Understanding the Relationship Between Spiritual Well-Being and Depression in Chronic Pain Patients: The Mediating Role of Pain Catastrophizing

BackgroundIt is well established that there is an association between chronic pain and depression.AimsThe present study aimed to identify whether pain catastrophizing and spiritual well-being may influence depression in chronic pain patients when other variables are controlled for (sociodemographic characteristics and pain intensity). Furthermore, it investigated possible mechanisms by which spiritual well-being can influence depression in these patients.DesignThe present study employed a cross-sectional design.Settings and ParticipantsThis study was performed with a convenience sample of 300 consecutive patients with different types of chronic pain (defined as recurrent or persistent pain over >3 months), referred to clinics affiliated with Shiraz university of Medical Sciences between March and October 2017.MethodsPatients completed validated self-report questionnaires: Spiritual Well-being Questionnaire, Patient Health Questionnaire, Pain Catastrophizing Scale, and Numeric Rating Scale.ResultsHierarchical multiple regression analysis indicated that a significant portion of the variance in depression scores can be explained by catastrophizing and spiritual well-being. In Multiple Mediation Procedure, pain catastrophizing could negatively mediate the relationship between spiritual well-being and depression when controlling for sociodemographic characteristics and pain intensity.ConclusionsThe findings add some evidence to further support the influence of spiritual well-being on depression levels through diminished pain catastrophizing. The present results could help clinicians to determine which variables should be emphasized for a successful treatment of depression in pain patients. Clinical interventions that increase meaningfulness and purpose in life may allow patients with chronic pain to overcome the maladaptive cognitions associated with pain, thereby reducing depressive symptoms.     

Symptom priority and course of symptomatology in specialized palliative care

The study aim was to explore which symptoms/problems cancer patients in palliative care consider most distressing, and to investigate how prioritization at first contact was associated with patient-assessed symptom intensity and change in intensity over time. Initially, 175 patients named and prioritized their five most distressing symptoms. Weekly, they completed the following self-assessment questionnaires: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, Edmonton Symptom Assessment System, and the Hospital Anxiety and Depression Scale. Initial symptom intensity scores and weekly changes were calculated and compared with prioritization of the same symptom. Pain, fatigue, physical function, appetite, nausea/vomiting, dyspnea, and depression were the symptoms most often prioritized. Priority was associated with initial scoring of pain, appetite, nausea/vomiting, dyspnea, constipation, depression, and anxiety, but not with fatigue, physical function, role function, or inactivity. Priority was associated with change in symptom intensity for pain, reduced appetite, nausea/vomiting, and constipation. Symptom prioritization may be a useful guide to choice of treatment as well as to longitudinal symptom evaluation.     

Quality of life in patients with advanced non-small cell lung cancer

Quality of life (QOL) has been shown to improve with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC), but the determinants of this improvement have not been thoroughly explored. Fifty consecutive NSCLC patients starting chemotherapy with measurable disease and with an Eastern Co-operative Oncology Group (ECOG) performance status of 相似文献   

榄香烯乳联合GP方案治疗晚期非小细胞肺癌

目的：探讨榄香烯乳（elemene emulsion）联合GP方案治疗晚期非小细胞肺癌（NSCLC）的临床疗效及其影响。方法：82例晚期NSCLC患者随机入组采用GP方案[吉西他滨（G）＋顺铂（P）]和EGP方案[榄香烯乳（E）＋GP]化疗。采用欧洲癌症研究和治疗组织的生活质量调查核心问卷（QLQ-C30）和肺癌症状量表观察者表评分,对治疗后患者的疗效、生活质量及不良反应进行评价及组间比较。结果：治疗后GP组有效率（RR）为41.5%,其中完全缓解（CR）1例,部分缓解（PR）16例;EGP组RR48.8%,CR2例,PR18例。1年和2年生存率GP组是40.0%和20.0%,EGP组为45.0%和25.0%。两组之间有效率和生存率的差异均无统计学意义（P〉0.05）。用Kaplan-Meier法描述两组的生存过程,chi2（1）=1.32,P=0.25。主要不良反应是Ⅲ~Ⅳ度骨髓抑制,治疗后GP组的白细胞减少发生率为46.3%,中性粒细胞减少发生率48.8%,血小板减少发生率36.6%,EGP组分别为17.1%、19.5%和12.2%,治疗前后两组间比较均有显著差异（P〈0.05）。肺癌症状量表观察者表评分显示,治疗后评分两组差异均有统计学意义（P〈0.05）,但呼吸困难、咯血的治疗效果GP组不如EGP组明显。结论：EGP与GP方案具有相似的疗效,但是,不良反应,特别是骨髓抑制,EGP方案比GP方案轻,因此,EGP方案治疗晚期NSCLC更容易被患者接受。     

