Psycho‐Oncology最新文献

Objective: Patients with relapsed or refractory (r/r) indolent non-Hodgkin lymphoma (iNHL) live with incurable disease for a long-term, experiencing multiple relapses and treatments that impair their health-related quality of life (HRQOL). We aimed to better understand the unmet needs and HRQOL of patients with r/r iNHL.

Methods: This convergent mixed-methods study evaluated patients with r/r iNHL who received treatment. Unmet needs and HRQOL were assessed quantitatively using self-administered questionnaires and analyzed statistically. Qualitative data were collected through face-to-face semi-structured interviews for reflexive thematic analysis. Quantitative and qualitative findings were integrated through narrative discussion and joint display.

Results: Questionnaire respondents (50 participants, mean age: 72.42 years) reported unmet needs in the health system and information and psychological domains and a negative association between unmet needs and HRQOL. Interviews (20 participants, mean age: 72.75 years) identified four themes: "unremarkable symptoms," "anxiety of progression in the near future," "make the best of life," and "means to live with uncertainty." Integration revealed that participants accepted their low HRQOL and attempted to make the best of life, influencing their perception of unmet needs.

Conclusions: Throughout the long course of r/r and repeated treatment, patients with iNHL accepted their low HRQOL, valued their current situations, and endeavored to make the best of life. In this situation, support in the psychological and health system and information domains is crucial. Support for the unmet needs of patients with r/r iNHL is essential as they strive to live their best lives while maintaining a favorable HRQOL.

Objective: Peers play a crucial role in supporting wellbeing and psychosocial development for young people aged 12-25. However, a cancer experience often leads to challenges maintaining friendships. There have been no prior attempts to map or synthesise available research or resources on support specifically from friends for young people with cancer, limiting the capacity to draw conclusions or determine next steps for how to best support young people with cancer. This review aims to address this gap by mapping and synthesising the available literature and resources.

Methods: Included studies were required to obtain data from young people with a history of cancer or their friends, and have a main aim or outcome related to relationships between young people with cancer and their friends. Five databases (Medline, Web of Science, Embase, ProQuest and PsycInfo) were searched, and grey literature were sourced using three search engines (Brave Browser, DuckDuckGo, and Google).

Results: A total of 52 studies and 10 resources met inclusion criteria. Three main themes were identified within the literature (valued friendship dimensions and actions, cancer-related challenges to friendships, and changes to social needs, experiences, and outcomes). Resources for friends included education about what young people with cancer may experience, advice on supporting or talking to their friend, and encouragement for self-care.

Conclusions: Reviewed studies highlight the importance of friends support for young people with cancer, and the challenges faced. We present a future research agenda to address identified gaps, including the absence of studies exploring the perspectives and needs of friends.

Objective: As survival rates from breast cancer increase, the post-treatment period poses several challenges, including a high burden of cancer-related symptoms that interfere with quality of life. This study aims to provide a better understanding of the relationship between coping (approach and avoidance), emotional processing (emotional awareness and acceptance of emotions), and cancer-related symptoms.

Methods: This is a cross-sectional, secondary analysis of baseline data from a randomized controlled trial entitled "The Role of Emotional Processing in Art Therapy" (REPAT) study. Participants included 179 breast cancer survivors 6.1 months on average after completing primary treatment. Participants completed questionnaires measuring approach and avoidance coping, acceptance of emotions, cancer-related symptoms (depression, fatigue, and pain), and the Level of Emotional Awareness a performance scale. Hierarchical linear regressions were performed while adjusting for background variables.

Results: Participants experienced significant depressive symptoms (51.7%), fatigue (78.8%), pain interference (78%), and pain intensity (66%). There were strong correlations between depression, cancer-related fatigue, and pain. After adjusting for confounders, acceptance of emotions was negatively associated with depression, and avoidance coping was positively associated with depression, cancer-related fatigue, and pain interference. Emotional awareness and approach coping were not associated with cancer-related symptoms, but both were significantly associated with acceptance of emotions.

Conclusions: Breast cancer survivors' post-treatment period presents the challenge of dealing with elevated cancer-related symptoms. Regardless, breast cancer survivors with high acceptance of emotions and low avoidance coping experienced fewer cancer-related symptoms.

Objective: This systematic review explores psychosocial interventions aimed at improving the well-being of teenage and young adult (TYA) survivors of childhood cancer. It focuses on post-treatment survivors aged 13-39 years, examining the types of interventions trialled, their efficacy in enhancing different facets of mental well-being, and any potential negative impacts. The review was prospectively registered on PROSPERO and utilised randomised controlled trials (RCTs) to assess psychosocial interventions such as cognitive-behavioural therapy, psychoeducation, peer support, and physical activity programmes.

Methods: Fifteen studies involving 1109 participants were included, covering interventions across multiple modes of delivery; online, in-person, and app-based.

