Quality of life and symptom attribution in long-term colon cancer survivors

Aims and objectives This study investigates how long‐term colon cancer survivors evaluate their health, functional status and quality of life, and whether there are differences based on age, gender or ethnicity. Methods Thirty long‐term survivors of at least stage I colon cancer were interviewed in person between December 2004 and May 2005. The interview protocol included the Medical Outcomes Study 36‐Item Short Form, Quality of Life – Cancer Survivor, and study‐specific questions that asked about physical and non‐physical problems they attributed to colon cancer. Results Substantial percentages of survivors attributed their problems with lack of energy (83%), sexual functioning (67%), bowel problems (63%), poor body image (47%) and emotional problems (40%) to having had colon cancer. Of those problems attributed to colon cancer, sexual functioning and pain were given the highest severity rankings by survivors. The majority of long‐term colon cancer survivors reported distress regarding future diagnostic tests, a second cancer, and spread of cancer. Women reported greater problems completing daily activities as a result of physical problems (P = 0.003) and more pain (P = 0.07) than men. African Americans appear to report marginally better overall quality of life (P = 0.07) and psychological well‐being than whites (P = 0.07). Conclusion The majority of long‐term colon cancer survivors with resected colon cancer and disease‐free for 5 years reported problems with low energy, sexual functioning and bowel problems.     

Psychological Distress in Bereaved Caregivers of Patients With Advanced Cancer

ContextIndividuals caring for patients with advanced cancer (caregivers) experience psychological distress during the patient's illness course. However, data on the prevalence of bereaved caregivers' psychological distress and its relationship with the quality of patient's end of life (EOL) care are limited.ObjectivesTo describe rates of depression and anxiety symptoms in bereaved caregivers of patients with advanced cancer and to understand the relationship between these outcomes and patient distress at the EOL.MethodsWe conducted a secondary analysis of 168 caregivers enrolled in a supportive care trial for patients with incurable lung and gastrointestinal cancers and their caregivers. We used the Hospital Anxiety and Depression Scale to assess caregivers' depression and anxiety symptoms at three months after the patient's death. Caregivers also rated the patient's physical and psychological distress in the last week of life on a 10-point scale three months after the patient death. We used linear regression adjusting for caregiver age, sex, randomization, and cancer type to explore the relationship between bereaved caregivers' depression and anxiety symptoms and their ratings of physical and psychological distress in patients at the EOL.ResultsOf the 168 bereaved caregivers, 30.4% (n = 51) and 43.4% (n = 73) reported clinically significant depression and anxiety symptoms, respectively. Caregiver ratings of worse physical (B = 0.32; P = 0.009) and psychological (B = 0.50; P < 0.001) distress experienced by the patient at the EOL were associated with worse depression symptoms in bereaved caregivers. Only caregiver rating of worse psychological distress experienced by the patient at the EOL (B = 0.42; P < 0.001) was associated with worse bereaved caregivers' anxiety symptoms.ConclusionMany bereaved caregivers of patients with advanced cancer experience symptoms of depression and anxiety, which are associated with their perceptions of distress in their loved ones at the EOL.     

卵巢癌患者可修饰性心理困扰影响因素及其与生存质量的相关性分析

目的分析卵巢癌患者可修饰性心理困扰影响因素及其与生存质量相关性。方法采用便利抽样法,选取2017年9月~2019年3月我院收治的卵巢癌患者262例,分析患者可修饰性心理困扰率、困扰程度、生存质量及心理困扰与生存质量的相关性。采用多因素Logistic回归分析可修饰性心理困扰影响因素。结果262例卵巢癌患者中,可修饰性心理困扰低状态126例(48.09%)、中等状态108例(41.22%)、高等状态28例(10.69%),生存质量良好118例(45.04%)、不佳144例(54.96%)。单因素分析结果显示,文化程度、独居、家庭月收入、肿瘤分期、社会支持度、疾病认知度、自我效能感、应对方式、生存质量比较,差异有统计学意义(P<0.05)。多因素Logistic分析结果显示,社会支持度、疾病认知度、自我效能感、应对方式、生存质量是卵巢癌患者可修饰性心理困扰处于中高状态的风险因素(P<0.05)。且可修饰性心理困扰状态与生存质量互为负相关关系(P<0.05)。结论卵巢癌患者可修饰性心理困扰影响因素多样,而弱化或消除影响因素利于减轻心理困扰,有助于改善生存质量,生存质量的改善又可缓解可修饰性心理困扰,促进良性循环形成。     

