Death Ideation in Cancer Patients: Contributing Factors

Advances in cancer research and therapy have improved prognosis and the quality of life of many patients. However, previous epidemiological studies in oncologic patients have shown an increased risk of suicide. Suicidal thoughts, relatively well known in those terminally ill, may be just as important for cancer patients who are survivors or are living with the disease. Nonetheless, there is a relative paucity of data about suicidality in this setting. The authors conducted a prospective observational study to identify death thoughts and to explore the factors associated with suicidal ideation in cancer patients. A sample of 130 patients referred for psychiatric consultation was obtained following informed consent and authorization from the local ethics committee. A semistructured interview assessed sociodemographic data, psychosocial support, and information regarding the cancer process and its treatment. Psychometric instruments were used to evaluate psychopathology, namely the Hospital Anxiety and Depression Scale, the Beck Hopelessness Scale, and the Beck Scale for Suicide Ideation. Psychiatric diagnoses were obtained through the application of the Mini International Neuropsychiatric Interview. Death ideation was identified in 34.6% of patients, yet only 10% had active suicidal thoughts. Risk of suicide was associated with female gender, a psychiatric diagnosis (major depressive disorder, panic disorder, or dysthymia), difficult interpersonal relationships, associated pain, high hopelessness, and depressive and anxiety symptoms. Although suicidal thoughts are frequent in cancer patients at different stages of disease, most are transitory. Risk factors for suicidal ideation have been identified, such as depression, hopelessness, uncontrolled pain, and difficult interpersonal relationships. Further assessment is necessary to identify those at higher risk of attempting suicide, and underlying psychiatric disorders should be vigorously treated.     

Psychometric Properties of the Death Anxiety Scale (DAS) Among Terminally Ill Cancer Patients

Research conducted with the terminally ill population in relation to death anxiety is rare and mostly outdated. The purpose of this study was to evaluate the psychometric properties of the widely used Death Anxiety Scale (DAS) on a sample of terminal cancer patients. Additionally, validation studies of the DAS have exclusively used traditional statistical methods for analysis. The current study utilized an item response theory technique (IRT), namely the Rasch Rating Scale model for data analysis. The methodology employed may be useful for other researchers conducting validation studies from an IRT perspective.     

Peculiarities of Anxiety Score Distribution in Adult Cancer Patients

The goal of the present research is to investigate and analyze possible peculiarities of the psychological state of cancer patients undergoing treatment. Scores characterizing the trait and state anxiety were acquired using the Integrative Anxiety Test from four groups: adults with no appreciable disease, pregnant women, cancer patients examined during the specific antitumor treatment, and cancer patients brought into lasting clinical remission. Statistical analysis of the testing results revealed the bimodal type of the distribution of scores. The only statistically significant exception was the distribution of the state anxiety scores in cancer patients undergoing treatment that was clearly unimodal.     

林州地区食管癌、贲门癌患者抑郁、焦虑心理状况分析

[目的]描述林州地区食管癌、贲门癌患者在住院治疗期间社会支持、焦虑及抑郁状况.[方法]采用临床心理评定量表中社会支持评价量表(SSRS)、焦虑自评量表(SAS)与抑郁自评表(SDS)对80例食管癌患者,32例贲门癌患者和80例健康对照进行心理调查.[结果]调查发现,肿瘤患者普遍存在严重的心理问题,食管癌患者焦虑、抑郁发生率分别为31.25％、85.00％,焦虑及抑郁得分为(42.03=9.83)分、(61.78±8.56)分,贲门癌患者焦虑、抑郁发生率为43.80％、93.80％,焦虑及抑郁得分为(44.69±10.52)分、(63.71 ±7.04)分,显著高于对照组焦虑[(33.64±5.75)分,P＜0.001,P＜0.001]、抑郁水平[(38.97±7.70)分,P＜0.001,P＜0.001].社会支持方面,肿瘤患者的社会支持程度普遍低于对照组,其社会支持总分[食管癌(34.11±8.77)分、贲门癌(31.34±8.47)分]和社会支持利用率[食管癌(5.56± 1.92)分、贲门癌(5.00±1.80)分]显著低于正常对照组[(37.40±5.43)分,(6.70±1.84)分,P=0.005,P＜0.001];此外,焦虑心理与社会支持总分、主观社会支持、社会支持的利用率显著负相关(P＜0.001),但与抑郁情绪无显著相关关系(P＞0.05).[结论]肿瘤患者在治疗过程中存在严重的焦虑、抑郁情绪,适当的社会支持可帮助肿瘤患者缓解焦虑、抑郁的情绪,减轻心理压力.     

