Psycho-Oncology Society (IPOS) Survivorship Online Survey, evaluating their patients' unmet needs. The country of HCPs was grouped into four major healthcare systems: Beveridge model, Bismarck model, National Health Insurance model, and out-of-pocket model. RESULTS Most HCPs were from countries with the Bismarck model. Substantial levels (> 50%) of unmet needs in all domains are reported across the four healthcare systems. Pediatric patients/survivors living in countries under out-of-pocket healthcare model were evaluated to have less unmet needs for managing decline in physical or cognitive functioning and insomnia/sleep difficulty/fatigue, than those in countries under Beveridge, Bismarck, and National Health Insurance models. Moreover, middle-aged patients/survivors under Beveridge and National Health Insurance models were likely to have greater unmet needs for dealing with cancer-related financial concerns than those under Bismarck model. CONCLUSION This study provides valuable insights into the unmet needs of patients with cancer in different healthcare systems, highlighting the significance of targeted interventions to address the unique needs of patients across diverse healthcare systems. Further investigation is warranted to identify the system factors associated with patients' unmet needs, enabling the development of effective healthcare policies and interventions to comprehensively address the multifaceted needs of patients with cancer.
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Affiliation(s)
- Cristiane Decat Bergerot
- Department of Supportive Care, Oncoclinicas, SMH/N Quadra 02, Ed de Clínicas, 12º Andar, Brasilia, DF, Brazil.
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Paley CA, Boland JW, Santarelli M, Murtagh FEM, Ziegler L, Chapman EJ. Non-pharmacological interventions to manage psychological distress in patients living with cancer: a systematic review. BMC Palliat Care 2023; 22:88. [PMID: 37407974 DOI: 10.1186/s12904-023-01202-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Psychological distress is common in patients with cancer; interfering with physical and psychological wellbeing, and hindering management of physical symptoms. Our aim was to systematically review published evidence on non-pharmacological interventions for cancer-related psychological distress, at all stages of the disease. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered on PROSPERO (CRD42022311729). Searches were made using eight online databases to identify studies meeting our inclusion criteria. Data were collected on outcome measures, modes of delivery, resources and evidence of efficacy. A meta-analysis was planned if data allowed. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS Fifty-nine studies with 17,628 participants were included. One third of studies included mindfulness, talking or group therapies. Half of all studies reported statistically significant improvements in distress. Statistically significant intervention effects on distress were most prevalent for mindfulness techniques. Four of these mindfulness studies had moderate effect sizes (d = -0.71[95% CI: -1.04, -0.37] p < 0.001) (d = -0.60 [95% CI: -3.44, -0.89] p < 0.001) (d = -0.77 [CI: -0.146, -1.954] p < 0.01) (d = -0.69 [CI: -0.18, -1.19] p = 0.008) and one had a large effect size (d = -1.03 [95% CI: -1.51, -0.54] p < 0.001). Heterogeneity of studies precluded meta-analysis. Study quality was variable and some had a high risk of bias. CONCLUSIONS The majority of studies using a mindfulness intervention in this review are efficacious at alleviating distress. Mindfulness-including brief, self-administered interventions-merits further investigation, using adequately powered, high-quality studies. SYSTEMATIC REVIEW REGISTRATION This systematic review is registered on PROSPERO, number CRD42022311729.
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Affiliation(s)
- Carole A Paley
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK.
