Psycho‐Oncology最新文献

Background: Pain, fatigue, psychological distress, and fear of progression often co-occur in postoperative pancreatic cancer patients. The coexistence and interaction of these symptoms can further exacerbate burden. Existing research has mainly focused on single symptom or broad symptom clusters, leaving the interaction structure and key symptoms insufficiently understood.

Aims: To characterize correlations among these symptoms in postoperative pancreatic cancer patients, and to identify the central and bridge symptoms most suitable as intervention targets through network analysis.

Methods: This multicenter cross-sectional study included 512 postoperative pancreatic cancer patients. Symptom data were collected using the Global Pain Scale, Cancer Fatigue Scale, Distress Management Screening Measure, and Fear of Progression Questionnaire. Network analysis was conducted to map symptom correlations, with central and bridge symptoms identified using the qgraph and networktools packages. The bootnet package was employed to assess model stability.

Results: The symptom network showed substantial overall connectivity. Two strongest positive edges were P1 (pain intensity) - D6 (distress thermometer) and F1 (physical fatigue) - FoP5 (peer-relationship strain). P1 (pain intensity) had the greatest expected influence value, followed by D6 (distress thermometer), indicating central symptoms. Moreover, D6 (distress thermometer), F1 (physical fatigue), P1 (pain intensity), and FoP5 (peer-relationship strain) were found as bridges linking different communities. The network demonstrated good stability in case-dropping bootstrap analyses.

Conclusion: Targeted interventions directed at the identified central and bridge symptoms may help reduce overall symptom burden and improve quality of life. These findings provide a foundation for developing more refined and individualized symptom management strategies.

Background: Adult cancer survivors are likely to be hospitalised with chronic illnesses, although evidence for childhood and AYA survivors is limited.

Aim: This study quantified hospitalisations and the costs of health services used by survivors of childhood, adolescent, and young adult (AYA) cancers with and without chronic conditions.

Methods: We assessed long-term survivors (≥ 5 years past diagnosis) of childhood and AYA cancers diagnosed at ages 0-39 years between 1997 and 2011 in Queensland, Australia. Utilising a linked administrative dataset, we determined the prevalence of chronic conditions from hospital records using classification codes (ICD-10-AM) and quantified hospitalisations and associated costs in 2024 Australian dollars (AU$). Generalised linear regression modelling was used to examine how chronic conditions affected healthcare costs, controlling for clinical and socio-demographic factors.

Results: Of 14,422 participants, 16% (n = 2286) were hospitalised with at least one chronic disease, with hypertension (n = 675, 4.7%) and depression (n = 463, 3.2%) being the most common. Inpatient admissions were significantly higher for survivors with chronic conditions (mean 3, SD = 10) compared to those without chronic conditions (mean 1, SD = 4). The mean annual costs were highest for those with chronic kidney disease (AU$26,428, SD = AU$30,331), schizophrenia (AU$22,835, SD = AU$37,204), epilepsy (AU$22,361, SD = AU$37,224), paralysis (AU$22,051, SD = AU$32,165) and chronic heart failure (AU$21,912 SD = AU$38,763). Hypertension (AU$5.4 million) and depression (AU$4.3 million) incurred the highest total costs over the follow-up period.

Conclusion: Implementing targeted survivorship care and preventative measures for high-cost conditions such as schizophrenia and chronic kidney disease may optimise healthcare resource use and reduce the economic burden for this population.

Purpose: This study aimed to examine health care use in a cross-sectional sample of Dutch cancer survivors > 2 years post-diagnosis.

Methods: The Dutch Federation of Cancer Patient Organizations (NFK), together with patient representatives and researchers, developed a cross-sectional online survey on life after cancer, which was distributed via email, websites, and social media.

Results: The study included 5710 respondents (> 2 years post-diagnosis). Among those who reported long-term cancer/treatment-related consequences (approximately 89% of participants), one-third (33%) had received professional care or support for these issues in the past 3 months. Those reporting more cancer- or treatment related consequences, those diagnosed 2-5 years ago, those (probably) not (getting) better, and those currently under treatment were more likely to receive professional care or support. Care was primarily provided by medical specialists (47%), physical therapists (37%), and/or general practitioners (32%). 15% expressed a desire for care or support that they did not receive, indicating reasons such as a long time since diagnosis or affordability. Overall, 68% knew where to turn for help; among those with consequences, 19% received peer/volunteer support and 10% wanted it but did not receive it.