克罗恩病患者焦虑抑郁状况及其影响因素分析

目的 分析克罗恩病（Crohn’s disease, CD）患者的焦虑和抑郁状况、相关影响因素及其对患者健康生命质量的影响。方法 选择2021年2月至2022年2月就诊于复旦大学附属中山医院的CD患者共100例,采集其人口学资料及疾病相关信息。研究对象填写焦虑自评量表(SAS)、抑郁自评量表（SDS）、患者报告结局（PRO）、炎症性肠病患者生活质量问卷（IBDQ）和慢性病治疗功能评估-疲劳量表（FACIT-F）。采用卡方检验和logistic回归分析焦虑、抑郁相关影响因素;采用独立样本t检验分析焦虑、抑郁对IBDQ和FACIT-F评分的影响。结果 CD患者合并焦虑、抑郁的比例明显高于健康对照组（焦虑：58.0%vs 9.4%,P<0.001;抑郁：43.0%vs 11.8%,P<0.001）,SAS和SDS评分升高。患者为女性、具有肠外表现、疾病处于活动期（PRO2=1）为焦虑危险因素（P<0.05）;文化程度较高和疾病处于活动期（PRO2=1）是抑郁危险因素（P<0.05）。具有焦虑和抑郁情绪患者的IBDQ和FACIT-F评分明显降低（P<0.05）。结...     

Demographic,medical, and psychosocial correlates to CAM use among survivors of colorectal cancer

Goals of work Complementary and alternative medicines (CAM) use among cancer patients is becoming more prevalent; however, our understanding of factors contributing to patients’ decisions to participate in CAM is limited. This study examined correlates of CAM use among colorectal cancer (CRC) survivors, an understudied population that experiences many physical and psychological difficulties. Materials and methods The sample was 191, predominantly white, CRC survivors (mean age = 59.9 ± 12.6) who were members of a colon disease registry at a NYC metropolitan hospital. Participants completed assessments of sociodemographic characteristics, psychosocial factors [e.g., psychological functioning, cancer specific distress, social support (SS), quality of life (QOL)], and past CAM use (e.g., chiropractic care, acupuncture, relaxation, hypnosis, and homeopathy). Main results Seventy-five percent of participants reported using at least one type of CAM; most frequently reported was home remedies (37%). Younger (p < 0.01) or female patients (p < 0.01) were more likely to participate in CAM than their older male counterparts. Among psychosocial factors, poorer perceived SS (p = 0.00), more intrusive thoughts (p < 0.05), and poorer overall perceived QOL (p < 0.05) were associated to CAM use. In a linear regression model (including age, gender, SS, intrusive thoughts, and perceived QOL), only age remained a significant predictor of CAM use. Conclusion These findings demonstrate that CAM use is prevalent among CRC survivors and should be assessed routinely by providers. CAMs may serve as a relevant adjunct to treatment among CRC patients as well as an indication of need for additional SS, especially among younger patients.     

Predicting psychological distress of informal carers of individuals with major depression or bipolar disorder

Caring for someone with a mental illness is associated with high levels of burden and psychological distress. Understanding these factors could be important to prevent the development of physical and mental health problems in carers. The purpose of the present study was to determine the contribution of coping styles and social support in predicting the psychological distress reported by informal carers (IC) of individuals with major depression or bipolar disorder. IC (n = 72) of adults with a diagnosed depressive illness were recruited from mental health organizations within the community setting. Carers completed the General Health Questionnaire, Brief COPE, and Social Support Questionnaire. Multiple linear regression analysis revealed that 63% of the variance in psychological distress could be accounted for by adaptive and maladaptive coping styles and perceived quantity and satisfaction with social support. Satisfaction with social support (β = ?0.508, P < 0.001) and maladaptive coping (β = 0.369; P < 0.001) were significant predictors of psychological distress. These findings suggest that interventions should consider coping styles, specifically the interaction between maladaptive behaviours and enhancement of quality of support, to assist carers to manage psychological distress, especially earlier in the caring role.     

