Psycho‐Oncology最新文献

Background: Esophageal cancer and gastric cancer patients require researchers' attention to address and resolve the issue of stigma. The aim of this study was to investigate whether behavioral activation (BA), an emerging psychosocial intervention method, can mitigate the stigma experienced by these patients and enhance their quality of life (QoL).

Methods: One hundred fifty-three patients with advanced esophageal cancer and gastric cancer were recruited and randomly assigned to either the BA plus care as usual group (BA + CAU group) or the care as usual group (CAU group). Pre- and post-intervention questionnaires, including the Social Impact Scale (SIS), as well as all functional areas and global health and QoL modules from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, version3).

Results: Generalized estimating equation analysis revealed that compared to usual care alone, combining BA with usual care significantly reduced stigma (time-by-group interaction, T1: β = -10.584, p < 0.001; T2: β = -22.619, p < 0.001) while improving physical, role, emotional, social functioning and global health and QoL particularly at T2 time point. Additionally, it also has the potential to decelerate the progressive decline of cognitive functioning. Furthermore, correlation analysis demonstrated a significant association between stigma levels and all functional areas as well as global health and QoL.

Conclusion: The issue of stigma among esophageal cancer and gastric cancer patients warrants increased attention due to its close relationship with patient QoL. This study presents a promising psychosocial intervention approach suitable for clinical application that deserves further promotion among cancer patients.

Trial registration: NCT06348940.

Objectives: Over half of new cancer diagnoses occur in patients aged 65 or older, with up to 40% experiencing anxiety. The American Society of Clinical Oncology recommends using the Generalized Anxiety Disorder Scale (GAD-7) for anxiety screening, but the GAD-7 psychometric properties in this population are unknown. This study examined the GAD-7's reliability, validity, and item parameters, comparing its utility with the GAD-2 in older adults with cancer.

Methods: This cross-sectional secondary analysis of a nationwide multi-site two-arm cluster randomized trial in older adults (≥ 70) with advanced cancer. The GAD-7 was administered at baseline. Properties were evaluated with Cronbach's α, Pearson correlation coefficients, and a 2-parameter logistic model. Logistic regression models compared the GAD-2 and GAD-7.

Results: The sample included 718 participants (Mean age = 77, SD = 5) with mild anxiety (M = 3.74, SD = 4.74). Internal consistency was strong (Cronbach's alpha = 0.89) and item-total correlations ranged 0.53 to 0.78. Item 2 (Not being able to stop or control worrying) was the most discriminating and item 5 (Being so restless that it is hard to sit still) was least discriminating. Area Under the Curve (AUC) analyses demonstrated the GAD-2 had a 0.93-0.96 AUC.

Conclusions: Establishing the psychometric properties of anxiety screening measures is crucial in the older adults with cancer to maximize referral efficiency and accuracy. This study indicates that the GAD-7 is reliable and valid for older adults with cancer. Analyses suggest the GAD-2 may be as sufficient as the GAD-7 in identifying anxiety in older adults with cancer, thereby reducing assessment burden.

Objective: We evaluated associations between social support and delays to surgery and adjuvant chemotherapy in a cohort of women with breast cancer (BC) from a large integrated healthcare system in Northern California.

Methods: This study included 3983 women from the Pathways Study diagnosed from 2005 to 2013 with stages I-IV BC, who had surgery as their first line of treatment and who responded to the Medical Outcomes Study Social Support survey ∼2 months following diagnosis. A second set of analyses included those receiving adjuvant chemotherapy (N = 1761). We used log binomial regression to evaluate associations of social support, and types of support, with relative prevalence of delays from diagnosis to definitive surgery > 30 days, delays to chemotherapy from diagnosis > 90 days, and delays to chemotherapy from definitive surgery > 60 days. We further examined analyses stratified by sociodemographic factors and disease severity.