Conclusion: A significant proportion of long-term cancer survivors in our sample reported unmet support needs (15% for professional care, 10% for peer support). Efforts should focus on improving access to affordable professional care, expanding peer support networks, providing personalized long-term follow-up care, and reducing stigma around seeking help, particularly within the context of the Dutch healthcare system.

Background: Young adult survivors of childhood brain tumors (YAS) are at risk for limited health-related quality of life (HRQOL) and extended dependence on their maternal caregivers during the transition to adulthood. A problem-solving intervention was adapted to address challenges to family management, self-management, and HRQOL.

Aims: To evaluate the acceptability, feasibility, and preliminary efficacy of a problem-solving intervention (TIPS; Training in Problem-solving) for condition-focused maternal caregivers of YAS.

Methods: Maternal caregivers who screened positive for condition-focused family management were randomized to TIPS (n = 26) or Enhanced Usual Care (EUC; n = 27) and completed measures of problem-solving, family management, YAS self-management, and caregiver and YAS HRQOL at baseline and post-intervention (T3)Acceptability and feasibility data were collected at T3 and described.

Results: Both TIPS and EUC had moderate to high acceptability ratings with higher ratings for TIPS utility in meeting family needs. Feasibility, as measured by retention (70% for TIPS) and limited, minor technical glitches, was supported. Session length was a notable exception for feasibility. The largest between-group differences were observed in condition management ability, favoring TIPS (d = -0.85), and condition management effort, favoring TIPS (d = 0.58). Smaller, yet notable, between group differences were identified for YAS self-management (d = 0.44), YAS HRQOL (d = -0.40), and Parent Mutuality (d = -0.32) in the hypothesized direction except for YAS self-management.

Conclusions: TIPS was highly acceptable and moderately feasible. EUC was also acceptable, but the TIPS group demonstrated improved family management and YAS HRQOL highlighting the role of active intervention for caregivers of YAS.

Clinical trials registration: NCI Clinical Trials Reporting Program (NCI-2019-05353).

Background: Young children with cancer (YCC; diagnosed ≤ 7 years) are at greatest risk for developmental late effects, yet research has mostly focused on school-aged youth.

Aim: To characterize psychosocial needs for YCC by comparing the perspectives of their women caregivers (WC), men caregivers (MC), and healthcare providers (HCP).

Methods: Thirty-four caregivers (22 women, 12 men) and 25 multidisciplinary HCP of YCC at a midwestern children's hospital completed surveys and interviews or focus groups to assess unmet needs and preferences for timing, format, and components of a caregiver intervention. Descriptive statistics compared unmet needs and intervention preferences across informants. Rapid analysis with three coders yielded qualitative themes, which were confirmed with member checking.

Results: Five major domains of unmet needs for caregivers of YCC related to: (1) anticipatory guidance about the developmental impact of treatment, (2) working with the school, (3) psychosocial needs of young survivors, (4) family impact, and (5) caregiver self-care. WC and HCP were aligned in their rank ordering of needs, while MC expressed different priorities. All participants reported that developmental activity ideas would help and were receptive to a virtual format for accessibility. HCP suggested intervention during transition off-treatment, while caregivers reported preference for more support during treatment.

Conclusions: Findings indicate better alignment between HCP and WC regarding unmet needs among caregivers of YCC, suggesting tailored approaches are needed to address the unique needs of MC. Future work should engage HCP and caregivers in co-designing tailored interventions to improve psychosocial outcomes for YCC and their families.

Background: Global analyses of hematologic malignancies often lack subtype integration and advanced forecasting, limiting public health planning.