106例晚期肝癌死亡原因分析

目的 分析晚期肝癌患者的死亡原因.方法 回顾性分析我院6年间确诊的106例晚期肝癌患者的最终死亡原因.结果 106例晚期肝癌患者死亡原因是全身衰竭、恶病质,肝肾综合征,上消化道出血,肝性脑病,肝癌结节破裂出血等.结论 晚期肝癌患者的死亡是多种因素相互作用的结果.     

Variability in Anxiety and Depression Over Time Following Diagnosis in Patients with Prostate Cancer

To determine the presence and nature of variability in anxiety and depression in patients with prostate cancer (PCa) over 3 years following diagnosis, 442 patients with PCa completed standardized anxiety and depression inventories via survey between 1 and 36 months after receiving their initial diagnosis. Data were analyzed from a series of 3-month cohorts, and results indicated that total scores and incidence of clinically significant anxiety and depression varied over time, but that this variability was restricted to specific subfactors of anxiety and depression. Provision of effective psychological treatment to patients with PCa is discussed.     

Factors Associated with Place of Death in Koprean Patients with Terminal Cancer

Aim: To investigate factors that affect the place of death (POD) of terminal cancer patients. Materials andMethods: We recruited 702 consecutive patients (≥18 years) from 12 centers during July 2005 to October 2006,and 481 completed the questionnaire. In April 2011, we linked the data for 96.0% (n=462) of the deceased patientsto the POD using the 2005-2009 death certificate data of Korea’s National Statistical Office. The primary outcomevariable was POD, and the predictive value of variables pertaining to patients and caregivers was evaluatedusing univariate and multivariate analyses. Results: Most patients died in a hospital (91.5%, n=441) and age,education, preference for place of terminal care, wish to use hospice/palliative care services, terminal cancerawareness, time between diagnosis and death, and global quality-of-life subscale of the EORTC QLQ-C30 ofpatients, and education and preference for place of terminal care of caregivers were significant predictors inunivariate analyses. On multivariate analysis, patients and caregivers who preferred hospital/palliative care asthe terminal care option over home care [adjusted odds ratio (aOR), 2.68; 95% confidential interval (CI), 1.18-7.04 and aOR: 2.65; 95%CI: 1.15-6.09 for patient and caregiver preferences, respectively] and caregivers whowere highly educated (aOR, 3.19; 95%CI, 1.44-7.06) were predictors of POD. Conclusions: Most of the terminalcancer patients died in a hospital. Our findings indicate that major predictors of hospital deaths are preferenceof both the patient and caregiver for hospital/palliative care as the terminal care option and higher educationof the caregiver.     

Anxiety Disorders in Family Caregivers of Breast Cancer Patients Receiving Oncologic Treatment in Malaysia

Background: Anxiety is recognized as a normal psychological reaction of those caring for cancer patients. However, anxiety disorders in caregivers may interfere with their care-giving role and require further clinical attention. Objectives: To determine the prevalence and associated factors of anxiety disorders among caregivers of breast cancer patients receiving oncologic treatment in Kuala Lumpur Hospital. Methodology: A cross-sectional study was conducted on 130 caregiver-patient dyads, recruited by non-random sampling at Kuala Lumpur Hospital. Data were collected in 2 stages: 1) the caregivers were screened for psychological distress using the Depression, Anxiety, Stress, Scale (DASS-21) while other related factors for the patients and their caregivers were obtained; 2) the identified distressed caregivers (n=64) were then administered the Mini International Neuropsychiatric Interview (MINI) to diagnose anxiety disorders. Results: A total of 11.5% (n=15) of the caregivers reported suffering from anxiety disorders. Bivariate analysis found duration of caregiving (OR=3.31; CI=2.21-11.93), shared caregiving (OR=4.07; CI=1.34-12.36), and patients’ treatment type (OR=3.42; CI=1.92-12.76) were significantly associated with anxiety disorders (p value <0.05), with shared caregiving and patient’s treatment type remaining significant using logistic regression (p value < 0.05, R2 = 0.255). Conclusions: Every one in ten of the caregivers in this study had a diagnosable anxiety disorder, associated with certain care-giving factors and patients’ treatment. This should alert clinicians to such risk and indicates psychological support needs for family caregivers.     

