Posttraumatic stress symptoms in young people with cancer and their siblings: results from a UK sample

Abstract

Purpose: This study investigated levels of posttraumatic stress symptoms (PTSS) in children with cancer and their siblings from a British sample. It also examined aspects of the Ehlers and Clark¹ Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Beh Res Therapy. 2000;38(4):319–345.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar] model of posttraumatic stress disorder in the current population.

Methods: Sixty participants (34 children with cancer and 26 siblings) aged between 8 and 18?years completed measures of PTSS, maladaptive appraisals, trauma-centered identity, perceived social support and family functioning.

Results: Over a quarter of the sample scored above the clinical cutoff on the Impact of Events Scale-Revised. No differences were observed between patients and siblings with respect to levels of PTSS. Maladaptive appraisals and age were found to account for unique variance in levels of PTSS for the overall sample.

Conclusions: Rates of PTSS in the sample were relatively high. Support was found for aspects of the Ehlers and Clark¹ Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Beh Res Therapy. 2000;38(4):319–345.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar] model in explaining PTSS for the current population.     

Burden,emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study

This study was conducted to explore the interrelationships among caregiver burden, emotional status and quality of life (QoL) in caregivers of lung cancer patients, and to identify whether caregiver burden and health status are associated with patient emotional status and QoL. Forty‐three dyads of lung cancer patients and their caregivers were included for analysis. Caregiver‐reported outcomes were measured by Caregiver Burden Scale (CBS), Caregivers Quality of Life Index‐Cancer (CQOLC) and Hospital Anxiety and Depression Scale (HADS), while patient‐reported outcomes were collected by HADS and Lung Cancer Symptom Scale (LCSS). The majority of the CBS and CQOLC scores were significantly higher in anxious and depressed caregivers than non‐anxious and non‐depressed caregivers (p < .01 or .05). Caregivers of depressed patients experienced significantly greater emotional distress than those of non‐depressed patients (p < .01). Significantly positive associations were identified among most of the CBS, CQOLC and caregiver HADS scores. Patient LCSS scores were positively correlated with the CBS and caregiver HADS scores, and patient HADS scores were also positively related to caregiver HADS scores. The close interrelationships between caregiver and patient health outcomes provide evidence that lung cancer patients and their caregivers should be viewed as a unit in future supportive service models.     

The association of metacognitive beliefs with emotional distress and trauma symptoms in adolescent and young adult survivors of cancer

ABSTRACT

Purpose/Objectives: Adolescent and young adults who have survived cancer are at an increased risk of psychological distress. This study investigated whether metacognitive beliefs are associated with emotional distress and trauma symptoms in adolescent and young adult (AYA) survivors of cancer independent of known covariates, including current physical health difficulties. Design: Cross-sectional survey using multiple self-report measures. Sample and Methods: Eighty-seven AYA survivors of cancer were recruited from follow-up appointments at an oncology unit and completed self-report questionnaires measuring emotional distress, posttraumatic stress symptoms, metacognitive beliefs, demographic information, and current physical health difficulties. Data were analysed using correlational and hierarchical multiple regression analyses. Findings: Metacognitive beliefs explained an additional 50% and 41% of the variance in emotional distress and posttraumatic stress symptoms, respectively, after controlling for known covariate effects, including current physical health difficulties. Conclusions/Implications for Psychosocial Providers or Policy: The metacognitive model of psychopathology is potentially applicable to AYA survivors of cancer who present with elevated general distress and/or posttraumatic stress symptoms. Prospective studies are required to determine whether metacognitive beliefs and processes have a causal role in distress in AYA survivors of cancer.     

Subjective,but not objective,cognitive complaints impact long-term quality of life in cancer patients

Objectives: Cognitive complaints, of objective or subjective nature, may negatively impact cancer patients’ quality of life (QoL). Further, the early detection of cognitive alterations may lead to an improved QoL. However, the content of such screening is yet unclear. This paper presents long-term QoL data of cancer patients treated with curative intent and its relation with objective and subjective cognitive complaints, and patient-reported outcome measures (PROMs).