Results: Interventions demonstrated varied effects on outcomes like quality of life, depression, anxiety, stress, mood, behaviour, coping skills, and social support. While some interventions, such as psychoeducation and physical activity programs, showed promising improvements in well-being, others demonstrated limited or mixed results. No significant adverse effects were reported.

Conclusions: The heterogeneity of interventions and outcome measures pose challenges for definitive conclusions, emphasising the need for future research with standardised measures, consistent sample sizes, and long-term follow-up to better assess the sustainability of intervention effects. Overall, the findings highlight the importance of tailored psychosocial support to address the unique needs of TYA cancer survivors during their survivorship journey.

Background: Cancer therapy de-escalation aims to reduce treatment intensity, minimizing the burden of short- and long-term toxicities on patients and family caregivers while maintaining current survival rates. While this approach holds potential benefits, it comes at a risk of worse patient health outcomes or treatment failure. An understanding of patient and family caregiver perspectives regarding cancer therapy de-escalation is required to design successful patient-and-caregiver-informed clinical trials, and optimally provide related patient-centered care.

Aim: To identify and synthesize the literature about patient and family caregiver perspectives of cancer therapy de-escalation to guide clinical care, research, decision-support resources, and education.

Methods: Following the Joanna Briggs Institute methodology, a systematic literature search was conducted in MEDLINE, EMBASE, PsycINFO, and CINAHL. We included quantitative, qualitative, and mixed-methods studies involving patients of all ages and cancer diagnoses and their family caregivers that focused on perceptions of cancer therapy de-escalation. Extracted data were organized according to the Framework for De-implementation in Cancer Care Delivery. Study quality was appraised.

Results: Twenty studies were included. De-escalation perspectives varied between patients and family caregivers, with factors including clinician trust and desire to improve quality of life noted as influential in de-escalation decisions. The decision-making process could be better supported through the provision of timely patient and family caregiver information and clinician communication training.

Conclusion: Cancer therapy de-escalation decisions are complex and multifactorial. Future research exploring which factors influence patient and family decision-making may offer insight into the design of optimal informational and supportive interventions.

Severe and persistent mental illness with psychotic features as a comorbidity to a cancer diagnosis presents unique challenges to delivery of cancer care. Current literature suggests that there are poorer outcomes and higher mortality in patients with severe mental illness, partly explained by barriers to access of screening services and social vulnerability factors. However, cancer care is also delivered differently in patients with SMI, and often less aggressive care is offered. These healthcare disparities could be addressed in part by preparing for the ethical issues that can arise during the course of care. Cancer care staff may have limited experience and knowledge about treatment of psychiatric symptoms and may feel troubled in scenarios when patients lack capacity and become unwilling to participate in their care. Conversely, patients may benefit from early involvement of their mental health team for psychiatric optimization and contingency preparation. Specifically, preemptive planning between the cancer care team and the mental healthcare team can alleviate distress for the patient and healthcare teams alike. This is especially important when medical decision-making capacity can fluctuate during treatment. A person-centered, team-based approach to care delivery provides bidirectional empowerment. A process is proposed to enhance medical decision-making in patients with severe mental illness and cancer. It is imperative to acknowledge the disparities that exist in this patient population and create a process that will improve care and alleviate distress for the patient and the cancer care team.

Background: Conscious and unconscious emotional processing (EP) may be related to breast cancer survivors' (BCS) response to the stress of dealing with cancer and its treatment, and often entails myriad psychological and physical symptoms.

Aims: To examine the relationship between EP expressed by BCS in drawings made during art therapy and its relationship with depression, pain, and fatigue.

Methods: This cross-sectional secondary analysis used data from the Role of Emotional Processing in Art Therapy study. BCS (N = 81) answered self-report questionnaires measuring depression, pain, and fatigue at baseline. Their drawings were coded for EP using the Drawing-Based Emotional Processing Scale (DRAWEP).

Results: Levels of depression, pain intensity and interference, and fatigue, were high, and a substantial percentage of participants were beyond the cutoff scores for severe symptoms. Controlling for background variables, EP subscales of making sense and organization were negatively associated with pain intensity, pain interference, and depression, but not with fatigue. These relationships are demonstrated with selected drawings.

Conclusions: Since drawing involves embodied processes and has the potential to capture latent aspects of EP, examining drawings can provide a means of investigating EP among BCS and its relationship to depression and pain and learn more about the emotional experiences of BCS.

Implications for practice: The DRAWEP can assist art therapists in increasing their awareness of EP, which may benefit their ability to identify women at risk. Moreover, this article can contribute to the development and enhancement of art therapists' awareness of EP.

Background: Exploring the role of structural power in relation to an individual's location in society can yield novel insights into cancer inequities. We aimed to understand how minority ethnic women's identities (age, gender, ethnicity, social position) intersected with social networks and healthcare services to influence their experiences of breast cancer care.

