Psycho‐Oncology最新文献

Background: Research confirmed that social support has an important impact on mental health, especially in traumatized individuals. Breast cancer patients who have experienced diagnosis, surgery and adjuvant treatment have distinct social support. They endured more posttraumatic stress symptoms in the course of their diseases. The aim of the present study was to investigate whether support was correlated with posttraumatic stress symptoms among breast cancer patients in China, explore the role of emotion status (including anxious and depressive symptoms) in this relationship, and further compare the magnitude of the two mediation effects.

Methods: A total of 612 breast cancer patients who had completed surgery and were on chemotherapy (radiotherapy) participated in this study by completing a set of questionnaires derived from a combination of the Chinese Version of Furman and Buhrmester's Network of Relationships Inventory, the Chinese version of General Anxiety Symptoms Scale, the Chinese version of Patient Health Questionnaire, and the Chinese version of Posttraumatic Stress SymptomsScale.

Results: The results revealed that social support was significantly negatively correlated with posttraumatic stress symptoms. Structural equation modeling showed that emotion status (including anxious and depressive symptoms) mediated the relationship between social support and posttraumatic stress symptoms. The two indirect effects do not differ significantly.

Conclusion: Negative emotion was one of the core responses of traumatized individuals. Improving emotion status (including anxious and depressive symptoms) in breast cancer patients may be one of the cruxes in the recovery of their posttraumatic stress symptoms. This prompts that providing more social support to breast cancer patients during treatment will relieve their anxious and depressive symptoms and thus alleviate their posttraumatic stress symptoms.

Introduction: High-grade gliomas, the most common and aggressive brain cancer, are associated with significant neurological disability and are almost uniformly fatal. Though the diagnosis of brain cancer is represented as one of the most stressful life events for patients as well as for their caregivers, the prevalence of depression as a longitudinal event during and after the initial diagnosis and sequential lines of treatment is under-researched.

Objectives: To inform clinical practice, we assembled published, time-specific estimates of the prevalence of depression in adult high-grade glioma patients to test the idea that depression prevalence varies across therapeutic trajectory milestones.

Methods: We a priori defined five time points in the clinical course of first-line therapy. After an exhaustive search of the current literature, we extracted time point-specific estimates of depression prevalence, pooled the data by time point across studies, and constructed 95% confidence intervals on depression prevalence at each time point. A total of 822 patients were identified and entered into our analyses.

Results: The prevalence of depression in adult high-grade glioma is about 16%-27% between surgery and the end of temozolomide maintenance therapy, which is higher than the 9% estimated for the general population. However, when assessed in the time interval between the initial diagnostic tumor imaging and the confirmatory surgery, at least 30% of these patients are depressed.

Conclusions: Because depression worsens the patient's quality of life and is treatable, the multidisciplinary treatment teams involved in the care of high-grade glioma patients should assess depression throughout the disease trajectory, and especially immediately after the first imaging study showing a suspicious intracranial mass.

Background: The patient-doctor relationship, including communication, is recognised as a critical aspect of the patient experience. Memorable messages are a part of communication between patient and doctor. However, little is known which memorable messages reduce patients' trust in doctors or lead to distrust.

Aims: To reconstruct memorable messages which breast cancer patients recalled while receiving care from their clinicians leads patients to distrust doctors.

Methods: In-depth interviews were conducted with 24 breast cancer patients, in Poland and Croatia. Participants ranged in age from 34 to 76 years. Reflexive thematic analysis was used.

Results: Breast cancer patients recalled many memorable messages that reduce trust in oncology care. The overarching theme of untrustworthy memorable messages was developed, and it embraces three themes: seemingly caring memorable messages, careless memorable messages, missing expected memorable messages. They come in verbal, nonverbal and absent forms. Patient's responses to them include drawing attention directly to inappropriate communication, changing the doctor, learning to be better prepared for medical encounters, or passive adaptation.

Conclusions: These results enrich the studies on memorable messages, enhancing the understanding of communication behaviors in triggering distrust toward doctors. Although patients are aware that doctors are overworked, they expect care, attention, individual approach, understanding, and empathy. However, doctors sometimes give untrustworthy memorable messages - especially messages perceived as dismissive, harmful, inadequate, or absent although expected - throughout the cancer trajectory. Thus, greater attention should be given to eliminating untrustworthy memorable messages, improving the understanding of trust dynamics in oncology, psycho-oncology and health education.

Introduction: Women with severe mental disorders (SMD) experience premature mortality, with disparities in healthcare access and quality contributing to this trend. This study aimed to analyze breast cancer screening rates in women with schizophrenia, major depressive disorder, and bipolar disorder, compared to women without SMD.

Methods: A systematic review and meta-analysis were conducted using PubMed, Embase, PsycINFO, Cochrane, and Web of Science databases. Studies were included if they examined women with SMD (schizophrenia, major depressive disorder, or bipolar disorder) who were within the age range eligible for participation in breast cancer screening programs, according to the guidelines in effect at the time and in the country where the study was conducted, and if they also reported screening rates. Odds ratios were calculated, and meta-analyses were performed using random-effects models.