A Phase II dose titration study of thalidomide for cancer-associated anorexia

ContextSixty-five percent of people with advanced cancer suffers from loss of appetite. Several inflammatory cytokines appear to cause appetite loss in animal models. Thalidomide is an immunomodulatory drug that has been associated with improved appetite in those with HIV infections and cancer.ObjectivesWe completed a two-stage Phase II dose titration study of thalidomide, the primary purpose of which was to assess appetite response to thalidomide in cancer-associated anorexia.MethodsIndividuals older than 18 years of age with active cancer, loss of appetite by numerical rating scale (NRS), life expectancy of at least four weeks, and Eastern Cooperative Oncology Group performance status of 0–3 were entered into the study. Pretreatment screening included medical history, neurologic examination, and symptoms by NRS and categorical scale (CAT). Patients received 50 mg of thalidomide by mouth at bedtime for two weeks. Individuals who did not respond were dose escalated to 100 mg at night for two weeks. Assessment of appetite, early satiety, fatigue, insomnia, night sweats, pain, and quality of life (QOL) occurred at two-week intervals. Toxicity also was assessed. The primary outcome was appetite response defined as a two-point reduction in the NRS or a one-point improvement in the CAT.ResultsThirty-five patients entered the study; 33 completed 14 days of therapy and were analyzed for efficacy and toxicity. Sixty-four percent who completed at least two weeks of thalidomide had improved appetite. The CAT scores for appetite, insomnia, and QOL improved significantly. The 95% confidence intervals did not overlap. Five participants dropped out because of toxicity: two before two weeks and three later.ConclusionThalidomide reduced multiple symptoms commonly associated with cancer-related anorexia and improved QOL. Our findings confirmed and validated a previously published single-arm trial. A recent randomized trial demonstrated greater benefits when thalidomide is used combined with other agents to treat cancer-associated anorexia and cachexia. Thalidomide helped cancer-associated anorexia in most patients. It also improved insomnia and QOL in advanced cancer.     

Assessment of the relationship of spiritual well-being to depression and quality of life for persons with spinal cord injury

Objective: This study sought to describe the association between spiritual well-being, demographic characteristics, quality of life (QOL) and depressive symptoms following spinal cord injury (SCI). We hypothesized QOL and depressed mood would both be explained by extent of spiritual well-being, and meaning-focused (M&;P) spirituality would have a stronger impact than faith-focused spirituality.

Methods: 210 individuals with SCI were screened as part of a randomized control trial of venlafaxine XR for major depressive disorder (MDD). 204 completed all measures: Patient Health Questionniare-9 (PHQ-9) assessed depression, the FACIT-Sp assessed spiritual well-being, the Neuro-QOL PAWB scale assessed QOL, and the PANAS assessed affect.

Results: Approximately 26% had major depression. Bivariate correlations of scores on PAWB and PANAS and FACIT-Sp showed that all four scales had strong associations with those on PAWB (p?β?=?0.544; p?p?=?0.004), though only the M&;P scale was an independently significant predictor of likely MDD.

Conclusion: The findings support that spirituality, as measured by the FACIT-Sp, is strongly associated with QOL and likelihood of MDD. Assessment of spirituality should be included along with more traditional psychological measurements to better inform treatment.

• Implications for Rehabilitation

• Spiritual beliefs can contribute to quality of life and may help moderate depressive symptoms that accompany chronic illness and disability, suggesting that rehabilitation professionals should address spirituality in working with their patients with spinal cord injury (SCI).

• While spiritual issues are often deferred to pastoral counselors during hospitalization, it is clear that addressing these is not the domain of one discipline and does not end upon inpatient discharge.

• In addressing spirituality, clinicians should tap the spiritual strengths present in their clients, whether meaning/peace-focused or religious, understanding that spirituality involves more than religiosity and also that having a sense of meaning and peace appears to be of great importance.