Methods: QoL data, measured by the EORTC QLQ C-30, were obtained at baseline, 6 (T1), 12 (T2), and 24?months (T3) after treatment start, and compared between patients with and without objective and subjective cognitive complaints. The predictive value of PROMs was also examined.

Results: QoL data at baseline was collected in 125 patients. Response rates at T1, T2, and T3 were 84.7%, 81.5%, and 83.1%, respectively. Eighty-nine patients returned their QoL questionnaires at all times. Baseline subjective cognitive complaints had a stronger association with worse scores on patients’ overall QoL and QoL subscale scores than objective cognitive complaints. An exploratory analysis into the value of PROMs in predicting long-term QoL at T3 revealed a significant effect for the Hospital Anxiety and Depression Scale-Depression and FACIT Fatigue scale.

Conclusions: Self-perceived cognitive alterations are negatively associated with patients’ overall QoL. As these troubles may already be present at baseline, oncology nurses should screen for the early signs of subjective cognitive complaints by use of PROMs, in order to refer the patient to proper intervention programs which may lead to an improved long-term QoL and faster reintegration into society.     

Predicting social withdrawal,anxiety and depression symptoms in pediatric brain tumor survivors

Objective: Pediatric brain tumor survivors (PBTSs) are at risk for impairments in social adjustment and psychological distress. This study investigated longitudinal associations between symptoms of social withdrawal and anxiety/depression in PBTS, as well as medical, demographic, and personal characteristics that may also influence reports of social withdrawal and anxiety/depression.

Method: About 91 PBTS (51% male, mean age 11.21?years, off-treatment) participated. At baseline and 8?months follow-up, primary caregivers of PBTS completed measures of social withdrawal, anxiety, and depression symptoms. Medical information (e.g. tumor type and location, cranial irradiation therapy) and child personal characteristics (e.g. child’s age and gender, executive function, social skills) were obtained at baseline.

Results: Baseline reports of depression symptoms and social skills predicted social withdrawal 8?months later. Social withdrawal at baseline predicted greater combined anxiety and depression symptoms 8?months later. Depression alone predicted greater anxiety symptoms at follow-up. Anxiety symptoms and poor global executive functioning predicted greater depression symptoms at follow-up.

Conclusions: The social adjustment and psychological distress of PBTSs are interrelated and can influence each other across time. These findings support the importance of multifaceted interventions targeting both psychological distress and social adjustment, in order to support the optimal psychosocial adjustment of PBTSs.     

Adjusting to life after treatment: distress and quality of life following treatment for breast cancer

Clinical and anecdotal findings suggest that the completion of cancer treatment may be marked by heightened distress and disrupted adjustment. The present study examined psychological adjustment during the 3 months following treatment among 89 women with stages 0-III breast cancer. Participants completed measures of depression, cancer-related anxiety, cancer concerns, and quality of life at three time points: during treatment, 3 weeks following the end of treatment, and 3 months post-treatment. Post-treatment scores were suggestive of good psychological adjustment among the majority of women. Moreover, distress did not increase following treatment; longitudinal analyses showed no significant changes in depression or recurrence worry, while intrusive thoughts decreased, and quality of life improved. Younger age predicted greater distress across measures. A history of depression or anxiety predicted greater depressive symptomatology, while more extensive treatment predicted greater cancer-related anxiety. Despite the lack of distress endorsed on general depression and anxiety indices, participants reported moderate distress associated with cancer-related concerns, including physical problems, fear of cancer recurrence, and resuming normal life. In sum, while breast cancer survivors demonstrate good adjustment on general distress indices following treatment, some women are at risk for sustained distress. Moreover, significant cancer-related concerns are prevalent and may be important intervention targets.     