Factors Contributing to Posttraumatic Growth and Its Buffering Effect in Adult Children of Cancer Patients Undergoing Treatment

This study examined relationships among demographic, clinical, and psychosocial variables in adult children of cancer patients. Two hundred and fourteen participants completed measures of posttraumatic growth (PTG), distress, posttraumatic stress disorder (PTSD) symptoms, social support, and family functioning. Significant gender differences in all PTG dimensions were found, as well as associations among PTG, gender, parental dependency, distress, PTSD, and family functioning. Social support was not a mediator in the relationship between gender and PTG. Gender, education, disease duration, dependency, distress, and family flexibility predicted PTG. Finally, PTG had a moderating effect in the relationship between distress and PTSD/social support. These results may guide psychosocial interventions in this population.     

Adherence to Capecitabine Treatment and Contributing Factors among Cancer Patients in Malaysia

Ensuring adherence to chemotherapy is important to prevent disease progression, prolong survival andsustain good quality of life. Capecitabine is a complex chemotherapeutic agent with many side effects that mightaffect patient adherence to treatment. This cross sectional study aimed to determine adherence to capecitabineand its contributing factors among cancer outpatients in Malaysia. One hundred and thirteen patients onsingle regime capecitabine were recruited from Hospital Sultan Ismail and Hospital Kuala Lumpur fromOctober 2013 to March 2014. Adherence was determined based on adherence score using validated MedicationCompliance Questionnaire. Patient socio-demographics, disease, and treatment characteristics were obtainedfrom medical records. Satisfaction score was measured using the validated Patient Satisfaction with Healthcarequestionnaire. The mean adherence score was 96.1% (standard deviation: 3.29%). The significant contributingfactors of adherence to capecitabine were Malay ethnicity [β=1.3; 95% confidence interval (CI): 0.21, 2.43; pvalue=0.020], being female [β=1.8; 95%CI: 0.61, 2.99; p value=0.003]), satisfaction score [β=0.08; 95%CI: 0.06,1.46; p value=0.035], presence of nausea or vomiting [β=2.3; 95%CI: 1.12, 3.48; p value <0.001] and other sideeffects [β=1.45; 95%CI: 0.24, 2.65; p value=0.019]. Adherence to capecitabine was generally high in our localpopulation. Attention should be given to non-Malay males and patients having nausea, vomiting or other sideeffects. Sufficient information, proactive assessment and appropriate management of side effects would improvepatient satisfaction and thus create motivation to adhere to treatment plans.     

A Randomized Trial of Hypnosis for Relief of Pain and Anxiety in Adult Cancer Patients Undergoing Bone Marrow Procedures

Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care. The hypnosis intervention reduced the anxiety associated with procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain. The authors explain this latter finding as indicating that the sensory component of a patient's pain experience may be of lesser importance than the affective component. The authors describe future studies to clarify their results and address the limitations of this study.     

术后乳腺癌患者焦虑、抑郁及生活质量分析

[目的]评价术后乳腺癌患者焦虑、抑郁和生活质量状况。[方法]采用一般调查问卷、生活质量测定量表、焦虑自评量表和抑郁自评量表对116例术后乳腺癌患者进行问卷调查。[结果]术后乳腺癌患者生活质量偏低,社会状况、情感状况、关注状况和生理状况得分均偏低。年龄、教育程度、婚姻状况、职业、家庭收入、病程、医疗费用等均与乳腺癌患者生活质量总分呈正相关,而肿瘤分期、焦虑总分、抑郁总分等与乳腺癌患者生活质量总分呈负相关。[结论]乳腺癌患者术后焦虑、抑郁情绪越严重,其生活质量越差。建议医护人员对乳腺癌患者加强疾病宣教、情绪疏导,促进其社会支持、提高乳腺癌患者的生活质量。     