Correlation between clinical features and circulating levels of soluble intercellular adhesion molecule-1 in Hodgkin's disease

Summary Previous reports have suggested soluble intercellular adhesion molecule-1 as a marker of disease activity in Hodgkin's disease. In the present study we investigated serum levels of intercellular adhesion molecule-1 at diagnosis in 104 patients with Hodgkin's disease and in 77 of these patients following the achievement of complete remission (within 12 months of diagnosis). Mean serum levels at diagnosis were significantly higher in patients than in controls (P<0.0001) and were related to advanced stages of disease (P=<0.0001) presence of “B” symptoms (P<0.0001), abnormality of laboratory indexes (P<0.0001), erythrocyte, sedimentation rate values (r=0.41,P<0.0001) and serum levels of soluble interleukin-2 receptor α chain (r=0.51,P<0.0001). Mean values in complete remission were significantly lower than at diagnosis (P=0.003). Lower mean values at diagnosis were detected in 30 patients with advanced disease who attained complete remission, compared with 6 patients who failed to attain complete remission with standard treatment. We conclude that in Hodgkin's disease, high serum levels of soluble intercellular adhesion molecule-1 are detectable at presentation and strictly correlate with some clinical features. Response to treatment is paralleled by reduced serum levels. Larger prospective studies are needed to evaluate the possible prognostic significance of serum levels of soluble intercellular adhesion molecule-1 at diagnosis.     

Relationship between quality of life and mood in long-term survivors of breast cancer treated with mastectomy

 This study sought to compare the mood and quality of life (QOL) of breast cancer survivors with those observed in low-risk breast cancer screening patients. A group of long-term stage I–III breast cancer survivors (n=60) was compared with low-risk breast cancer screening patients (n=93) on measures of depression, anxiety, and QOL. Patients without a previous psychiatric history were studied. Although the groups differed in age and education, correlations performed between age, education, and the outcome measures showed no association of age and education with the outcome measures. Breast cancer patients with stage III disease showed significantly poorer functioning in all areas except family than did other breast cancer patients; however, when compared with the breast cancer screening group, they showed higher QOL scores in several domains. Higher mood scores were correlated with poorer scores in all QOL areas except family functioning in the breast cancer group. Only significantly elevated depression scores correlated with poorer QOL areas in the breast cancer screening group. The psychological measures were found to be more robust predictors of QOL than the demographic variables in both the cancer and the screening patients. These results suggest that long-term survivors of breast cancer continue to experience significant stress and emotional distress, as evidenced by increased depression and lower QOL functioning.     

Cross-sectional survey of the health behaviour of southeast Queensland women with cancer-treatment induced menopause: Implications for cancer and primary care nurses

PurposeWomen who experience cancer treatment-induced menopause are at risk of long-term chronic morbidity. This risk can be prevented or offset with adherence to health promotion and risk reduction guidelines. The purpose of this study was to explore health behaviours in younger female survivors of cancer and the variables (quality of life and psychological distress) believed to moderate health behaviours.DesignCross-sectional survey of a convenience sample of women (n = 85) in southeast Queensland.MethodsHealth behaviour and health status were elicited with items from the Australian Health Survey and the Behavioural Risk Factor Surveillance System. The WHO Quality of Life (Brief) measured participants’ self-reported quality of life and their satisfaction with their health. The Brief Symptom Inventory-18 measured psychological distress.FindingsHigher self-reported health status was associated with regular exercise and better quality of life. However, a substantial proportion of participants did not engage in the physical activity, dietary or cervical screening practices recommended by Australian guidelines.ConclusionsThe participants require education regarding the benefits of diet, exercise, weight loss and decreased alcohol intake, as well as information on future health risks and possible comorbidities. These education sessions could be addressed by a nurse-led health promotion model of care at the time of discharge or in the community.     

Evaluation of a screening programme for psychological distress in cancer survivors

Purpose

This study is aimed at evaluating the feasibility of a screening procedure for psychological distress in cancer survivors.

Methods

Consecutive series of 339 cancer patients from three centres were requested to fill in two questionnaires measuring psychological distress (PDI) and social support (MOSS). Psychological intervention was offered to patients with significant degree of distress.

Results

Most patients accepted to be screened (72.0%; n?=?244), and a subgroup (16.0%) showed high psychological distress. A higher ratio of distressed patients was observed among those with lower social support (P?=?0.017). A significant (P?<?0.01) negative correlation between psychological distress and social support was observed. A psychological intervention was offered to patients with high psychological distress, but only 15.6% completed it.

Conclusions

Results from this study provide both some insights into the characteristics of psychological distress and some input on issues that may arise when implementing a screening procedure for psychological distress in cancer survivors. Further research is needed to assess both the clinical significance of distress and the most appropriate tools to carry out screening procedures within the target population.     