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Martina Santarelli
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lucy Ziegler
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK
| | - Emma J Chapman
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK
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Hlubocky FJ, Dokucu ME. Addressing Suicidal Ideation in Patients With Cancer: Recommendations for the Oncology Clinician on How to Optimize Routine Screening in the Outpatient Setting. JCO Oncol Pract 2023:OP2300124. [PMID: 37290018 DOI: 10.1200/op.23.00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Fay J Hlubocky
- Department of Medicine, Section Hematology/Oncology, Maclean Center for Clinical Medical Ethics, Supportive Oncology Program, University of Chicago Medicine, Chicago, IL
| | - Mehmet E Dokucu
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL
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El-Jawahri A, Luskin MR, Greer JA, Traeger L, Lavoie M, Vaughn DM, Andrews S, Yang D, Boateng KY, Newcomb RA, Ufere NN, Fathi AT, Hobbs G, Brunner A, Abel GA, Stone RM, DeAngelo DJ, Wadleigh M, Temel JS. Psychological mobile app for patients with acute myeloid leukemia: A pilot randomized clinical trial. Cancer 2023; 129:1075-1084. [PMID: 36655338 DOI: 10.1002/cncr.34645] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with acute myeloid leukemia (AML) experience a substantial decline in quality of life (QoL) and mood during their hospitalization for intensive chemotherapy, yet few interventions have been developed to enhance patient-reported outcomes during treatment. METHODS We conducted a pilot randomized trial (ClinicalTrials.gov identifier NCT03372291) of DREAMLAND, a psychological mobile application for patients with a new diagnosis of AML who are receiving intensive chemotherapy. Patients were randomly assigned to DREAMLAND or usual care. DREAMLAND included four required modules focused on: (1) supportive psychotherapy to help patients deal with the initial shock of diagnosis, (2) psychoeducation to manage illness expectations, (3) psychosocial skill-building to promote effective coping, and (4) self-care. The primary end point was feasibility, which was defined as ≥60% of eligible patients enrolling and 60% of those enrolled completing ≥60% of the required modules. We assessed patient QoL (the Functional Assessment of Cancer Therapy-Leukemia), psychological distress (the Hospital Anxiety and Depression Scale and the Patient Health Questionnaire-9), symptom burden (the Edmonton Symptom Assessment Scale), and self-efficacy (the Cancer Self-Efficacy Scale) at baseline and at day 20 after postchemotherapy. RESULTS We enrolled 60 of 90 eligible patients (66.7%), and 62.1% completed ≥75% of the intervention modules. At day 20 after chemotherapy, patients who were randomized to DREAMLAND reported improved QoL scores (132.06 vs. 110.72; p =.001), lower anxiety symptoms (3.54 vs. 5.64; p = .010) and depression symptoms (Hospital Anxiety and Depression Scale: 4.76 vs. 6.29; p = .121; Patient Health Questionnaire-9: 4.62 vs. 8.35; p < .001), and improved symptom burden (24.89 vs. 40.60; p = .007) and self-efficacy (151.84 vs. 135.43; p = .004) compared with the usual care group. CONCLUSIONS A psychological mobile application for patients with newly diagnosed AML is feasible to integrate during hospitalization for intensive chemotherapy and may improve QoL, mood, symptom burden, and self-efficacy.
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Affiliation(s)
- Areej El-Jawahri
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Marlise R Luskin
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joseph A Greer
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Traeger
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell Lavoie
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dagny Marie Vaughn
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie Andrews
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel Yang
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kofi Y Boateng
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard A Newcomb
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nneka N Ufere
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amir T Fathi
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriela Hobbs
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Brunner
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory A Abel
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Richard M Stone
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel J DeAngelo
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Martha Wadleigh
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Divsion of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Ma H, Zhu F, Zhai H, Ma Y, Liu Y, Wang S, Xu Y. Prevalence of psychological distress among people living with HIV/AIDS: a systematic review and meta-analysis. AIDS Care 2023; 35:153-164. [PMID: 35642250 DOI: 10.1080/09540121.2022.2080802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although people living with HIV/AIDS (PLWHA) are known to be vulnerable to psychological distress (PD), little is known about the prevalence of PD among PLWHA. A systematic literature search of several databases was conducted from inception to August 2021 focusing on studies reporting on PD symptoms among PLWHA. The overall prevalence estimates were pooled using a random-effects meta-analysis. Differences according to study-level characteristics were examined using stratified meta-analysis. We pooled and analyzed data from 15 studies comprising 5593 PLWHA. The prevalence rate of PD among PLWHA was 43.7% (95% Confidence Interval: 29.9-57.5%). Subgroup analyses by gender, country, CD4 count, employment status and ever attended school found no statistically significant differences in the prevalence of PD. Heterogeneity in the prevalence of PD among PLWHA was partially explained by the assessment tool. Further large-scale studies of high quality are warranted to identify risk factors of PD in PLWHA in their respective socio-cultural contexts.