     

头颈部癌症病人术后生活质量研究

目的 :评价头颈部癌症病人术后 1a内的生活质量 (QOL)及其影响因素。方法 :应用欧洲研究和治疗癌症组织核心生活质量调查表 3 0 -项 (EORTCQLQ -C3 0 )和医院焦虑和抑郁等级(HADS) ,评估分析手术或手术加放射治疗的头颈部癌症病人88例术后 1a的QOL。结果 :头颈部癌症病人治疗结束后 1个月与诊断时比较 ,功能维度中的生理活动机能和全身QOL、症状维度中的疲劳、单项中的食欲丧失和便秘所引起的QOL变化有统计学意义 (P <0 .0 1或P <0 .0 5 ) ;治疗结束后 6月与诊断时比较 ,功能维度中的情感活动机能、单项中的失眠所引起的QOL变化有差异 (P <0 .0 1) ;治疗结束后 6个月与 1个月比较 ,症状维度中的疼痛所引起的QOL有差异 (P <0 .0 1) ;治疗结束后 12个月与 6个月比较 ,症状维度中的恶心和呕吐所引起的QOL变化有差异 (P <0 .0 5 )。结论 :治疗后 1个月～ 6个月 ,头颈部癌症病人的生活质量较低 ,护理应提供临床治疗干预和心理干预。     

The effect of a physical exercise program in palliative care: A phase II study

The purpose of this pilot study was to assess the effects of a physical exercise program on physical performance and quality of life (QOL) in a population with incurable cancer and a short life expectancy. Thirty-four patients participated in a 50-minute group exercise program twice a week for 6 weeks. Physical performance was measured by three tests: "6-minute walk test," "timed repeated sit to stand," and "functional reach." Fatigue was measured by the Fatigue Questionnaire. QOL was assessed by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. The outcome variables were assessed before and after the intervention. The walk length increased and the "timed repeated sit to stand" was reduced (P < 0.05). Emotional functioning improved and physical fatigue was reduced (P < 0.05). Physical exercise seems to be a feasible way to improve well-being among patients with incurable cancer. Future randomized trials are needed to confirm the results.     

Spirituality, religiosity, and spiritual pain in advanced cancer patients

ContextSpirituality, religiosity, and spiritual pain may affect advanced cancer patients’ symptom expression, coping strategies, and quality of life.ObjectivesTo examine the prevalence and intensity of spirituality, religiosity, and spiritual pain, and how spiritual pain was associated with symptom expression, coping, and spiritual quality of life.MethodsWe interviewed 100 advanced cancer patients at the M.D. Anderson palliative care outpatient clinic in Houston, TX. Self-rated spirituality, religiosity, and spiritual pain were assessed using numeric rating scales (0 = lowest, 10 = highest). Patients also completed validated questionnaires assessing symptoms (Edmonton Symptom Assessment Scale [ESAS] and Hospital Anxiety and Depression Scale), coping (Brief COPE and Brief R-COPE), the value attributed by the patient to spirituality/religiosity in coping with cancer (Systems of Belief Inventory-15R), and spiritual quality of life (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-Expanded [FACIT-Sp-Ex]).ResultsThe median age was 53 years (range 21–85) and 88% were Christians. Almost all patients considered themselves spiritual (98%) and religious (98%), with a median intensity of 9 (interquartile range 7–10) of 10 and 9 (range 5–10) of 10, respectively. Spiritual pain was reported in 40 (44%) of 91 patients, with a median score of 3 (1–6) among those with spiritual pain. Spiritual pain was significantly associated with lower self-perceived religiosity (7 vs. 10, P = 0.002) and spiritual quality of life (FACIT-Sp-Ex 68 vs. 81, P = 0.001). Patients with spiritual pain reported that it contributed adversely to their physical/emotional symptoms (P < 0.001). There was a trend toward increased depression, anxiety, anorexia, and drowsiness, as measured by the ESAS, among patients with spiritual pain (P < 0.05), although this was not significant after Bonferroni correction.ConclusionA vast majority of advanced cancer patients receiving palliative care considered themselves spiritual and religious. Spiritual pain was common and was associated with lower self-perceived religiosity and spiritual quality of life.     

Health-related quality of life before and during adjuvant interferon-α treatment for patients with malignant melanoma (DeCOG-trial)