Long-term wellbeing and neurocognitive functioning of diffuse low-grade glioma patients and their caregivers: A longitudinal study spanning two decades

BackgroundWhile patients with diffuse low-grade glioma (LGG) often survive for years, there is a risk of tumor progression which may impact patients’ long-term health-related quality of life (HRQOL) and neurocognitive functioning (NCF). We present a follow-up of LGG patients and their informal caregivers (T3) who took part in our previous HRQOL investigations (T1, M = 7 and T2 M = 13 years after diagnosis).MethodsParticipants completed HRQOL (short form-36 health survey [SF-36]; EORTC-BN20), fatigue (Checklist Individual Strength [CIS]), and depression (Center for Epidemiological Studies-Depression [CES-D]) questionnaires and underwent NCF assessments. T3 scores were compared with matched controls. Changes over time (T1–T2–T3) on group and participant level were assessed. Where available, histology of the initial tumor was revised and immunohistochemical staining for IDH1 R132H mutant protein was performed.ResultsThirty patients and nineteen caregivers participated. Of N = 11 with tissue available, 3 patients had confirmed diffuse LGG. At T3, patients (M = 26 years after diagnosis) had HRQOL and NCF similar to, or better than controls, yet 23.3% and 53.3% scored above the cut-off for depression (≥16 CES-D) and fatigue (≥35 CIS), respectively. Caregivers’ HRQOL was similar to controls but reported high rates of fatigue (63.2%). Over time, patients’ mental health improved (P < .05). Minimal detectable change in HRQOL over time was observed in individual patients (30% improvement; 23.3% decline; 20% both improvement and decline) with 23.3% remaining stable. NCF remained stable or improved in 82.8% of patients.ConclusionsWhile HRQOL and NCF do not appear greatly impacted during long-term survivorship in LGG, depressive symptoms and fatigue are persistent.     

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。     

Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre

The purpose of the present study is to determine the impact of illness characteristics and psychopathological comorbidity on the quality of life (QoL) of radio-oncological patients in health-related and individual dimensions. Sixty-three of 93 eligible patients (40 women and 23 men) were included in the study during their radiation therapy visit to an outpatient centre annexed to a community hospital in Southern Bavaria, Germany. In a semi-structured interview, we elicited individually relevant life domains rated by the patients according to the 'Schedule for the Evaluation of Individual Quality of Life - Direct Weighting'. In addition, the participants completed the 'European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30' and the 'Hospital Anxiety and Depression Scale'. We also assessed the demand for psychotherapy and utilization of psycho-oncological services. In total, 9.5% of the examined patients suffer from clinically relevant anxiety and/or depression [total Hospital Anxiety and Depression Scale (HADS) score >19]. There was a weak positive correlation between Karnofsky's Performance Status and QoL. Anxiety and depression were significantly correlated with impaired QoL, especially with impaired individual QoL. There was no association between psychopathological comorbidity and the requirement for psycho-oncological support. Conversely, patients who report difficulties in accepting help had a significantly lower QoL. Psychopathological comorbidity has a considerable influence on QoL of patients undergoing radiotherapy. Measuring the individual QoL appears as an adapted needs assessment and helps the psychotherapist in focusing on the patient's problems and desires. Furthermore, the patient's QoL is a main target in providing or planning mental health care in non-university oncological services.     

Beyond cancer: changes, problems and needs expressed by adult lymphoma survivors attending an out-patients clinic

Little is known about the impact of the cancer experience on people following the completion of treatment. Work has begun to outline such experiences primarily in the United States. The purpose of this study was to explore the 'survival'experience within a British context of care, outlining the changes, problems and needs expressed by adult cancer survivors.
A convenience sample of 10 adult lymphoma patients from one large teaching hospital was interviewed a minimum of 18 months following the completion of successful treatment. Data were collected by means of tape-recorded semi-structured interviews, using a schedule based on the Cancer Survivorship Questionnaire (Loescher et al. , 1990).
Data were analysed using content analysis and this indicated that, whilst survival itself may be reward enough for some, others seek to improve or adjust their current status, physically, psychologically or socially. It was concluded that the British cancer survivors were affected in many ways, some having to adjust more than others to the consequences of cure. The preliminary findings pointed towards a notion of 'subtle survivorship'in the British survivors. While they reported many changes in their lives after treatment, many were typically accepting of these and successfully adjusted to their new lives.     

