Demoralization syndrome among cancer outpatients in Taiwan

Goals

This paper aims to explore characteristics of demoralization syndrome as well as the relationship between demoralization syndrome and psychosocial issues as seen through examinations of cancer outpatients in Taiwan.

Materials and methods

Outpatients with different cancer types were enrolled in this study. The Demoralization Scale Mandarin Version (DS-MV), Patient Health Questionnaire, Beck Hopelessness Scale, and McGill Quality of Life Questionnaire—Taiwan Version were used as instruments. All data were analyzed using SPSS 18.0.

Results

Among the 234 patients studied (97 men and 223 women), the majority had cervical cancer (29.1%), followed by breast cancer (26.5%) and head and neck cancer (24.3%). The mean score of DS-MV was 31.05 (SD 14.87). The results of ANOVA analysis showed a significant effect of occupation F(4.209)?=?7.145 (p?F(7.206)?=?3.795 (p?F(8.206)?=?3.553 (p?Conclusions Demoralization syndrome was found to be related to psychosocial issues, different cancer types, and treatments. Further studies are recommended to better understand causes and impacts of demoralization in the quality of life and care of cancer patients.     

Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy

Purpose

This study examined the relationships between physical symptoms, self-efficacy for coping with symptoms, and functional, emotional, and social well-being in women who were taking adjuvant endocrine therapy for breast cancer.

Methods

One hundred and twelve women who were taking adjuvant endocrine therapy (tamoxifen or an aromatase inhibitor) for breast cancer completed measures of physical symptoms, self-efficacy for coping with symptoms, and functional, social, and emotional well-being at the time of routine medical follow-up (women were on average 3.4 years post-surgery; range 3 months to 11 years).

Results

Multiple linear regression analyses showed that higher self-efficacy for coping with symptoms was associated with greater functional, emotional, and social well-being after controlling for physical symptoms (p?B?=?0.05, SE?=?0.02, t?=?2.67, p?=?0.009) and emotional well-being (B?=?0.03, SE?=?0.01, t?=?2.45, p?=?0.02). As self-efficacy increased, the relationship between greater physical symptoms and lower well-being became weaker. Among women with high levels of self-efficacy, physical symptoms were not related to functional and emotional well-being.

Conclusions

Self-efficacy for coping with symptoms may reduce the negative impact of physical symptoms and contribute to well-being in breast cancer survivors taking adjuvant endocrine therapy. Future studies could examine whether psychosocial interventions aimed at increasing self-efficacy for managing symptoms help women better cope with treatment side effects and improve quality of life.     

Oral health conditions affect functional and social activities of terminally ill cancer patients

Purpose

Oral conditions are established complications in terminally ill cancer patients. Yet despite significant morbidity, the characteristics and impact of oral conditions in these patients are poorly documented. The study objective was to characterize oral conditions in terminally ill cancer patients to determine the presence, severity, and the functional and social impact of these oral conditions.

Methods

This was an observational clinical study including terminally ill cancer patients (2.5–3-week life expectancy). Data were obtained via the Oral Problems Scale (OPS) that measures the presence of subjective xerostomia, orofacial pain, taste change, and the functional/social impact of oral conditions and a demographic questionnaire. A standardized oral examination was used to assess objective salivary hypofunction, fungal infection, mucosal erythema, and ulceration. Regression analysis and t test investigated the associations between measures.

Results

Of 104 participants, most were ≥50 years of age, female, and high-school educated; 45 % were African American, 43 % Caucasian, and 37 % married. Oral conditions frequencies were: salivary hypofunction (98 %), mucosal erythema (50 %), ulceration (20 %), fungal infection (36 %), and other oral problems (46 %). Xerostomia, taste change, and orofacial pain all had significant functional impact; p?<?.001, p?=?.042 and p?<?.001, respectively. Orofacial pain also had a significant social impact (p?<?.001). Patients with oral ulcerations had significantly more orofacial pain with a social impact than patients without ulcers (p?=?.003). Erythema was significantly associated with fungal infection and with mucosal ulceration (p?<?.001).

Conclusions

Oral conditions significantly affect functional and social activities in terminally ill cancer patients. Identification and management of oral conditions in these patients should therefore be an important clinical consideration.     

