Analysis of anxiety in cancer patients: The effects of telling the truth

Background The mental distress suffered by cancer patients after telling them the truth about their diagnosis, is one of the main reasons why disclosure of cancer is not becoming more common in Japan. Using the State-Trait Anxiety Inventory (STAI), a self-rating scale, we assessed the anxiety level among cancer patients given information about their disease. Methods One hundred and sixty-one patients were solicited for participation in this study and complete answers to the Inventory were obtained from 118 patients. The STAI was administered twice, on the day of admission and after a precise explanation of the patient's disease, and was later compared. The information the patients had been given about their disease prior to admission, and the later explanations from the 8 attending physicians, given at the time of informed consent to treatment, were reviewed. The patients were divided into the following 4 groups according to the explanations given by the doctors; (1) 32 patients needed treatment for benign diseases, (2) 18 patients (all had cancers of digestive organs) were told euphemistically that they had tumors that required treatment, (3) 23 patients were newly diagnosed with cancer after admission, and (4) 41 patients had the same diagnosis of cancer as they had before admission. The remaining 4 patients were excluded because of an incorrect diagnosis. Results Many patients showed high State (43–72%) and Trait (21–46%) anxiety levels on admission. There was, however, no difference in the STAI scores between the 4 groups. The State anxiety scores in most of the patients with benign diseases were reduced to the normal range after explanation. Scores for those patients told euphemistically about their condition were also decreased significantly after admission, but their overall anxiety levels were still high. The patients diagnosed with cancer before admission and those newly diagnosed showed no significant changes in their STAI scores. Conclusion Anxiety remains high in cancer patients after clear or even euphemistic disclosure of cancer. This study demonstrated that giving patients an ambiguous explanation about their disease did not bring about additional emotional stability, and the anxiety already present did not get worse, even when the diagnosis was changed from tumors with the possibility of cancer to definite cancer.     

Different attitudes of Chinese patients and their families toward truth telling of different stages of cancer

OBJECTIVE: Cancer patients and their families differed in their attitude toward truth telling. The objective is to investigate different attitudes of Chinese patients or families toward whether and how to disclose diagnosis to patients with different stages of cancer and to examine the difference between the two groups. METHODS: A questionnaire was delivered to 1023 participants. RESULTS: Three hundred and eighty-two patients and 482 families completed the questionnaire. Cancer patients were more likely than families to believe that patient should be informed of the diagnosis (early-stage, 90.8 vs 69.9%, P<0.001; terminal stage, 60.5 vs 34.4%, P<0.001), and that doctor-in-charge was the appropriate person to disclose the diagnosis. Most participants thought that patient should be disclosed immediately after the diagnosis. Nearly half of participants reported that patient should be disclosed in a quiet and undisturbed room. When the hypothetic diagnosis changed from early-stage cancer to terminal illness, the number of participants, who wanted patient to know the diagnosis, decreased significantly. CONCLUSION: Our findings indicated that Chinese cancer patients and their families differed in their attitude toward truth telling and the attitudes toward such a disclosure were influenced by disease stage. Physicians should realize this phenomenon and pay more attention to the skills of how to disclose the cancer diagnosis.     

Not telling the truth: circumstances leading to concealment of diagnosis and prognosis from cancer patients

SHAHIDI J. (2010) European Journal of Cancer Care 19 , 589–593 Not telling the truth: circumstances leading to concealment of diagnosis and prognosis from cancer patients While autonomy has gradually become a key concept in the doctor–patient relationship, truth‐telling is far from being the norm in many countries in the world. Despite the general agreement on the benefits of open communication between physicians and cancer patients, there is still strong resistance against disclosure of cancer diagnosis and prognosis in many cultures. Although fear of causing psychological morbidity to patients and their reluctance to find out the truth are two main justifications of non‐disclosure attitudes, there are other important contributing factors that need to be further explored and better understood including those related to the relatives, doctors and healthcare systems. Cultural disparities in attitudes towards truth‐telling persist; however, these differences should not be used as excuses not to respect the rights and individual preferences of cancer patients by making assumptions based on their age, sex, type of cancer, language and/or cultural background.     

Pancreatic cancer and depression: myth and truth

Background  

Various studies reported remarkable high incidence rates of depression in cancer patients compared with the general population. Pancreatic cancer is still one of the malignancies with the worst prognosis and therefore it seems quite logical that it is one of the malignancies with the highest incidence rates of major depression.     

Antisense therapy for cancer--the time of truth

The recent acceleration in the identification and characterisation of new molecular targets for cancer and the limited effectiveness of conventional treatment strategies has focused considerable interest on the development of new types of anticancer agents. These new drugs are hoped to be highly specific for malignant cells with a favorable side-effect profile due to well-defined mechanisms of action. Antisense oligonucleotides are one such class of new agent--they are short, synthetic stretches of DNA which hybridise with specific mRNA strands that correspond to target genes. By binding to the mRNA, the antisense oligonucleotides prevent the sequence of the target gene being converted into a protein, thereby blocking the action of the gene. Several genes known to be important in the regulation of apoptosis, cell growth, metastasis, and angiogenesis, have been validated as molecular targets for antisense therapy. Furthermore, new targets are rapidly being uncovered through coordinated functional genomics and proteomics initiatives. Phosphorothioate oligonucleotides are the current gold standard for antisense therapy; they have acceptable physical and chemical properties and show reasonable resistance to nucleases. Recently, new generations of these phosphorothioate oligonucleotides that contain 2'-modified nucleoside building blocks to enhance RNA binding affinity and decrease indirect toxic effects have been developed. Antisense therapeutics are, after decades of difficulties, finally close to fulfilling their promise in the clinic.     