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Affiliation(s)
- Haiqi Ma
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Fu Zhu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Huimin Zhai
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Yue Ma
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Yiting Liu
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Shangjie Wang
- School of Nursing, Southern Medical University, Guangzhou, People's Republic of China
| | - Ying Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
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30
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Labouvie H, Dietz T, Schiewer V, Kusch M. Früherkennung seelischer Belastung in der onkologischen Versorgungspraxis. DIAGNOSTICA 2023. [DOI: 10.1026/0012-1924/a000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Zusammenfassung. Die Distress-Skala (DS) bildet ein Single-Item-Instrument in Form einer zehnstufigen Likertskala in 2 Varianten zur Identifikation psychosozialer Belastungen zum Krankheitsbeginn (Screening-Variante) sowie im Krankheitsverlauf (Verlaufsvariante). Die DS wurde an einer Stichprobe onkologisch erkrankter Patientinnen und Patienten mit einer Größe von N = 661 nahe am Diagnosezeitpunkt validiert. Bei N = 92 der Stichprobe lagen insgesamt 3 Erhebungszeitpunkte vor, anhand dessen die Validierung der Verlaufsvariante erfolgte. Unter Verwendung des HADS-Gesamtsummenscore-Schwellenwerts > 14 als externes Kriterium wurde für die Screening-Variante der DS ein Schwellenwert > 7 mit einer Sensitivität von 81 % bzw. 78 % und einer Spezifität von 71 % bzw. 75 % ermittelt. Die Verlaufsvariante der DS erzielte bei einem Schwellenwert von > 5 eine Sensitivität zu T2 von 77 % und zu T3 von 70 % und eine Spezifität zu T2 von 67 % und zu T3 von 78 %. Die Ergebnisse weisen eine gute Diskriminierungsfähigkeit auf und empfehlen den Einsatz der DS zu Beginn der Krebserkrankung bzw. im Krankheitsverlauf.
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Affiliation(s)
- Hildegard Labouvie
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Uniklinik Köln, Deutschland
| | - Thilo Dietz
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Uniklinik Köln, Deutschland
| | - Vera Schiewer
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Uniklinik Köln, Deutschland
| | - Michael Kusch
- Psychoonkologische Versorgungsforschung, Klinik I für Innere Medizin, Uniklinik Köln, Deutschland
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31
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Hamilton AC, Donnelly DW, Fitzpatrick D, Coleman HG. Early-Onset Cancers in Adults: A Review of Epidemiology, Supportive Care Needs and Future Research Priorities. Cancers (Basel) 2022; 14:4021. [PMID: 36011014 PMCID: PMC9406462 DOI: 10.3390/cancers14164021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Rising incidence of specific types of early-age onset cancers in adults aged 18-49 years has been reported in high-income countries. In this review, we summarise the epidemiology of early-onset cancers using exemplar data from a high-income UK region, discuss supportive care needs for young patients and outline future research directions. The incidence rate of early-onset cancers increased by 20.5% from 1993 to 2019 in Northern Ireland. Differences in types of cancer were observed between sexes and across age groups of 18-29, 30-39 and 40-49 years. One and five-year net survival was mostly better in 18-29-year-olds for all cancers combined compared to older age groups for both sexes, but there were variations in specific cancer types. Poorer survival was observed for patients with brain/central nervous system, connective and soft tissue or lung cancers. Patients with early-onset cancers face unique supportive care needs and require holistic care. The impact of cancer treatment on fertility and fertility preservation treatments is an important consideration. Social media can be used for patient support, information, fundraising, advocacy work and recruitment to research studies. We also outline suggested future research priorities for early-onset cancers, spanning prevention, diagnosis, treatment and supportive care needs.