Results: The review included 22 studies. Women with SMD showed significantly lower odds of mammography screening compared to women without SMD (pooled OR = 0.66, 95% CI: 0.65-0.80, p-val = < 0.0001). Subgroup meta-analyses revealed significantly reduced screening rates in women with schizophrenia (OR = 0.58, 95% CI: 0.38 - 0.88, p-val = 0.005) and major depressive disorder (OR = 0.41, 95% CI: 0.17 - 0.97, p-val = < 0.0001), but no significant difference for bipolar disorder.

Conclusion: Women with SMD, particularly schizophrenia and major depressive disorder, have lower mammography screening rates than women without a SMD diagnosis. Addressing this disparity requires targeted interventions and increased healthcare provider awareness to improve screening rates and ensure equitable access to preventive care.

Objective: Patient trust is fundamental to ensuring optimal cancer care, especially for vulnerable patients who may face additional challenges. However, there is a limited understanding of what it entails for nurses to establish and maintain trust among vulnerable patients. Grounded in the concept of Trust Work, this study explored nurses' efforts to nurture patient trust.

Methods: Drawing on qualitative insights from NAVIGATE, a multicenter randomized controlled trial, we explored the interaction between nurses and vulnerable patients with lung cancer in clinical encounters. We included 16 patients and eight nurses from five Danish hospital sites. Among other sources, data comprised 45 audio-recorded clinical encounters conducted over one year, 15 of which were also observed in clinic settings or patients' homes, as well as semi-structured interviews with all participating patients and nurses. Analyses were based on thematic analysis principles.

Results: We found that nurses were continuously engaged in nurturing trust. This trust work involved three interrelated aspects: (1) 'Recognition' - meticulous preparation to remember individual patients and recognize their lived experiences, (2) 'Witnessing' or 'Guarding' - sustained support, though with varying levels of engagement, and (3) 'Involvement' or 'Detachment'-engaging with affirming resources or disengaging from colleagues' or the broader healthcare system. These aspects were shaped by contextual factors, including nurses' available time and continuity of care, professional affiliations and roles, and collegial and institutional relationships.

Conclusion: This study highlights nurses' critical role in nurturing patient trust and identifies important contextual factors for improving care targeting vulnerable cancer patients.

Objectives: Parents of children with cancer are at increased risk for anxiety, depression, and post-traumatic stress, although wide variability among parents has been documented. This cross-sectional study was designed to examine the individual contributions and simultaneous interaction of three coping constructs-coping strategy, repertoire of coping techniques, and flexibility in applying these techniques-in parental distress related to childhood cancer.

Methods: A sample of 88 mothers and 57 fathers (N = 145) of children undergoing active cancer treatment were recruited from a pediatric hematology-oncology department. Parents' ages ranged from 22 to 58 years. Parents completed standardized measures including the Brief COPE, Coping Flexibility Scale-Revised, the Pediatric Parenting Stress Inventory, and the Profile of Mood States.

Results: Avoidance-focused coping strategy, repertoire of coping techniques, and coping flexibility were individually found to be significantly correlated with parental distress. Bootstrap mediation analysis revealed that the collective model explained 37%-43% of the variance in parental distress, with avoidance-focused coping strategy emerging as the most significant predictor, accounting for approximately 29% of the total variance.

Conclusions: These results suggest that clinical interventions should prioritize identifying and reducing parental reliance on avoidance-focused coping techniques as a primary target. Subsequently, expanding parents' repertoire of problem- and emotion-focused coping techniques and enhancing flexibility in their application could lead to better distress reduction. However, the cross-sectional design limits causal interpretation, and future longitudinal studies employing larger sample sizes are needed to establish the relationships between these constructs.

Objectives: Social participation plays a key role in the rehabilitation process, improving mental health, reducing isolation, and enhancing quality of life. Despite its importance, existing tools for assessing social participation in pediatric cancer patients are limited in comprehensiveness and specificity. The aim of this study was to develop and evaluate the psychometric properties of a Social Participation Scale for Pediatric Cancer Patients (SPS-PC).

Methods: Items were created after an extensive literature review and evaluated through expert consultation and a pilot study. A convenience sampling approach was employed to recruit 420 pediatric cancer patients from pediatric departments of three tertiary grade-A hospitals in Zhengzhou for psychometric testing of the scale. Item selection was based on item analysis, exploratory factor analysis was conducted to extract factors, and confirmatory factor analysis was used to assess structural validity.

Results: The final version of the SPS-PC includes 16 items across four dimensions: school participation, family participation, peer participation, and health management participation. The scale demonstrated excellent content and construct validity, with high internal consistency (Cronbach's α = 0.900) and strong reliability (test-retest reliability = 0.820). Exploratory and confirmatory factor analyses confirmed a robust four-factor structure.

Conclusion: The SPS-PC is a reliable and valid instrument for assessing social participation in pediatric cancer patients. The scale's comprehensive approach makes it an essential tool for clinical practice and research in pediatric oncology, contributing to the social reintegration of these children.