Adjuvant treatment with interferon-α (IFN-α) for patients with malignant melanoma can improve relapse-free and overall survival, but IFN-associated side effects may reduce patient's quality of life. The aim of the study was to prospectively evaluate health-related quality of life (HRQoL) in patients with melanoma before and during Low-Dose IFN-α therapy. In a prospective multicenter trial conducted by the Dermatologic Cooperative Oncology Group, 850 patients with cutaneous stage II malignant melanoma received a standard Low-Dose of IFN-α-2a. We evaluated HRQoL using the European Organization for Research and Treatment of Cancer Quality of Life Core 30 questionnaire at baseline and after 3, 6, and 12 months of IFN-α treatment in 282 patients. Nine of 15 subscales showed significant poorer results after 3 months of adjuvant IFN treatment. Symptoms included reduced physical functioning, reduced cognitive functioning, fatigue, nausea, pain, dyspnea, insomnia, diarrhea, and loss of appetite. We did not find a significant change over time for role, emotional, or social functioning. Only cognitive functioning and dyspnea continuously worsened through the twelfth month. At baseline women had significantly lower scores for physical and emotional functioning and for fatigue compared with men. During treatment, women scored significantly poorer on physical functioning, emotional functioning, fatigue, pain, and constipation subscales. Patients who reported having a bad or very bad QoL before treatment were 5.8 times more likely to discontinue treatment early because of psychiatric problems. We conclude that adjuvant low-dose IFN treatment is associated with significant deterioration of HRQoL. Specific psychosocial care should be offered especially for patients who report lower HRQoL and emotional problems before treatment to prevent early discontinuation.     

The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study

Purpose

Disease symptom management in patients with advanced non-small cell lung cancer (NSCLC) is a critical aspect of therapy. The main objective of our study was to assess patient-reported outcomes and the degree of concordance between physician and patient perceptions of symptom severity in advanced NSCLC in the USA.

Methods

Patients with advanced (stage IIIB/IV) NSCLC (N?=?450) were recruited in a nationwide (USA) lung cancer study. Patients and their oncologists completed patient and physician versions of the Lung Cancer Symptom Scale (LCSS). Patient-reported lung cancer-specific quality of life was assessed with the Functional Assessment of Cancer Therapy—Lung (FACT-L). Concordance was assessed using the kappa-statistic. Regression analysis was performed with FACT-L total score as the dependent variable and patient-reported LCSS symptom scores as predictors.

Results

A high proportion of patients experienced lung cancer symptoms: fatigue (100 %), loss of appetite (97 %), shortness of breath (95 %), cough (93 %), pain (92 %), and blood in sputum (63 %). Concordance between physician and patients was lowest for loss of appetite (kappa 0.1701) and greatest for hemoptysis (kappa 0.4586). Loss of appetite (β?=??0.204; p?<?0.001), cough (β?=??0.145; p?<?0.01), pain (β?=??0.265; p?<?0.001), and shortness of breath (β?=??0.145; p?<?0.01) were found to be significant predictors of the quality of life.

Conclusions

Symptom burden in patients with advanced NSCLC is high and has a negative impact on the quality of life. Patient-reported outcomes data could help optimize disease outcomes and therapy management in NSCLC.     

Dyspnea, anxiety, body consciousness, and quality of life in patients with lung cancer

Dyspnea is a common symptom of lung cancer that can impact patient physical, social, and psychological well-being. Study goals were to evaluate quality of life (QOL) and dyspnea in patients with lung cancer and the relationships between QOL, dyspnea, trait anxiety, and body consciousness. Sociodemographic and cancer-related variables (stage, cell type, performance status) were evaluated. One hundred twenty outpatients with stage I-IV lung cancer participated in the study. Patients completed 5 questionnaires assessing QOL, dyspnea, trait anxiety, body consciousness, and pain. Eighty-seven percent of study participants experienced dyspnea. Patients with high dyspnea scores had lower QOL (P = 0.04). Dyspnea was worse in men than in women (P = 0.02), and there was a trend towards older patients reporting more severe dyspnea than younger patients (P = 0.06). There was no difference in dyspnea based on cancer stage, cell type, or performance status. Pain and anxiety scores were higher in patients with high dyspnea (P = 0.02, P = 0.03). Dyspnea was more severe in patients taking opioid analgesics when compared to non-opioids or no pain medications (P = 0.03). No significant association was found between dyspnea, anxiety, and private body consciousness.     

Psychosocial and Sensory Factors Contribute to Self-Reported Pain and Quality of Life in Young Adults with Irritable Bowel Syndrome