Correlates of resistance training in post-treatment breast cancer survivors

Purpose

To explore demographic, health, social-cognitive and behavioural correlates of resistance training among post-treatment breast cancer survivors.

Methods

A sample of 330 post-treatment breast cancer survivors recruited from across Australia completed a mailed questionnaire. A multivariate logistical regression model was used to test associations between independent variables and meeting the resistance training guidelines.

Results

Less than a quarter of the participants were meeting the resistance training guidelines of at least two sessions of resistance training per week. Higher task self-efficacy for resistance training (p?p?Conclusions Strategies targeting task self-efficacy and goal-setting behaviours are likely to be important intervention components in resistance training interventions for breast cancer survivors.

Implications for cancer survivors

The findings of this study will be useful for informing the development of evidence-based interventions aiming to promote resistance training among this group.     

Satisfaction with information and its association with illness perception and quality of life in Indonesian breast cancer patients

Purpose

The aims of this study were to assess the level of satisfaction with the information on illness and treatment among breast cancer patients, to explore its association with patients’ illness perceptions and quality of life, and to provide recommendations for improvement of the information provided.

Methods

Seventy breast cancer patients at the Outpatient Surgical Oncology Clinic in Hasan Sadikin Hospital in Indonesia were recruited consecutively in a cross-sectional study design. They completed a demographic form, the Satisfaction with Cancer Information Profile, the Brief Illness Perception Questionnaire, and the World Health Organization Quality of Life.

Results

A considerable number of breast cancer patients (41–86 %) were dissatisfied with the amount and content of the information they received, particularly on the information about access to patient support groups and the impact of their treatment on long-term quality of life. The majority of patients were dissatisfied with the amount of written information provided. Patients who were satisfied with the type and timing of information received had stronger beliefs in personal control (β?=??0.30, p?<?0.05), lesser concerns about their health condition (β?=??0.47, p?<?0.01), and better understanding of their illness (β?=??0.27, p?<?0.05), and were less emotionally affected by their illness (β?=??0.27, p?<?0.05). In addition, the satisfied patients had a more positive perception of their general health (β?=?0.31, p?<?0.05) and better psychological health condition (β?=?0.33, p?<?0.05).

Conclusions

Satisfaction with the information provided is associated with better health outcomes, including more positive illness perceptions. This study appears to highlight the importance of providing adequate and sufficient information that meets the needs of patients.     

Topical silver sulfadiazine for the prevention of acute dermatitis during irradiation for breast cancer

Purpose

This study aimed to evaluate the effectiveness of topical silver sulfadiazine (SSD) in preventing acute radiation dermatitis in women receiving radiotherapy for breast cancer.

Methods

A randomized controlled clinical trial was conducted on patients with breast cancer referred for radiotherapy after treatment with mastectomy and chemotherapy. The patients were randomized into the intervention (n?=?51) and control (n?=?51) groups and were instructed on general skin care during radiotherapy. The intervention group received SSD cream 1%, three times a day, 3?days a week, for 5?weeks during radiotherapy and one week thereafter. A blinded observer assessed the severity of dermatitis weekly (for 6?weeks) and graded it from 0 to 4 according to the Radiation Therapy Oncology Group criteria.

Results

The two groups were similar in baseline characteristics. Two patients in the control group discontinued the radiotherapy course because of severe skin injuries (grades 3 and 4). The intervention group encountered significantly less severe dermatitis during radiotherapy compared to the controls. The total score of skin injury was also lower in the intervention group compared with controls (5.49?±?1.02 vs. 7.21?±?1.76, p?p?p?=?0.008) were significantly associated with a decreased skin injury.

Conclusions

SSD cream reduced the severity of radiation-induced skin injury compared with general skin care alone. Further studies in patients with other types of cancer and also comparing SSD cream with other topical agents are warranted.     

Patterns of physical activity participation across the cancer trajectory in colorectal cancer survivors

Purpose

The purpose of the present study was to explore the participation in physical activity (PA) by colorectal cancer survivors across cancer trajectories and based on selected demographic and medical variables.

Methods

A total of 431 participants were surveyed individually at the Shinchon Severance Hospital, Seoul, Korea, to determine their PA levels before diagnosis, during treatment and after completion of cancer treatment.