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Affiliation(s)
| | - David W. Donnelly
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast BT12 6DP, UK
| | - Deirdre Fitzpatrick
- Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast BT12 6DP, UK
| | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast BT12 6DP, UK
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK
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32
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Hao R, Jin H, Zuo J, Zhao R, Hu J, Qi Y. Quality assessment of clinical practice guidelines on psychological distress of cancer patients using the AGREE II instrument. Front Oncol 2022; 12:942219. [PMID: 36016612 PMCID: PMC9396033 DOI: 10.3389/fonc.2022.942219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to assess the quality of the clinical practice guidelines on psychological distress among cancer patients and provide users with recommendations for coping with psychological distress. Methods A systematic search of relevant clinical practice guidelines was undertaken to identify and select the clinical practice guidelines related to psychological distress among cancer patients. Literature databases were searched in PubMed, Web of Science, Excerpta Medica Database, the Cumulative Index to Nursing & Allied Health Literature, China Biology Medicine, China National Knowledge Infrastructure, WanFang and Weipu Journal Database. The guideline databases include Yimaitong Guidelines Network, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence, American Society of Clinical Oncology (ASCO), New Zealand Guidelines Group, Scottish Intercollegiate GuidelinesNetwork, American Psychological Association, Registered Nurses' Association of Ontario and Cancer Care Ontario (CCO). Four independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Results Six clinical practice guidelines were included and assessed for critical evaluation. The median score for the scope and purpose domain was 71.5% (IQR 64%-77.25%), the stakeholder involvement domain was 65% (IQR 47.5%-74.5%), the rigour of the development domain was 61.5% (IQR 45.5%-85.25%), the clarity of the presentation domain was 91% (IQR 72.25%-94.5%), the applicability domain was 70% (IQR 33%-78.75%), and the editorial independence domain was 48.84% (IQR 61.75%-95%). Four guidelines (ASCO, 2014; Canadian Association of Psychosocial Oncology, 2015; NCCN, 2020, and CCO, 2016) were classified as "recommended," and the remaining (European Palliative Care Research Collaborative and Chinese Psychosocial Oncology Society) were "recommended with modifications," especially in the domains of Stakeholder involvement, rigour of development, and applicability. The inter-rater consistency of each domain showed moderate level (0.52-0.90) analyzing by intraclass correlation. Conclusions The clinical practice guidelines on psychological distress among cancer patients varied in quality, and there were discrepancies in terms of the recommendations and recommendation grades. These findings could contribute to improving the quality of clinical practice guidelines on psychological distress, and enable the development and implementation of evidence-based guidelines for cancer patients. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42020209204.