Distress among African American and White adults with cancer in Louisiana

Abstract

Purpose/Objectives: Screening for distress is a key priority in cancer care, and African American patients may experience increased distress compared to White patients. However, this question has not yet been addressed in Louisiana. The purpose of the present study was to examine the relationship between African American race and distress at a cancer center in Louisiana.

Design/Methods: This was a retrospective study of 1,544 patients who were treated at an academic cancer center in 2015. Extracted data included patient self-reports of distress using the single-item Distress Thermometer (DT) and demographic and clinical characteristics. Hypotheses were tested using logistic regression.

Findings: Distress was present in 19.7% of the sample. In univariate analyses, African American patients were more likely than White patients to experience distress (OR?=?1.38, p?=?.013). However, race was no longer associated with distress in a multivariate analysis that adjusted for the covariates of age, gender, cancer site, presence of metastases, and number of distress screenings (OR?=?1.07, p?=?.670). Distress was more common in patients who were younger (OR?=?2.26, p?<?.001), diagnosed with lung/bronchus cancer (OR?=?5.28, p?<?.001), or screened more often (OR?=?5.20, p?<?.001). Distress was less common among patients with female breast cancer (OR?=?0.39, p?=?.015).

Conclusions/Implications: This study suggests that African American individuals with cancer in Louisiana are at increased risk for distress, but that this can be attributed to African American patients being younger, more likely to have lung cancer, and screened more frequently. Implications include careful consideration of patient race, age, and cancer site during distress management in cancer care.     

Notification of an abnormal Pap smear result: An intervention study

This study aims to assess whether notification of an abnormal Pap smear result via a phone call, delivered by a trained healthcare provider, has an effect on women's HRQoL, coping and awareness of HPV. For this intervention study, women were consecutively recruited from a women's health clinic in Sweden. Women in the intervention group (n = 113) were notified of their Pap smear result via a phone call by a trained healthcare provider, while those in the comparison group (n = 122) were notified via a standard letter. A questionnaire was used to collect data. The results found no significant differences between the groups for HRQoL. However, 42.5% of women in the intervention group versus 48.3% in the comparison group reported anxiety. Women in the intervention group were more satisfied with the manner in which they were notified of their abnormal result than those in the comparison group (92.0% vs. 67.2%; p < 0.001), more aware of HPV (71% vs. 50%; p = 0.001), and called healthcare services less often (10.6% vs. 18.0%; p = 0.113), no significance. In conclusion, notification of an abnormal Pap smear result via a phone call does not increase women's HRQoL or reduce their anxiety.     

Anxiety and its correlates among young adults with a history of parental cancer

Purpose: We assessed whether experiencing parental cancer during childhood was associated with anxiety levels during young adulthood—and whether parental survival status moderated anxiety or related psychosocial outcomes. Methods: Young adults who experienced parental cancer during their childhood (n = 68) and those who did not (n = 298) completed measures of current anxiety and family functioning. The parental cancer group completed measures of social support and life changes during the parental cancer and posttraumatic growth. Results: Young adults who experienced parental cancer endorsed higher state and trait anxiety than matched controls. Higher anxiety correlated with less current family cohesion and lower past social support satisfaction. Parental cancer outcome moderated the relationship between current anxiety and dimensions of posttraumatic growth and predicted the number of cancer-related life changes. Conclusion: Experiencing parental cancer during childhood predicted higher reported anxiety during young adulthood. Anxiety levels were partially moderated by parental survival status.