Results: Twenty-one percent had surgery delays and 18.3% had chemotherapy delays from diagnosis (24.7% from surgery). Adjusted for covariates, women in the lowest tertile of social support were more likely to have delays to surgery (prevalence ratio (PR) = 1.27, 95% confidence interval (CI):1.08-1.48, p-continuous = 0.01) and chemotherapy (PR = 1.48, 95% CI: 1.08-2.02, p = 0.05) from diagnosis, due to associations of low tangible and emotional support with delays. We noted no effect modification in these analyses. By contrast, low social support was related to chemotherapy delays from diagnosis in women < 54 (PR = 1.96, 95% CI: 1.33-2.88) but not ≥ 54 (PR = 1.09, 95% CI: 0.79-1.49) years of age, p-interaction = 0.05. Other tests of effect modification were nonsignificant.

Conclusions: Low social support was associated with delays to BC surgery and chemotherapy.

Objectives: This meta-analysis was to critically evaluate the effectiveness of Internet-based Cognitive Behavioral Therapy (ICBT) on psychological distress and quality of life in breast cancer survivors.

Methods: A search was conducted across eleven databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, ProQuest, CINAHL, CBM, CNKI, VIP and Wanfang) to identify relevant randomized controlled trials (RCTs) published from databases inception to September 2023. Two reviewers independently conducted study screening, data extraction, and quality assessment of the included studies. Review Manager 5.4 and Stata 18.0 were utilized for analysis.

Results: Ten studies with 1409 patients were included. Meta-analysis indicated that ICBT alleviated anxiety [SMD = -0.34, 95% CI (-0.64, -0.04), p = 0.03] and depression [SMD = -0.43, 95% CI (-0.76, -0.09), p = 0.01] in breast cancer patients. Therapist-guided ICBT outperformed self-guided ICBT, with interventions lasting ≤ 9 weeks better than > 9 weeks, and module quantity didn't affect the results. Additionally, ICBT significantly improved quality of life [SMD = 0.37, 95% CI (0.21, 0.52), p < 0.001], yet didn't reduce fatigue [SMD = -0.13, 95% CI (-0.59, 0.34), p = 0.60], insomnia [MD = -2.24, 95% CI (-5.77, 1.28), p = 0.21], or fear of progression [SMD = -0.10, 95% CI (-0.31, 0.11), p = 0.34].

Conclusions: ICBT, especially therapist-guided and lasting for ≤ 9 weeks, can effectively relieve anxiety and depression, as well as enhance breast cancer patients' quality of life. Nevertheless, it fails to improve fatigue, insomnia, or fear of progression. High-quality, large-sample studies must be conducted in the future for further validation.

Introduction: Fear of cancer recurrence (FCR) is prevalent and distressing among survivors of cancer. Evidence-based mind-body and cognitive-behavioral skills lack integration and testing in scalable formats.

Objective: This pilot randomized controlled trial (NCT04876599) tested a synchronous, virtual mind-body group resiliency intervention for FCR (IN FOCUS).

Method: Adults with elevated FCR (FCR Inventory severity ≥ 16; 16-21 = elevated, 22-36 = clinically elevated) after completing primary treatment for non-metastatic cancer were randomly assigned (1:1) to eight weekly sessions of IN FOCUS or usual care (UC; synchronous, virtual community group support referral). Feasibility metrics included ≥ 70% retention per arm (primary outcome), ≥ 75% attendance in ≥ 6 sessions, ≥ 75% adherence to relaxation skills practice ≥ 3 days per week and by delivery fidelity (% content covered in video-recorded sessions). Acceptability was assessed quantitatively via ratings of enjoyableness, convenience, helpfulness, odds of future use, and satisfaction (benchmark ≥ 80% of ratings ≥ 4 on 1-5 Likert scale) and qualitatively via individual exit interviews. Linear mixed models explicated slopes in FCR (secondary) and resiliency (exploratory; Current Experiences Scale) from baseline to 2 months (primary endpoint) and 5 months using intention-to-treat.