基于SEER数据库的转移性结肠癌患者早期死亡预测列线图模型构建

目的构建预测转移性结肠癌(mCC)患者早期死亡的列线图模型。方法从SEER数据库中选择6669例符合条件的mCC患者。根据多因素Logistic回归中的危险因素构建列线图。通过C-index、校准曲线和临床决策曲线分析(DCA)评估列线图的预测性能。结果原发肿瘤位置、肿瘤分化、T分期、M分期、骨转移、脑转移、CEA、肿瘤大小、年龄和婚姻状态是mCC患者早期死亡的独立影响因素。基于这些变量构建列线图,C-index和校准曲线显示模型具有很好的预测能力,DCA曲线显示列线图可以使患者有较好的临床获益。结论该列线图具有良好的预测能力,能够帮助医生识别可能早期死亡的高危mCC患者,有助于制定个性化治疗策略。     

Depression and Anxiety Levels in Early Stage Turkish Breast Cancer Patients and Related Factors

Psychiatric disorders such as depression and anxiety are common among cancer patients. If left untreated,these disorders can lead to poor treatment compliance, prolonged hospital stay and reduced life quality. In thisprospective study, we aimed determine anxiety and depression levels and related factors among female breastcancer patients presenting to a breast surgery clinic in Istanbul and who met the inclusion criteria. Data werecollected using a questionnaire and the Hospital Anxiety and Depression Scale (HAD). The mean age was 48.2years and the mean post-operative period was 17.9 months. It was found that 46.3 % of the patients had stageI, and 53.7 % stage II, 59.3 % of them undergoing breast conserving surgery and 40.7 % mastectomy. Whenevaluated according to the HAD Scale, it was found that anxiety scores of 35.1 % of the patients and depressionscores of 17.1 % of the patients were higher than their cut-off points. With regard to the affecting factors,depression scores of those with no family history of breast cancer were significantly higher than those with nofamily history of breast cancer (t= 1.53; p= 0.03); that the depression scores of the patients who underwentmastectomy were significantly higher than those who underwent breast conserving surgery (t= 1.75; p= 0.04).Additionally, it was found that low income was an important risk factor for anxiety; whereas a history of breastcancer in the family and mastectomy was an important risk factor for depression.These results indicate theimportance of determining psychiatric problems and appropriate approaches in addition to medical treatmentin breast cancer patients.     

Assessment of Depression and Anxiety in Breast Cancer Patients: Prevalence and Associated Factors

Introduction: Having breast cancer or receiving treatment has been seen as a traumatic experience for women dueto its impacts on their self-image and sexual relationship, and may lead to an psychological reactions such as denial,anger, or intense fear toward their disease and treatment process. Also many of breast cancer patients have psychiatricmorbidities such as depression and anxiety. Purpose: The purpose of this study was to assess the prevalence andassociated factors of depression and anxiety in breast cancer patients, in order to identify independent predictors of mentalhealth disorders risk. Material and Methods: A cohort of 152 breast cancer patients who were attending an outpatientoncology department was recruited. Data were collected with a structured questionnaire consisted by social, clinicaland demographic information and PHQ-2 and GAD-2 scales. Results: The mean age of the patients was 53.25 years(SD=12.10), 69.7% of the patients underwent mastectomy and 30.3% ongectomy. Chemotherapy received 46.1% ofpatients as adjuvant therapy, 15.8% radiotherapy and 38.2% received both chemotherapy and radiotherapy. A largepercentage found to be classified as depressed (38.2%) and anxious (32.2%) and factors that found to be associatedwere age, marital status, educational level, stage of cancer from univariate analyses and place of residence, religion,symptoms burden from multivariate analysis (for depression and anxiety). Conclusions: Breast cancer patients arein high risk for developing psychiatric disorders such as depression and anxiety. Being rural resident, non-OrthodoxChristian and experiencing extend symptom burden can be predicting factors associated with depression and anxietyin breast cancer patients.     