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Affiliation(s)
- Ran Hao
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Haoyu Jin
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Jinfan Zuo
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Rumeng Zhao
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Jie Hu
- Department of Science and Technology, Hebei Medical University, Shijiazhuang, China
| | - Yixin Qi
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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33
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Falk D, Zebrack BJ. Advancing Health Equity in Cancer-Related Distress: Lessons Learned From the COVID-19 Pandemic on Leveraging Digital Tools and Future Directions. J Natl Compr Canc Netw 2022; 20:850-852. [PMID: 35830890 DOI: 10.6004/jnccn.2022.7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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Gascon B, Panjwani AA, Mazzurco O, Li M. Screening for Distress and Health Outcomes in Head and Neck Cancer. Curr Oncol 2022; 29:3793-3806. [PMID: 35735413 PMCID: PMC9221700 DOI: 10.3390/curroncol29060304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
Head and neck cancers (HNC) have higher rates of emotional distress than other cancer types and the general population. This paper compares the prevalence of emotional distress in HNC across various distress screening measures and examines whether significant distress or distress screening are associated with cancer-related survival. A retrospective observational cohort design was employed, with data collected from the Distress Assessment and Response Tool (DART) and linkages to administrative databases from 2010 to 2016. Descriptive and prevalence data were reported using multiple concurrently administered distress tools, including the Patient Health Questionaire-9 (PHQ-9), Generalized Anxiety Disorders-7 (GAD-7), Edmonton Symptom Assessment Scale-revised (ESAS-r), and MD Anderson Symptom Index-Head and Neck module (MDASI-HN). Across measures, 7.8 to 28.1% of the sample reported clinically significant emotional distress, with PHQ-9 and GAD-7 identifying lowest prevalence of moderate/severe distress, and the ultrashort distress screens within ESAS-r and MDASI-HN performing equivalently. Cox hazards models were used in univariate and multivariate survival analyses. ESAS depression (≥4), but not anxiety, was associated with increased risk of cancer-related mortality and patient completion of DART was associated with greater cancer-related survival. The findings underscore the importance of implementing routine distress screening for HNC populations and the utility of ultra-brief screening measures.
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Affiliation(s)
- Bryan Gascon
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (A.A.P.); (O.M.)
| | - Aliza A. Panjwani
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (A.A.P.); (O.M.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Olivia Mazzurco
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (A.A.P.); (O.M.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Madeline Li
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (A.A.P.); (O.M.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence: ; Tel.: +1-416-946-4501 (ext. 7505); Fax: +1-416-946-2047
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35
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Javellana M, Hlubocky FJ, Somasegar S, Sorkin M, Kurnit KC, Jani I, Stock E, Mills K, Lengyel E, Lee NK. Resilience in the Face of Pandemic: The Impact of COVID-19 on the Psychologic Morbidity and Health-Related Quality of Life Among Women With Ovarian Cancer. JCO Oncol Pract 2022; 18:e948-e957. [PMID: 35201895 DOI: 10.1200/op.21.00514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has created new challenges for ovarian cancer survivors. This study aims to evaluate the psychologic morbidity and alterations in medical care caused by the pandemic. METHODS Advanced-stage ovarian cancer survivors at our institution were contacted for participation in a cross-sectional telephone-based quantitative survey study assessing pandemic-related psychologic morbidity. Psychologic domains using validated measures were explored: health-related quality of life (HRQOL; functional assessment of cancer therapy [FACT-G7]), anxiety (generalized anxiety disorder-7 [GAD7]), depression (Patient Health Questionnarie-2 [PHQ2]), global health Patient-Reported Outcomes Measurement Information System - Global Physical Health/Global Mental Health (PROMIS-GMH/GPH), resilience (brief resilience scale), and loneliness (English Longitudinal Study on Aging). Novel COVID-19 pandemic questions were drawn from a larger survey developed in our department. RESULTS Fifty-nine percent (61 of 104) of contacted patients completed the survey. One quarter of respondents had high resilience, with only 10% reporting low resilience. Only one patient screened positive for depression, and two for anxiety. Increased loneliness was reported by 43% of respondents. Patients' overall HRQOL was good (median = 21; range = 6-28). Few patients experienced treatment delays, with only four experiencing chemotherapy interruption and two reporting surgical delays. Multiple regression analyses revealed that high FACT-G7 HRQOL was predicted by age > 65 years, high self-reported mental health, high resilience, and being off chemotherapy. Lower COVID-19 concern was predicted by recurrent cancer and high resilience. CONCLUSION Despite the far-reaching impact of the COVID-19 pandemic, ovarian cancer survivors' HRQOL has been maintained. Older age, high resilience, high mental health, and being off chemotherapy predicted better HRQOL. Ovarian cancer survivors remain resilient in the face of the pandemic, and the support of clinicians to preserve this invaluable personal resource is critical for well-being.