Results: From July 2021 to March 2022, 64 survivors enrolled (25-73 years old, M = 7 years since diagnosis). IN FOCUS was feasible and acceptable (91% retention; attendance median = 7 sessions, 97% relaxation practice adherence, 95% content fully covered; 82% of acceptability ratings ≥ 4). Interviews (n = 59) revealed benefits in both arms. By 2 months, compared to UC, IN FOCUS reduced FCR to a medium-to-large effect (Mdiff = -2.4; 95% CI = -4.2, -0.7; d = 0.66). By 5 months, FCR effects had attenuated (Mdiff = -0.16, 95% CI -1.97, 1.65; d = -0.04), although levels of resiliency had increased with a medium-to-large effect (Mdiff = 10.0; 95% CI = 4.9, 15.1; d = 0.78).

Conclusions: For survivors of non-metastatic cancer, a synchronous, virtual mind-body resiliency program for FCR is feasible, acceptable, and seemingly beneficial compared to a community group referral.

Objective: Cancer patients generally have high stress levels, which often leads to depression, anxiety and other psychological problems. Laughter therapy has been used to relieve stress, depression and anxiety in cancer patients, but its efficacy is uncertain. The study aims to summarize evidence on the efficacy of laughter therapy on psychological symptoms of people with cancer.

Methods: A search was conducted in 10 electronic databases for randomized controlled trials (RCTs) reported before May 2023. This systematic review was reported based on the PRISMA 2020 statement. The evaluation of methodological quality and risk of biases were conducted by the Cochrane Risk of Bias Assessment tool version 2, and evidence evaluation was conducted using the GRADE pro online assessment tool. Statistical analysis adopted the Review Manager version 5.4 software.

Results: A total of eight studies were included involving 543 participants. Meta-analysis showed that laughter therapy plus routine nursing produced more positive effects than routine nursing in relieving stress (SMD = -1.18, 95% CI -1.73, -0.62, p < 0.0001), depression (SMD = -1.05, 95% CI -1.30, -0.81, p < 0.00001) and anxiety (SMD = -0.81, 95% CI -1.20, -0.43, p < 0.0001).

Conclusions: Laughter therapy could effectively relieve stress, depression and anxiety of cancer patients. Future studies should improve the methodological quality of randomized controlled trials, conduct appropriate follow-up, and report details of follow-up. Additionally, it should perform multi-center and large-sample studies, and combine both subjective and objective outcome indications to enhance the persuasiveness of evidence supporting the effectiveness of laughter therapy.

Trial registration: PROSPERO register: CRD 42023452739.

Introduction: This study investigated the prevalence, methods and factors leading carers of childhood cancer patients to seek second opinions.

Methods: A prospective, questionnaire-based study was conducted among families attending oncology clinics at Sydney Children's Hospital, Randwick. Participants were asked whether they had sought a second opinion for their child and if so, their motivations. Factors including cancer diagnosis, carer demographics and online health seeking behaviours were evaluated in association with second opinions. A separate online questionnaire invited paediatric oncologists worldwide to indicate the frequency of, and their approach to, second opinion requests via email.

Results: Fourteen out of 126 carers (11.1%) sought a second opinion from another oncologist to confirm diagnoses (64.3%), explore treatment options (64.3%) or receive additional information (57.1%). A brain cancer diagnosis was the most significant predictor for second opinion seeking in univariate (p = 0.009) and multivariate analyses (p = 0.015). Among carers who reported using the internet for health information seeking (n = 98), second opinions were independently associated with social media use (p = 0.014) and frequent health-related searches (p = 0.027). Most paediatric oncologists (71/89, 79.8%) had received second opinion requests via email, with 21.3% (19/89) reporting that these occur at least weekly. Surveyed oncologists provided a second opinion for some (59.2%) or all (33.8%) requests they received, with 68.5% supporting guideline development for second opinions in paediatric oncology.

Conclusions: Second opinions are regularly sought by carers of childhood cancer patients, with many paediatric oncologists approached over email. International guidelines may be warranted to assist paediatric oncologists and families in navigating these requests.

Background: Psychosocial risk factors (PSRFs) have emerged as important nontraditional risk factors for poor medical outcomes but have not been well-studied in the field of hematopoietic stem cell transplantation (HSCT).

Objectives: In this study, we retrospectively examined in-hospital and short-term outcomes in patients with PSRFs who underwent HSCT.