Depression and anxiety

Anxiety and depression are common in patients with cancer and in palliative care settings. These symptoms can be reactive to the illness or can be related to the direct physiologic effects of the disease or to drug therapies. Effective treatment of these symptoms includes both psychopharmacologic and psychotherapeutic approaches. The newer antidepressants, anxiolytics, and hypnotics are better tolerated and can be continued safely if necessary, or they can be reduced and discontinued as symptoms improve.     

Refractory cachexia and truth‐telling about terminal prognosis: a qualitative study

The purpose of this paper is to examine the consequences that medical practitioners' decisions about whether or not to be candid about terminal prognosis have for those suffering from refractory cachexia and their families. It presents the findings of a qualitative study that used focus groups and semi‐structured interviews of a volunteer sample of doctors, nurses and dieticians in a cancer centre of a large teaching hospital in Northern Ireland. Respondents reported that some physicians tended to avoid discussing terminal prognosis in a direct manner with their patients. Nurses and dieticians tended to be reluctant to engage in conversations about weight loss with patients with cachexia. One of the reasons they reported for their lack of acknowledgement of weight loss concerned the close association between refractory cachexia and terminal prognosis. Because they viewed the telling of bad news as an exclusive prerogative of medical practitioners, they did not feel in a position to discuss cachexia because they were concerned that this had the potential to raise end‐of‐life issues that lay outside the boundaries of their professional role. This meant patients and their families were provided with little information about how to cope with the distressing consequences of cachexia.     

Sensory and affective dimensions of advanced cancer pain

The present study was designed to explore the extent to which advanced cancer pain is explicable in terms of both physical pain intensity and affect. Most notably, it expanded on previous findings by more clearly elucidating the relationship between several discrete emotional states and the total experience of cancer pain. One hundred and eleven patients with cancer pain attending a Pain and Symptom Control Clinic were studied. Visual Analogue Scales (VASs) were used to quantify overall pain intensity and the accompanying affect. Then, correlations were calculated to evaluate the relationships both between and within these two variables. Overall, the participants rated both the pain intensity and the negative affect associated with that pain as high. Of the examined affective components of pain, frustration and exhaustion were found to be the most significant. In addition, some gender differences were identified in terms of frustration, anger, fear, exhaustion, helplessness, and hopelessness.     

Health effects of the Chernobyl accident: fears,rumours and the truth

The impact of the world's worst nuclear disaster at Chernobyl in 1986 is reviewed within a framework of a triad of fear, rumour and truth. The scope of the accident, Soviet secrecy about it, and the lack of general awareness of, or disregard for, the effects of radiation created a fertile ground for persistent fears and rumours attributing any health problem to Chernobyl. Scientifically correct answers to health issues have been the means to combat disinformation, and to replace interconnected fears, misconceptions and rumours. To date, according to the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2000 Report, based on a review of epidemiological and radiobiological studies, the main radiation-related effect of the Chernobyl accident is an increased risk of childhood thyroid cancer. In addition, the accident has had serious non-radiation-related psychological consequences on the residents of the contaminated territories, resettled populations and clean-up workers. Researchers in search of the truth through epidemiological reasoning are facing serious challenges which are reviewed within this article.     

Influence of truth disclosure on quality of life in cancer patients

Background Whether truth disclosure may harm patients may be critical for the promotion of truth disclosure in patients with cancer. We used the Functional Living Index-Cancer (FLIC) to study the influence of truth disclosure on quality of life (QOL) in cancer patients. Methods. Twenty-three truth-disclosed patients with cancer (TD group) and 21 truth-concealed patients (TC group) were asked to answer 22 FLIC questions at the outpatient clinic. Results were compared with those in 18 patients with irritable bowel syndrome (IBS group) and in 37 patients with other gastrointestinal diseases (OGD group). Results. Average FLIC scores were the same in the TD and IBS groups and in the TC and OGD groups. There were significant differences among the four groups for four FLIC items: Discouraged about life (P = 0.04), Uncomfortable today (P = 0.03), Pain disrupts activity, (P = 0.0003) and How much nausea (P = 0.04). The IBS group had the worst FLIC scores for the former three of these items. Truth disclosure influenced only one FLIC item, in that the TD group was more likely to think that their daily activities were disrupted by pain or discomfort than the TC group (P = 0.01). However, incurability of cancer worsened the score for ten FLIC items, among which incurability was independently associated with the deterioration of FLIC-QOL in terms of Family disruption (P = 0.03) and Cancer-related pain (P = 0.02). Conclusion. Incurability of cancer, not truth disclosure, negatively affects patients' QOL. Thus, if sufficient supportive care is provided particularly to patients with incurable cancer, the truth could be disclosed without fear of being cruel or harming patients.     

Novel dimensions of piRNAs in cancer

Piwi-interacting RNAs (piRNAs), a newly identified class of small non-coding RNAs, direct the Piwi-dependent transposon silencing, heterochromatin modification and germ cell maintenance. Owing to our limited knowledge regarding their biogenesis, piRNAs are considered as the most mysterious class of small regulatory RNAs, particularly in pathogenesis such as tumorigenesis. Recently, several lines of evidence have emerged to suggest that piRNAs may be dis-regulated and play crucial roles in tumorigenesis in previously unsuspected ways. In this prospective piece, we will discuss the emerging insights into the potential novel roles of piRNAs in carcinogenesis and highlight their potential implications in cancer detection, classification and therapy.