AimsPsychosocial and sensory factors, including anxiety, depression, and pressure pain threshold have been used to cluster chronic symptoms in irritable bowel syndrome (IBS). This study examined the contribution of psychosocial sensory factors on pain interference and quality of life (QOL) in this population.DesignWe performed a cross-sectional analysis of baseline data from a randomized controlled trial.SettingsTwo gastrointestinal clinics, general communities, and two large campuses of a public university in the Northeastern United States.Participants/SubjectsEighty young adults with IBS aged 21 ± 2.57 years (76.25% female).MethodsDemographic and psychosocial factors including anxiety, depression, fatigue, cognition or general concerns, sleep disturbance, self-efficacy, coping, and food intake were measured as independent variables. Quantitative sensory testing was conducted to measure mechanical, thermal, and pressure pain thresholds. Self-reported pain measured by the brief pain inventory (BPI) and IBS-QOL were assessed as the outcome variables. Regression analysis and mediation analysis were conducted to determine the associated factors of IBS pain and QOL.ResultsAge, sex, and psychosocial factors including coping, self-efficacy, alcohol intake, mechanical pain sensitivity, and cold pain threshold were significantly associated with pain interference (all p < 0.05). Coping, and self-efficacy were significantly associated with IBS-QOL (all p < 0.05). In the mediation analysis, coping catastrophizing and self-efficacy were indirectly associated with IBS-QOL mediated by fatigue.ConclusionsPsychosocial factors including coping and self-efficacy, and quantitative sensory testing factors significantly correlate with self-reported pain and QOL among young adults with IBS. This preliminary research calls for further interventional studies that target personalized psychosocial and quantitative sensory factors to improve pain management and quality of life in IBS patients.     

The effects of spiritual care intervention on spiritual well-being,loneliness, hope and life satisfaction of intensive care unit patients

BackgroundThe intensive care unit is a place where patients try to cope with pain and question the meaning and purpose of life and spiritual needs emerge.ObjectiveThe present study was conducted to examine the effects of spiritual care interventions on the spiritual well-being, loneliness, hope, and life satisfaction of patients treated in intensive care.Research methodologyThe study was conducted in an intensive care unit as an interventional study with a randomized pre-test, post-test, and control group between September and December 2021. A total of 64 patients, 32 in the intervention group and 32 in the control group, were included in the sample. The patients in the intervention group received eight sessions (twice a week) of spiritual nursing interventions according to the Traditions-Reconciliation-Understandings-Searching-Teachers model in the intensive care unit, while the control group received routine nursing care.ResultsThe mean age of the participants was 63.53 ± 4.10 years in the intervention group and 63.37 ± 3.18 years in the control group. Most of the participants in both the intervention (59.4 %) and control (68.7 %) groups were female. Following the intervention, the findings showed that the intervention had positive effects on patients’ spiritual well-being (t = -10.382), loneliness (t = 13.635), hope (t = -10.440), and life satisfaction (t = -10.480) levels (p < 0.001).ConclusionsIt was found that the spiritual care provided in the intensive care unit positively affected patients’ spiritual well-being, hope, loneliness, and life satisfaction levels. It can be recommended that nurses working in intensive care develop a spiritually supportive environment by addressing the spiritual issues of patients and their relatives and using existing spiritual care services.Implications for clinical practiceIntensive care nurses should provide an environment and nursing care that meet their patients’ spiritual needs. Spiritual care can be given to improve spiritual well-being, hope, and life satisfaction levels and to alleviate loneliness in intensive care patients.     

Suicide ideation in stomach cancer survivors and possible risk factors

Purpose

Although the suicide rate of cancer survivors is higher than that of the general population, few studies have examined the potential risk factors. We assessed suicide ideation (SI) and investigated its correlates among survivors of stomach cancer, which is one of the most prevalent cancers in Korea.

Methods

We surveyed 378 stage I–III stomach cancer survivors who had been disease free for at least 1 year. The survey contained demographic questions and quality of life assessments from the European Organization for Research and Treatment of Cancer QLQ-C30 and its stomach cancer-specific module, the McGill Quality of Life Questionnaire, the Brief Fatigue Inventory, and one question from the Beck Depression Inventory.

Results

We found that 131/378 stomach cancer survivors (34.7 %) experienced SI. Univariate analyses showed that SI was significantly associated with income, comorbidity, smoking, and the following quality of life factors: general health status, emotional functioning, fatigue, nausea/vomiting, dyspnea, appetite loss, constipation, diarrhea, financial problems, eating restriction, anxiety, dry mouth, trouble belching, hair loss, body image, existential well-being, and social support. Multivariate logistic regression confirmed that SI was independently associated with diarrhea (adjusted odds ratio (aOR) 2.84; 95 % confidence interval (CI) 1.44–5.62), hair loss (aOR 2.77; 95 % CI 1.04–7.36), existential well-being (aOR 6.18; 95 % CI 2.91–13.1), and usual fatigue (aOR 2.29; 95 % CI 1.30–4.06).

Conclusion

Our findings reveal a high prevalence of SI among stomach cancer survivors and identify health-related quality of life issues such as diarrhea, hair loss, existential well-being, and fatigue as important risk factors of SI.