盆腔恶性肿瘤患者抑郁、焦虑发生影响因素分析

[目的]探讨盆腔恶性肿瘤患者抑郁、焦虑的发病特点及其相关影响因素.[方法]采用Zung抑郁自评量表(SDS)、焦虑自评量表(SAS)及患者一般临床特征调查表对128例盆腔恶性肿瘤患者进行数据采集及相关因素分析.[结果] 128例盆腔恶性肿瘤患者中有抑郁障碍者87例(67.97％),平均得分62.61±6.97分.有焦虑者38例(29.69％),平均得分58.84±9.49分.Logistic回归多因素分析显示,抑郁、焦虑的发生率均与患者年龄、文化程度、医疗费用来源、临床分期、慢性癌痛呈显著相关性(P＜0.05),而与患者性别、KPS评分、日常锻炼无相关性.[结论]盆腔恶性肿瘤患者中抑郁和焦虑发生率较高.对于老年、肿瘤晚期、伴有慢性癌痛等因素的患者,需要进行心理—生理方面的综合干预.     

晚期肺癌患者肺部感染死亡危险因素分析

目的 分析肺癌伴肺部感染患者死亡的相关危险因素。方法　回顾2010年1月—2017年5月收治的186例晚期肺癌患者临床资料,其中肺部感染死亡者52例,并收集肺部感染死亡的相关危险因素。结果　晚期肺癌患者肺部感染死亡率为27.96%（52/186）。在诸多因素中,年龄（P=0.039）、BMI值（P=0.000）、组织分化程度低（P=0.003）、功能状态评分（P=0.022）、转移部位≥3（P=0.029）、合并症（P=0.034）、多重耐药菌感染（P=0.000）、血红蛋白浓度<90 g/L（P=0.014）等在死亡组和非死亡组之间差异具有统计学意义。结论　年龄（≥60岁）、BMI值（<20 kg/m²）、组织分化程度（低）、抗肿瘤治疗药物（≥3种）、靶向药物治疗、转移部位（≥3）、合并症、多重耐药菌感染、血红蛋白浓度（<90 g/L）等是晚期肺癌患者肺部感染死亡的主要危险因素。     

乳腺癌围手术期突发肺事件及猝死8例临床分析

目的：探讨腺癌患者术中，术后发生猝死的原因及预防抢救措施。方法：对1991年至2000年底乳腺癌患者术中，术后发生的猝死及心肺事件8例进行回顾性临床多因素分析。结果：猝死原因：1）急性心肌梗死；2）急性肺梗塞；3）原发性室颤。结论：乳腺癌患者术中，术后猝死及突发心肺重症疾患与术前诸危险因素有关：心肌缺血、高血压、QTd增加、血高凝状态、心脏病史。     

晚期癌症患者硬膜外自控镇痛(PECA)疗效观察

目的：为更好地治疗晚期癌痛患者,特别是剧烈的顽固性疼痛。方法：我们引进和采用了硬膜外自控镇痛的方法ＰａｔｉｅｎｔＥｐｉｄｕｒａｌＣｏｎｔｒｏｌｌｅｄＡｎａｌｇｅｓｉａ（ＰＥＣＡ）,观察了２２例疼痛交剧烈的患者,其虽经不同途径使用大剂量阿片类药物,但未能很好地控制疼痛。同时毒副作用较大,对此采用ＰＣＡ方法用于以上患者的除８痛,在减少阿片类药物用量的同时使除痛效果明显提高。注射液浓度依病程长短焦部位及     

Anxiety and Pain in Surgically Treated Breast Cancer Patients

The aim of the study was to evaluate the level of anxiety and pain in women with breast cancer. Patientswho had been treated with modified radical mastectomy or breast conserving surgery were included. Datawere gathered using the state-trait anxiety inventory and the visual analog scale. The pain levels and analgesicconsumption of the patients were evaluated after surgery. The study sample consisted of 150 women. The meanage of the participants was 50.54±10.02. Most of the patients (58%) received breast conserving surgery. Themean state anxiety score was 44.74±11.91, and the mean trait anxiety score was 48.78±9.48 before surgery. Themean pain level on the first day following surgery was 3.26±1.91 and analgesic consumption was 2.98±1.08.There was no correlation between patient pain and anxiety levels. There was very slightly positive correlationbetween trait anxiety and total analgesic consumption. Assessing the levels of anxiety in breast cancer patientsbefore surgery may contribute to the determination of postoperative pain.