Results

Percentage of survivors meeting American College of Sports Medicine guideline significantly reduced from 27 % before diagnosis to 10 % during treatment due to reduced strenuous intensity PA (28.8?±?106.2 vs 11.8?±?95.9 min, p?=?0.042), while total PA and mild intensity PA did not change. Total (187.2?±?257.7 vs. 282.6?±?282.0 min, p?<?0.001) and mild (99.1?±?191.5 vs. 175.1?±?231.2 min, p?<?0.001) intensity PA significantly increased after the completion of treatments compared with their PA level before diagnosis. Further analyses showed that age (more vs. equal or less than 60 years) and chemotherapy (chemotherapy vs. no chemotherapy) significantly influenced the level of physical activity (p?=?0.004). Survivors who were older or received chemotherapy increased their total PA and mild intensity PA after the completion of treatment more than those who did not receive chemotherapy.

Conclusions

The level and the pattern of physical activity by colorectal cancer survivors differed across cancer trajectories, which were significantly influenced by age and adjuvant chemotherapy.     

Distress among young adult cancer survivors: a cohort study

Purpose

Being diagnosed with cancer as a young adult can lead to significant psychological distress and impaired quality of life. Compared to children and older adults diagnosed with cancer, fewer studies have addressed psychological distress among young adult cancer survivors. This study sought to identify the prevalence of, and factors associated with, distress among young adult cancer survivors (ages 18–39).

Methods

Young adult cancer survivors (N?=?335, mean age?=?31.8, women?=?68.4 %) were recruited from an online research panel and stratified by cohort (time postactive treatment: 0–12, 13–24, and 25–60 months). Participants completed measures assessing demographic and clinical characteristics, global impact of cancer, cancer-related education and work interruption, and cancer-specific distress using the impact of event scale (IES).

Results

The mean score on the IES (M?=?31.0, range?=?0–75) was above the cut point of 20, suggesting clinically elevated distress. Analysis of covariance revealed significant main effects for cohort, global impact and cancer-related education/work interruption, and an interaction between cohort and cancer-related education/work interruption on distress. Although there was no significant effect of education/work interruption on distress for those in the 0–12 month cohort (p?=?.88), survivors in the 13–24 and 25–60 month cohorts reporting education/work interruption were significantly more distressed than those not reporting education/work interruption in the respective cohorts (p?<?.05).

Conclusions

Young adult cancer survivors face unique challenges. These data underscore the importance of attending to cancer-related distress beyond the completion of treatment and may help inform targeted interventions to prevent or reduce significant distress and related sequelae in this population.     

Evaluation of intrapsychic processes, anxiety, and depression in postmenopausal women affected by breast cancer: a case–control study

Background

The study of intrapsychic modalities can help to understand the association between depression and breast cancer patients and what kind of intervention can be planned. There is evidence that breast cancer is associated with the development of depression. The study of intrapsychic modalities may explain this association. Therefore, we aimed at investigating the intrapsychic and interpersonal processes of the structure of personality, anxiety, and depression of postmenopause breast cancer women.

Methods

All participants (n?=?63) underwent the following tests: SASB questionnaire (Structural Analysis of Interpersonal Behavior), describing intrapsychic and interpersonal processes, validated on the basis of DSMIV, and the CDQ and ASQ questionnaires describing depression and anxiety. We compared two groups: breast cancer (n?=?63) and a healthy control group of women without cancer (n?=?83).

Results

Patients with breast cancer presented medium to high levels of anxiety and depression and intrapsychic level showed that they had less autonomy in their choices with low acceptance of their own feelings and tendency to be depressed compared to the control group (Cl 1 autonomy F?=?10.21, p?<?0.05, Cl 2 autonomy and love F?=?13.01, p?<?0.001, Cl 3 love F?=?10.50, p?<?0.01, Cl 5 control F?=?6.44, p?<?0.05, Cl 6 control and hate F?=?4.49, p?<?0.05, ASQ F?=?6.07, p?<?0.05, and CDQ F?=?6.24, p?<?0.05).

Conclusions

Intrapsychic characteristics such as tendency to depression, inability to being in contact with their own feelings, may be linked to difficulties in facing treatment and their condition of illness. Knowledge of these modalities could allow to plan a psychotherapeutic and multidisciplinary intervention aimed at facing the different phases of medical treatment.     