经黏膜下隧道憩室间脊切开术治疗食管憩室患者的生存质量分析

目的:探讨经黏膜下隧道憩室间脊切开术(submucosal tunneling endoscopic septum division, STESD)对食管憩室患者生存质量的改善情况。方法:回顾性分析2016年4月至2018年4月在复旦大学附属中山医院接受STESD治疗的11例食管憩室患者的临床资料,包括术前术后的食管造影和内镜检查资料、术前及术后5个月SF-36量表评分。结果:出现黏膜损伤2例,无严重并发症。3例(27.3%)在最后一次随访时症状消失,7例(63.6%)症状得到缓解。术前、术后SF-36量表总分分别为(116.0±23.6)分和(135.1±9.0)分(P=0.014)。所有患者术后的一般健康状况、精力和精神健康状况均较术前均有显著改善(P=0.003,P=0.006,P=0.037)。结论:STESD是一种安全有效的内镜微创手术,能有效提高食管憩室患者的生存质量。     

Informing future research priorities into the psychological and social problems faced by cancer survivors: A rapid review and synthesis of the literature

PurposeTo establish what is known regarding the psychological and social problems faced by adult cancer survivors (people who are living with and beyond a diagnosis of cancer) and identify areas future research should address.MethodA rapid search of published literature reviews held in electronic data bases was under taken. Inclusion and exclusion criteria, and removal of duplicated papers, reduced the initial number of papers from 4051 to 38. Twenty-two review papers were excluded on grounds of quality and 16 review papers were selected for appraisal.ResultsThe psychological and social problems for cancer survivors are identified as depression, anxiety, distress, fear of recurrence, social support/function, relationships and impact on family, and quality of life. A substantial minority of people surviving cancer experience depression, anxiety, and distress or fear associated with recurrence or follow up. There is some indication that social support is positively associated with better outcomes. Quality of life for survivors of cancer appears generally good for most people, but an important minority experience a reduction in quality of life, especially those with more advanced disease and reduced social and economic resources. The majority of research knowledge is based on women with breast cancer. The longer term implications of cancer survival have not been adequately explored.ConclusionsFocussing well designed research in the identified areas where less is already known about the psychological and social impact of cancer survival is likely to have the greatest impact on the wellbeing of people surviving cancer.     

Exploring the experience of psychological morbidity and service access in community dwelling stroke survivors: a follow-up study

Abstract

Purpose: Post-stroke depression occurs in one-third of stroke survivors with a similar risk of development across short, intermediate and long-term recovery stages. Knowledge of factors influencing psychological morbidity beyond the first year post-stroke can inform long-term interventions and improve community service access for stroke survivors. This paper aimed to identify the physical and psycho-social functioning status of stroke survivors beyond 12 months post-stroke. Qualitative processes explored the longer term experiences of psychological morbidity and service access needs. Method: A cross-sectional follow-up of participants from a prospective cohort study. In that study, patients and were followed for 12 months post-stroke. In this study, participants from that cohort study were interviewed up to five years post-stroke. Data generation and analysis were concurrent and were analysed thematically, employing a process of constant comparison. Results: Our sample included 14 participants, aged 58–89 years at an average of three years post-stroke (range 18 months to five years). Our qualitative key themes emerged as follows: physical impacts on post-stroke psychological morbidity, the experience of psychological distress, factors attenuating distress and service delivery implications. Conclusions: The experience of psychological morbidity persists beyond 12 months post-stroke, having a profound impact on community access, and social participation. Clinical implications are a need for long-term psychological monitoring post-stroke and for ongoing rehabilitation that addresses disability, community participation and social support.

• Implications for Rehabilitation

• Psychological distress post-stroke is complex and persists over time, thus requiring longer term monitoring beyond the first 12 months of stroke onset.

• Longer term access to allied health can play a significant role in providing interventions that address distress and maintain community participation.

• If patients meet threshold scores at any time, then GPs should consider initiating appropriate treatment, including pharmacotherapy, referral to psychotherapy and referral to community stroke rehabilitation.

     

Development and evaluation of a problem-focused psychosocial intervention for patients with head and neck cancer

Goals of the work  Patients with head and neck cancer have complex needs that affect many basic functions of life and contribute to substantial psychosocial problems. The aim of this study was to evaluate the effectiveness of a problem-focused intervention for patients with psychosocial dysfunction who had completed treatment for head and neck cancer. Patients and methods  Using a quasi-experimental design, 54 participants who were above pre-determined cutoff points for psychosocial dysfunction (hospital and depression scale, work and social adjustment scale) were given the opportunity to self-select into either the experimental group for the psychosocial intervention programme which was delivered in an individualised format, with bibliotherapy as an adjunct, or the control group for usual care. Main results  Analysis of covariance results demonstrated a reduction in psychological distress (anxiety, p = 0.001; depression, p = 0.005), improving social functioning (p = 0.048) and quality of life scores (p = <0.05) for the experimental group, all of which were sustained into the 3-month follow-up period. No such improvements were evident for the control group. Conclusions  This study suggests that head and neck cancer patients with post-treatment psychosocial dysfunction can benefit from a problem-focused psychosocial intervention. Such evidence can inform practice, policy and future research, aimed at improving post-treatment quality of life for patients with head and neck cancer.     