Methods: We used the National Readmission Database (NRD) to identify patients who underwent HSCT between 2011 and 2020. Patients were stratified based on the presence of either 0 or ≥ 1 PSRFs, which included factors such as mental illness, substance abuse, cognitive problems, a low income level, and an uninsured status. Patients were also classified into allogeneic-HSCT (allo-HSCT) and autologous-HSCT (auto-HSCT) groups. Our primary endpoints were in-hospital and short-term outcomes.

Results: In this nationally representative cohort, 90,747 patients underwent auto-HSCT, while 26,600 patients underwent allo-HSCT. In the auto-HSCT group, individuals with PSRFs exhibited notably higher in-hospital mortality (2.4% vs. 2.8%; p < 0.001) and 30-day all-cause readmission rates (14.4% vs. 17.8%; p < 0.001) compared to those without PSRFs. Similarly, within the allo-HSCT group, patients with PSRFs had significantly higher in-hospital mortality (5.4% vs. 6.4%; p < 0.001) and 30-day all-cause readmission rates (27.3% vs. 31.2%; p < 0.001) compared to those without PSRFs. After adjusting for risk factors, the presence of PSRFs emerged as a substantial predictor for heightened 30-day readmission in allo-HSCT and auto-HSCT.

Conclusion: The presence of PSRFs is correlated with poorer in-hospital and short-term outcomes after both allo-HSCT and auto-HSCT, with a more pronounced effect observed in allo-HSCT. This research underscores the significance of pinpointing high-risk patients and implies support for merging PSRFs after HSCT is beneficial.

Objective: Psychosocial oncology specialists in academic medical centers are at risk for burnout as they deliver a wide range of clinical, research, educational, and administrative services in high demand work environments. No national productivity benchmarks exist for this specialty. This study examines factors contributing to burnout among academic psychosocial oncology psychologists (PSOP), presents viable productivity standards, and a sustainable care model to mitigate burnout.

Methods: Psychosocial oncology specialists recruited from the American Psychosocial Oncology Society membership were surveyed to determine frequency of burnout as measured by the Mini Z, professional fulfillment via the Stanford Professional Fulfillment Index, as well as demographic, clinical practice, and systems predictors of burnout. We examine salary discrepancies by gender and race. We focus on psychologists providing services in academic medical centers.

Results: Burnout was reported by 37%-44% of psychologists and was associated with high clinical volumes, mid-career status, and less than 10% administrative time. There were no differences in burnout by gender or race. However, females earned significantly less than men at each academic rank.

Conclusions: PSOP report high levels of burnout consistent with other oncology professionals. Critical predictors include patient volume and lack of administrative time. Mid-career providers are more vulnerable to burnout, suggesting an inflection point at which individuals may be more likely to leave the field. We recommend a benchmark for clinical volume and sufficient administrative time to support the tripartite mission (education, research, patient care) and quadruple aim (patient experience, population health, cost, worker well-being) of academic medical centers.

Objective: Many cancer patients are raising young children while suffering from the seriousness of the illness, and it is challenging for parents to talk to their children about their parents' advanced cancer. The purpose of this systematic review was to synthesize the existing evidence on parents' and children's experiences of communicating about parental advanced cancer.

Methods: Seven databases including Pubmed, Web of Science, Embase (OVID), PROQUEST health and medical, CINAL Complete (EMBSO), Medline (OVID), Cochrane Library were systematically searched. A total of 3480 articles were retrieved. Finally, 21 articles were appraised and synthesized.

Results: Three synthesized findings were identified, including open communication with children, concerns about communication, and factors influencing ongoing communication. Most parents appreciated open communication, but struggled with the words, timing and amount of information, and were concerned about causing additional worry to their children. Talking openly about a parent's advanced cancer provided an opportunity for both parents and their children to support each other emotionally, although some parents reported distress in their children.

Conclusions: This systematic review showed the current evidence on parent-child communication when a parent was diagnosed with advanced cancer. Future studies should be conducted to explore how parent-child communication about a parent's advanced cancer affects children's physical and psychological health, and explore children's experiences more directly. Interventions should be developed to help parents with advanced cancer and their children of different ages.