Methods: Semi-structured interviews with 20 women aged 31-60 years with a breast cancer diagnosis identifying as: Asian (n = 7), Black (n = 9), and of mixed ethnicity (n = 4) about their breast cancer journey. Data were analysed using Framework Analysis.

Results: We developed four themes; feeling stereotyped by (a) healthcare professionals (HCPs) and (b) social networks; influence of HCPs' knowledge, attitudes, and behaviours; perceived barriers in healthcare services; and influence of cultural beliefs. We provided a visual representation to illustrate the multifaceted factors that explain pathways to breast cancer inequities for these groups.

Conclusion: Our findings underscored that minority ethnic women negotiated complex processes that influence their coping responses, access to services, and management of their disease. Our study exposed institutional deficiencies that systematically disadvantage minority ethnic women. These findings suggest that policymakers and clinicians should reformulate policies and cancer services to ensure all women with breast cancer receive equal and optimal care.

Background: In recent years, technology-based interventions have emerged as effective approaches to provide psychological support for the parents of children with cancer. Despite their increasing use, evidence on the effectiveness of technology-based empowerment interventions remains limited, largely due to the heterogeneity in intervention designs and measured outcomes.

Aim: This meta-analysis aims to evaluate the effectiveness of technology-based psychological empowerment interventions on the psychological well-being of parents of pediatric cancer patients.

Methods: A comprehensive literature search was conducted databases including Scopus, Medline, PubMed, Embase, Cochrane Library, Web of Science, APA PsycINFO, CINAHL Complete, and the Ovid Nursing Database Scopus, Medline, and PubMed identified 8020 studies, from which 9 RCTs involving 698 parents of children with cancer were included. The risk of bias was assessed using the revised Cochrane Risk of Bias (RoB 2) tool. Data analysis was assessed using a random effects model with standardized mean difference (SMD) using Review Manager Version 5.4. Heterogeneity was assessed using the chi-square test and I² statistic. Subgroup analyses and sensitivity analyses were performed.

Results: The meta-analysis revealed significant improvements in psychological outcomes, including decreases in distress (SMD: -0.42, 95% CI [-0.70, -0.13], p = 0.005), depression (SMD: -0.92, 95% CI [-1.56, -0.27], p = 0.005) and anxiety (SMD: -1.47, 95% CI [-2.50, -0.44], p = 0.005) immediately after the intervention. Follow-up analyses showed maintained decreases in depression (SMD: -0.39, 95% CI [-0.61, -0.17], p = 0.005) and anxiety (SMD:-0.32, 95% CI [-0.58, -0.07], p = 0.01). Additionally, significant increases were observed coping (SMD: 4.31, 95% CI [1.19, 7.44], p = 0.007) and resilience (SMD: 4.68, 95% CI [1.23, 8.13], p = 0.008) immediately after the intervention. However, no significant effect was found on health-related quality of life (SMD: 0.02, 95% CI [-0.25, 0.29], p = 0.88).

Conclusion: This meta-analysis provides evidence that technology-based psychological empowerment interventions dramatically improve the psychological well-being of parents of children with cancer. By effectively decreasing distress, depression, and anxiety while enhancing coping skills and resilience, these interventions are emerging as essential components of psychosocial support programs. These findings underscore the transformative potential of technology-driven approaches in addressing the unique and multifaceted needs of families, paving the way for more accessible and personalized support systems.

Background: Many childhood cancer survivors (CCS) experience cancer-related worries (CRW), for example about late effects and cancer recurrence. CRW are associated with lower quality of life (QoL) and maladaptive health care use. We examined the prevalence, severity, and factors associated with CRW in adult CCS.

Methods: We included quantitative studies of ≥ 100 participants reporting on prevalence, severity, mean scores and/or associated factors of CRW among CCS aged ≥ 18 years, diagnosed at ≤ 21 years, and ≥ 2 years post-diagnosis. We searched MEDLINE/PubMed and APA PsycINFO, hand-searched reference lists, and consulted experts. Risk of bias was assessed using the Cochrane Childhood Cancer Risk of Bias Criteria. Results were synthesized descriptively.

Results: The 17 included studies with a total of 26,306 CCS identified three main themes of CRW: health-related, financial, and interpersonal. Most prevalent were health-related worries regarding future health (88%-92%), late effects (83%), cancer recurrence (25%-88%), second cancers (50%-91%), and infertility (34%-68%). Factors associated with increased CRW varied depending on the specific CRW. These included female sex, more pain, anxiety, depression, chronic conditions (e.g., neurologic, being overweight), and treatment history (chemotherapy, radiotherapy).

Discussion and implications: Although most included studies used single items to assess CRW, this review underscores that health-related worries are particularly prevalent among CCS. Effectively identifying CCS at high risk, for example through using validated measures, and addressing severe CRW can facilitate adaptive healthcare use and improve QoL among CCS. Potential interventions can be providing information about late effects, psycho-education, discussions during follow-up care, and targeted psychosocial support for those with severe CRW.