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Affiliation(s)
- Melissa Javellana
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
| | - Fay J Hlubocky
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL.,Department of Medicine, Section of Hematology/Oncology, MacLean Center for Clinical Medical Ethics, Cancer Research Center, Supportive Oncology Program, Chicago, IL
| | - Sahana Somasegar
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
| | - Mia Sorkin
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
| | - Katherine C Kurnit
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
| | - Ina Jani
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
| | - Elizabeth Stock
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
| | - Kathryn Mills
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
| | - Ernst Lengyel
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
| | - Nita K Lee
- The University of Chicago Medicine, Department of Gynecology/ Obstetrics, Section of Gynecologic Oncology, Chicago, IL
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36
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Timely Palliative Care: Personalizing the Process of Referral. Cancers (Basel) 2022; 14:cancers14041047. [PMID: 35205793 PMCID: PMC8870673 DOI: 10.3390/cancers14041047] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Timely palliative care is a systematic process to identify patients with high supportive care needs and to refer these individuals to specialist palliative care in a timely manner based on standardized referral criteria. It requires four components: (1) routine screening of supportive care needs at oncology clinics, (2) establishment of institution-specific consensual criteria for referral, (3) a system in place to trigger a referral when patients meet criteria, and (4) availability of outpatient palliative care resources to deliver personalized, timely patient-centered care aimed at improving patient and caregiver outcomes. In this review, we discuss the conceptual underpinnings, rationale, barriers and facilitators for timely palliative care referral. Timely palliative care provides a more rational use of the scarce palliative care resource and maximizes the impact on patients who are offered the intervention. Several sets of referral criteria have been proposed to date for outpatient palliative care referral. Studies examining the use of these referral criteria consistently found that timely palliative care can lead to a greater number of referrals and earlier palliative care access than routine referral. Implementation of timely palliative care at each institution requires oncology leadership support, adequate palliative care infrastructure, integration of electronic health record and customization of referral criteria.
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37
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Chang LC, Hsu YC, Chiu HM, Ueda K, Wu MS, Kao CH, Shen TL. Exploration of the Proteomic Landscape of Small Extracellular Vesicles in Serum as Biomarkers for Early Detection of Colorectal Neoplasia. Front Oncol 2021; 11:732743. [PMID: 34589434 PMCID: PMC8473825 DOI: 10.3389/fonc.2021.732743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background Patient participation in colorectal cancer (CRC) screening via a stool test and colonoscopy is suboptimal, but participation can be improved by the development of a blood test. However, the suboptimal detection abilities of blood tests for advanced neoplasia, including advanced adenoma (AA) and CRC, limit their application. We aimed to investigate the proteomic landscape of small extracellular vesicles (sEVs) from the serum of patients with colorectal neoplasia and identify specific sEV proteins that could serve as biomarkers for early diagnosis. Materials and Methods We enrolled 100 patients including 13 healthy subjects, 12 non-AAs, 13 AAs, and 16 stage-I, 15 stage-II, 16 stage-III, and 15 stage-IV CRCs. These patients were classified as normal control, early neoplasia, and advanced neoplasia. The sEV proteome was explored by liquid chromatography-tandem mass spectrometry. Generalized association plots were used to integrate the clustering methods, visualize the data matrix, and analyze the relationship. The specific sEV biomarkers were identified by a decision tree via Orange3 software. Functional enrichment analysis was conducted by using the Ingenuity Pathway Analysis platform. Results The sEV protein matrix was identified from the serum of 100 patients and contained 3353 proteins, of which 1921 proteins from 98 patients were finally analyzed. Compared with the normal control, subjects with early and advanced neoplasia exhibited a distinct proteomic distribution in the data matrix plot. Six sEV proteins were identified, namely, GCLM, KEL, APOF, CFB, PDE5A, and ATIC, which properly distinguished normal control, early neoplasia, and advanced neoplasia patients from each other. Functional enrichment analysis revealed that APOF+ and CFB+ sEV associated with clathrin-mediated endocytosis signaling and the complement system, which have critical implications for CRC carcinogenesis. Conclusion Patients with colorectal neoplasia had a distinct sEV proteome expression pattern in serum compared with those patients who were healthy and did not have neoplasms. Moreover, the six identified specific sEV proteins had the potential to discriminate colorectal neoplasia between early-stage and advanced neoplasia. Collectively, our study provided a six-sEV protein biomarker panel for CRC diagnosis at early or advanced stages. Furthermore, the implication of the sEV proteome in CRC carcinogenesis via specific signaling pathways was explored.