Patient satisfaction with service quality as a predictor of survival outcomes in breast cancer

Purpose

Despite the recognized relevance of symptom burden in breast cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality of care received might influence outcome. We therefore evaluated the relationship between patient-reported satisfaction with service quality and survival in breast cancer.

Methods

A random sample of 1,521 breast cancer patients treated at Cancer Treatment Centers of America. A questionnaire which covered several dimensions of patient satisfaction was administered. Items were measured on a seven-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. Univariate and multivariate Cox regression was used to evaluate the association between patient satisfaction and survival.

Results

Of 1,521 patients, 836 were newly diagnosed, and 685 had previously been treated. A number of 409, 611, 323, and 178 patients had stage I, II, III, and IV disease, respectively. A total of 1,106 (72.7 %) patients were completely satisfied with the overall service quality, while 415 (27.3 %) were not. On univariate analysis, completely satisfied patients had a significantly lower risk of mortality compared to those not completely satisfied (HR?=?0.62; 95 % CI 0.50–0.76; p?<?0.001). On multivariate analysis, completely satisfied patients demonstrated significantly lower mortality (HR?=?0.71; 95 % CI 0.57–0.87; p?=?0.001) compared to those not completely satisfied.

Conclusions

Patient satisfaction with service quality was an independent predictor of survival in breast cancer. Further exploration of a possible meaningful relationship between patient satisfaction with the care they receive and outcomes in breast cancer is indicated.     

Predictors of anxiety and depression in people with colorectal cancer

Background

People living with colorectal cancer are at risk of anxiety and depression. We investigated what factors were most highly associated with these.

Methods

Four hundred and ninety-six people with colorectal cancer completed the Hospital Anxiety and Depression Scale (HADS). Data on functioning, symptoms, illness perceptions and social difficulties were collected by questionnaire. Case-note-identified disease, treatment and co-morbidity data were recorded. Multiple logistic regression identified factors independently predictive of anxiety and depression caseness.

Results

Self-reported history of anxiety/depression predicted anxiety but not depression caseness. Depression caseness predicted anxiety caseness (p?=?0.043), as did poorer self-reported cognitive functioning (p?=?0.001), dyspnoea (p?=?0.015) or diarrhoea (p?=?0.021), reporting a high negative life and emotional impact (p?<?0.001) and having difficulties with finance (p?=?0.007). Having neo-adjuvant radiotherapy increased the odds of depression caseness (p?=?0.007), as did poorer physical (p?=?0.007), cognitive (p?<?0.001) and social (p?<?0.001) functioning, having constipation (p?=?0.011), reporting a high negative life and emotional impact (p?<?0.001), having difficulties with personal care (p?=?0.022) and communicating with others (p?=?0.014).

Conclusion

Levels of anxiety caseness were similar to those of non-clinical samples, but depression caseness was higher, particularly in those who had received neo-adjuvant radiotherapy. Most factors associated with possible or probable depression may be modified with appropriate intervention.     

Worrying about one’s children after breast cancer diagnosis: desired timing of psychosocial intervention

Background

The purposes of this observational study were to analyze at what time point mothers desired psychosocial support regarding the worry about their children during the year after breast cancer diagnosis and to identify any psychosocial factors associated with this worry.

Methods

In a population-based study, we analyzed data from 280 mothers diagnosed with breast cancer at Sahlgrenska University Hospital in Gothenburg, Sweden.

Results

Of those who did not receive chemotherapy treatment, 70 out of 112 women (63 %) reported a desire to receive support about the worry about their children, and of those who received chemotherapy treatment, 20 out of 49 (41 %) reported a need for support immediately following diagnosis and before surgery. We identified having children at home (P?P?=?0.0009), fear of dying from breast cancer (P?=?0.0055), and worried about one’s personal financial situation (P?=?0.0413) as the variables most closely related to worry about the children.

Conclusions

Our population-based study shows that mothers with breast cancer had an immediate desire to receive psychosocial support regarding the worry about their own children. If we wish to shorten the pain associated with this worry among women diagnosed with breast cancer, it may be helpful to offer support as early in the disease trajectory as possible as it may reduce the risk of a later, more complicated, unnecessarily prolonged psychosocial rehabilitation process.     