Patient-reported family distress among long-term cancer survivors

Two quality of life studies at the University of Nebraska Medical Center and 3 similar studies in the nursing literature were compared regarding family distress to illness scores as reported by long-term cancer survivors. All studies were cross-sectional mail surveys and used City of Hope National Medical Center questionnaires. Participants represented a broad range of survivorship in terms of diagnosis and length of survival (range of means 3Y8 years). Single-item scores were compared among participants regarding the item "How distressing has your illness been for your family?" Significant levels of patient-reported family distress to illness were reported in all 5 studies. Patient survivors may have been able to recall past levels of significant family distress despite prolonged survival or they may have reported significant ongoing family distress as a result of their disease and treatment. Longitudinal assessment of patients' and families' quality of life is essential throughout survivorship. Future studies should identify and compare the types distress experienced by patient survivors and families over time and also measure the intensity of their distress. Interventions designed to meet their individual and collective needs, thereby decreasing their distress, are needed to improve quality of life for survivors and families.     

Longitudinal screening and management of fatigue,pain, and emotional distress associated with cancer therapy

Goals of work Fatigue, pain, and emotional distress are common symptoms among patients with cancer. We sought to learn about patient perceptions of these symptoms and their treatment. Materials and methods At a baseline assessment and two monthly follow-up assessments, we asked a diverse sample of patients with solid tumor or lymphoma (N = 99) about their fatigue, pain and distress, their treatment for these symptoms, and their satisfaction with treatment via standardized questionnaires and semistructured interviews. Main results In this observational study, patients reported fatigue, pain, emotional distress, and general quality of life at expected levels. Across all assessments, at least half of our sample experienced at least some fatigue, pain, or distress. On the whole, patients and providers do communicate about these concerns, and at least 75% of patients found these discussions helpful when they occurred. Conclusions Improved symptom identification and communication may optimize the detection of those at risk of morbidity and decreased quality of life because of excess symptom burden.     

The burden and impact of severe and long-term sequelae of meningococcal disease

This review describes current knowledge on the severity and long-term sequelae of meningococcal disease (MD) specifically. The literature databases Medline and Embase were used by combining search terms for MD and Neisseria meningitidis with terms for severity, mortality and sequelae. Case fatality for sufferers of MD remains high, typically 5–10%, despite the best medical care. Long-term sequelae in survivors may include physical, neurological, cognitive, behavioral and psychological consequences, such as hearing loss, amputations, skin scarring and neurodevelopmental deficits. A significantly lower quality of life is seen in survivors of MD compared with unaffected controls, with detrimental effects of childhood MD continuing into adulthood. MD carries a substantial risk of long-term sequelae and mortality. This should be recognized by physicians treating patients with this disease and lends support for the implementation of preventative measures such as vaccination.     

Depression and the use of complementary medicine among breast cancer patients

This was a cross-sectional study to examine the association between anxiety, depression and quality of life and the use of complementary and alternative medicine. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS), and quality of life was measured using the global quality of life subscale selected from the European Organization for Treatment and Research of Cancer (EORTC) quality of life core questionnaire (QLQ-C30). In all, 177 breast cancer patients were studied, and 32% (n=57) reported that they used or were using complementary medicine. Users and nonusers did not differ significantly in almost all variables studied, with the exception of duration of their diagnosis. The most commonly used complementary medicine was prayer and spiritual healing (n=45, 73.8% of responses). Performing the logistic regression analysis controlling for age, marital status, educational level, knowledge of diagnosis, time since diagnosis, global quality of life, depression, and anxiety scores, the results indicated that the use of complementary medicine among breast cancer patients was associated with sever depression (odds ratio 2.49, 95% CI 1.06–5.89, P 0.04). The other variables studied did not show any significant results. The study findings confirm that the use of complementary medicine is more common among depressed breast cancer patients and might be a marker of greater psychological distress in this group of patients.The preliminary results of this study was presented at the 4th European Breast Cancer Conference, Hamburg, Germany, 16–20 March 2004