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Affiliation(s)
- Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chiung Hsu
- Department of Biomedical Science and Engineering, National Central University, Taoyuan, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Koji Ueda
- Cancer Precision Medicine Center, Japanese Foundation of Cancer Research, Tokyo, Japan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiun-How Kao
- Department of Statistics, Tamkang University, New Taipei City, Taiwan
| | - Tang-Long Shen
- Department of Plant Pathology and Microbiology, National Taiwan University, Taipei, Taiwan.,Center for Biotechnology, National Taiwan University, Taipei, Taiwan.,Genome and Systems Biology Degree Program, National Taiwan University, Taipei, Taiwan
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38
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Wells-Di Gregorio S, Deshields T, Flowers SR, Taylor N, Robbins MA, Johnson R, Dwyer M, Siston A, Cooley ME, Kayser K. Development of a psychosocial oncology core curriculum for multidisciplinary education and training: Initial content validation using the modified Delphi Method. Psychooncology 2021; 31:130-138. [PMID: 34523775 DOI: 10.1002/pon.5791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Despite its four decade history, the multidisciplinary specialty of psychosocial oncology (PSO) has no official consensus on core content. In 2014, the American Psychosocial Oncology Society (APOS) Board charged the APOS Professional Education Committee with outlining curricular content needed for core competence. METHODS Content validation was completed using a four-phase modified Delphi Method. During Phase I, a Professional Education Committee subgroup proposed domains and items, which were rated by the APOS Fellows and Board via online survey. During Phase II, Fellows completed a second, revised survey. Phase III incorporated early career members. Developmental and diversity items were integrated into each domain. In Phase IV, a larger group of subject matter experts were surveyed, with feedback incorporated. Validation across phases involved average rating thresholds, intraclass correlations, and final percent agreement. RESULTS The Delphi Method supported 12 content domains: Cancer Basics, Psychosocial Oncology, Professional Development, Ethics, Emotional/Psychological Concerns, Sexuality and Relationship Concerns, Spiritual/Religious Concerns, Healthcare Communication and Decision Making, Social/Practical Problems, Caregiver Concerns, Cognitive Concerns, Physical Symptoms and Psychosocial Assessment/Treatment. High levels of agreement were achieved across domains (86%-100%) and items, with no significant rating differences by discipline. CONCLUSIONS This proposed core content can enhance and standardize education and training in PSO including APOS' Virtual Psychosocial Oncology Core Curriculum, focused on broadly expanding the PSO workforce, particularly in underserved areas. Next steps include development of core competencies and establishment of online training modules based on this content validation.
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Affiliation(s)
- Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus, Ohio, USA
| | - Teresa Deshields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Stacy R Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Nicole Taylor
- Graduate School of Professional Psychology, University of Denver, Denver, Colorado, USA
| | - Mona A Robbins
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rhonda Johnson
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Meagan Dwyer
- Department of Psychiatry & Behavioral Sciences and Department of Internal Medicine, Division of Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amy Siston
- Department of Psychiatry & Behavioral Neurosciences, University of Chicago Medicine, Chicago, Illinois, USA
| | - Mary E Cooley
- Phyllis F Cantor Center Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Karen Kayser
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
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