Are we being overly cautious? A qualitative inquiry into the experiences and perceptions of treatment-focused germline BRCA genetic testing amongst women recently diagnosed with breast cancer

Purpose

Women with breast cancer, who are found to be BRCA1/2 mutation carriers, have a high risk of ovarian cancer and metachronous breast cancer. Treatment-focused genetic testing (TFGT), offered around the time of diagnosis, allows genetic test results to inform surgical treatment decisions. However, concern has been raised that offering TFGT at this time may overly increase psychological burden. This study aimed to qualitatively explore women’s attitudes and experiences of TFGT.

Methods

Women who had been diagnosed with breast cancer at age 50?years or less undertook a semi-structured telephone interview (n?=?26). The sample included women who had been offered TFGT, based on family history and/or other risk criteria (n?=?14), and women who had been diagnosed within the past 6–12?months and had not been offered TFGT (n?=?12). Interviews explored women’s attitudes towards TFGT, perceived benefits and disadvantages, implications of TFGT and impact on surgical decision making. Interviews were transcribed verbatim and thematically analysed.

Results

Women expressed positive attitudes towards TFGT and felt it was highly relevant to their surgical decision making. They did not feel that an offer of TFGT shortly after, or at the time of diagnosis, added undue psychological burden. The majority of women interviewed felt that TFGT should be incorporated into standard clinical care.

Conclusions

TFGT is viewed favourably by women newly diagnosed with breast cancer. Future randomized controlled trials are needed to examine the long-term impact of TFGT. We conclude that an offer of TFGT is not perceived as ‘too much, too soon’ by relevant patients.     

Cancer patients’ willingness to answer survey questions about life expectancy

Purpose

This study aimed to determine the proportion and characteristics of radiation oncology outpatients who were willing to answer questions about their life expectancy.

Methods

A cross-sectional patient self-report survey was conducted using touch screen computers in Australian radiation oncology treatment centers. The primary outcome was the respondent’s willingness to complete a survey subsection about life expectancy. Demographic and disease characteristics were also collected, and level of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale.

Results

Of the 469 oncology outpatients who completed the survey, 327 (70?%; 95?% CI, 65?%, 74?%) indicated that they were willing to answer questions about life expectancy. Being female (p?<?0.001), older (p?<?0.05), born in Asia (p?<?0.05), and being diagnosed with cancer types other than breast and prostate cancer (p?<?0.01) were associated with lower odds of answering life expectancy questions.

Conclusions

The opportunity to opt-out of survey questions about sensitive issues such as life expectancy is a feasible method for accessing important information about patient preferences while minimizing burden. Further research may be needed to improve acceptability of life expectancy research to some patient groups.     

Racial disparities in traumatic stress in prostate cancer patients: secondary analysis of a National URCC CCOP Study of 317 men

Introduction

African American men have the highest rates of prostate cancer of any racial group, but very little is known about the psychological functioning of African American men in response to prostate cancer diagnosis and treatment.

Purpose

In this secondary analysis of a national trial testing a psychological intervention for prostate cancer patients, we report on the traumatic stress symptoms of African American and non-African American men.

Methods

This analysis includes 317 men (African American: n?=?30, 9%; non-African American: n?=?287, 91%) who were enrolled in the intervention trial, which included 12?weeks of group psychotherapy and 24?months of follow-up. Using mixed model analysis, total score on the Impact of Events Scale (IES) and its Intrusion and Avoidance subscales were examined to determine mean differences in traumatic stress across all time points (0, 3, 6, 12, 18, and 24?months). In an additional analysis, relevant psychosocial, demographic, and clinical variables were added to the model.

Results

Results showed significantly higher levels of traumatic stress for African American men compared to non-African American men in all models independently of the intervention arm, demographics, and relevant clinical variables. African Americans also had a consistently higher prevalence of clinically significant traumatic stress symptoms (defined as IES total score ??27). These elevations remained across all time points over 24?months.

Conclusions

This is the first study to show a racial disparity in traumatic stress specifically as an aspect of overall psychological adjustment to prostate cancer. Recommendations are made for appropriate assessment, referral, and treatment of psychological distress in this vulnerable population.