Background: consideRATE is a patient- and care-partner-reported measure of care experience during serious illness. We used consideRATE with patients and care partners at the Dartmouth Cancer Center to assess patient experience, evaluate psychometric properties, and explore scoring approaches.

Methods: Patients and care partners who are aged 18+ and English proficient participated in a cross-sectional survey. Participants completed consideRATE (8 items), CANHELP Lite (21 items), and demographic questions. Reliability was assessed using Cronbach's α, and validity was evaluated with Pearson's correlations. Continuous and top-box scoring approaches were used. Psychometric properties were analyzed for patients, care partners, and subgroups with lower educational attainment or income.

Results: 244 participants (114 patients, 128 care-partners, 2 unspecified) completed the survey. consideRATE has internal reliability (α = 0.86); the correlation (r) between consideRATE continuous scoring and CANHELP Lite scores for all participants was 0.5; p < 0.001, for patients 0.5; p < 0.001, for care-partners 0.5; p < 0.001, for patients (n = 71) with lower educational attainment 0.5, p < 0.001, and for patients (n = 50) with lower income 0.7, p < 0.001. We also found correlations between consideRATE top-box scoring and CANHELP Lite scores for all participants (r^pb = 0.4, p < 0.001), with stronger associations among the patient (r^pb = 0.5, p < 0.001) and lower income (r^pb = 0.6, p = 0.005) subgroups. We found discriminant validity between consideRATE and Single-item Health Literacy (SIL) measures for continuous scoring (r = -0.05 to 0.09, p > 0.05) and top-box scoring (r = -0.02 to 0.09, p > 0.05). We found no significant difference in overall experience between patients with solid and hematologic malignancy cancer categories.

Conclusion: We demonstrated in this sample of patients attending a cancer center that consideRATE has good internal reliability and is well correlated with CANHELP Lite.

Background: Fatigue is a common consequence of low-grade gliomas (LGG), but its specific nature has not been extensively studied. In particular, it remains unclear if the prevalence and determinants of mental fatigue differ from those of physical fatigue. Therefore, this study aimed to examine (1) whether the prevalence and severity of mental fatigue differ from physical fatigue in patients with LGG; (2) the specific determinants of mental and physical fatigue, including cognitive impairments, affective symptoms and radiological abnormalities.

Methods: A total of 148 patients with LGG were included and assessed with the Dutch Multifactor Fatigue Scale (DMFS; mental and physical fatigue) and the Hospital Anxiety and Depression Scale (HADS; affective symptoms). Neuropsychological tests were administered to measure cognitive impairments, particularly in basic and complex information processing speed.

Results: Severe mental fatigue affected 38% of patients, a significantly different prevalence than that of severe physical fatigue (22%), with an overlap of 15%. Patients with severe mental fatigue had significantly lower scores on a divided attention task, compared to patients with non-severe mental fatigue. In a hierarchical linear prediction model with demographical, radiological and psychological variables, different sets of determinants were found for mental fatigue (anxiety and depression) and physical fatigue (depression, educational level and tumor volume).

Conclusions: Mental fatigue can be distinguished from physical fatigue in patients with LGG, characterized by a high prevalence and unique determinants. Therefore, mental fatigue should be considered as a distinct construct and presumably requires a different (neuro)psychological therapeutic approach compared to physical fatigue.

Background: Fear of cancer recurrence (FCR) is prevalent among patients with breast cancer, yet those at high risk are not well characterized.

Aims: This study aimed to identify the patient characteristics associated with FCR after diagnosis.

Methods: Between July and September 2023, participants in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort completed the 9-item FCR-Short Form Inventory. A score of 22 or higher indicated clinically significant FCR (csFCR). Logistic and linear regression estimated associations between different risk factors and csFCR and FCR scores, respectively. Missing data were addressed using multiple imputation.

Results: Among 1390 stage I-III patients (mean age 63.1 years and 9.1 [mean] years since diagnosis), 262 (18.8%) reported csFCR. In adjusted models, csFCR was associated with having another cancer excluding non-melanoma skin (adjusted odds ratio [aOR], 2.64; 95% CI, 1.66-4.21), greater levels of stress (aOR, 2.40 per 1-SD increment; 95% CI, 1.98-2.91), having a prior recurrence (aOR, 2.26; 95% CI, 1.14-4.47), and having estrogen receptor-positive tumors (aOR, 1.60; 95% CI, 1.06-2.40). Older age at diagnosis (aOR, 0.64 per 10-year increment; 95% CI, 0.56-0.73) was associated with lower odds of csFCR. Similar associations were observed with continuous FCR scores, along with advanced stage at diagnosis associated with higher FCR scores (p-trend = 0.001).

Conclusions: Nearly 1 in 5 breast cancer patients reported csFCR. Key risk factors included younger age at diagnosis, history of recurrence or other malignancies, greater levels of stress, and estrogen receptor-positive breast cancer, which can inform targeted interventions to support survivorship.