Methods: Using GBD 2021 data (1990-2021), we analyzed age-standardized incidence (ASIR), mortality (ASDR), and disability-adjusted life years (DALYs) for leukemia, lymphoma, and multiple myeloma. Spatiotemporal models quantified age-, sex-, and Socio-demographic Index (SDI)-stratified disparities. The Prophet model forecasted trends to 2031.

Results: In 2021, global ASIRs were 5.63, 7.93, and 1.74 per 100,000 for leukemia, lymphoma, and multiple myeloma, respectively. ASIR correlated positively with SDI for all subtypes (e.g., multiple myeloma: ρ = 0.81, p < 0.001). Mortality patterns were heterogeneous; Hodgkin lymphoma ASDR correlated negatively with SDI (ρ = -0.26, p < 0.001). Projections suggest stable or declining ASDRs by 2031 (e.g., leukemia: 3.86 to 3.40) but persistent male predominance. DALYs remain high in low-SDI regions.

Discussion: The disparity between high incidence in high-SDI areas and higher mortality fractions in low-SDI areas underscores diagnostic and therapeutic inequities. DALYs reflect associated long-term functional and psychosocial burden.

Conclusion: This study reveals profound global inequalities in hematologic malignancies. Mitigating this burden requires strengthening early diagnosis and treatment in low-SDI regions while integrating psychosocial support into global survivorship care.

Background: Major abdominal cancer surgery can significantly affect patients' psychosocial wellbeing, including anxiety, depression, sleep quality, and self-perceived health. Support from family caregivers during hospitalization may influence these outcomes.

Aim: This study evaluates the psychosocial outcomes of a Family Involvement Program (FIP) for patients undergoing major abdominal cancer surgery.

Methods: A secondary analysis was conducted using data from a patient-preferred prospective cohort study. Patients who participated in the FIP alongside a family caregiver were compared to those who received usual care. The following psychosocial outcomes were assessed and analyzed using linear mixed-effects models with stepwise backward selection: sleep quality, anxiety and depression (HADS), self-perceived health (EQ-VAS) and health related quality of life (EQ-5D-5L) index score. Satisfaction with care was analyzed using linear regression. Fidelity metrics included completion rates of fundamental and optional care activities and the number of caregivers staying overnight.

Results: Patients in the FIP group reported significant higher sleep quality and significantly higher satisfaction with healthcare than those receiving usual care. No significant differences were found in anxiety, depression, or self-perceived health between groups. Engagement in fundamental and optional care activities by family caregivers varied across activities and postoperative days, with 80%-90% of caregivers staying overnight.

Conclusion: Family caregiver involvement during hospital admission for major abdominal cancer surgery improved sleep quality and satisfaction with care. Participation in the FIP did not significantly affect patients' anxiety, depression, or self-perceived health. These findings suggest that family involvement programs may enhance the patients' psychosocial wellbeing during cancer recovery.

Objective: Numerous psychosocial interventions have been developed to improve physical and psychological health-related outcomes among breast cancer survivors (BCS). Given the longstanding racial and ethnic disparities in breast cancer, culturally adapted psychosocial interventions aim to meet the unique needs of racial and ethnic minority BCS. This systematic review evaluates the efficacy of culturally adapted psychosocial interventions in improving psychological distress and quality of life for racial and ethnic minority BCS.

Methods: Search criteria included the following: studies reported psychosocial interventions with a control group, were conducted in the U.S., were culturally adapted for a racial or ethnic minority group, and included at least one of our target outcomes (distress, depression, anxiety, stress, mood disturbance, quality of life, coping, adjustment). Systematic searches were conducted using PubMed/MEDLINE, Scopus, CINAHL, and PsycINFO databases. The Effective Public Health Practice Project Quality Assessment Tool was used to evaluate risk of bias.

Results: Twenty-three studies met inclusion criteria. Interventions were adapted for Asian/Asian American, Latina, and African American/Black female patients, the vast majority of whom were diagnosed with non-metastatic breast cancer. Most studies used methodology classified as "weak" and did not report significant improvements in target outcomes compared to the control group.

Conclusions: Future culturally adapted psychosocial interventions should include more diverse patient populations (e.g., race and ethnicity, gender identity) and more rigorous study designs. Review findings have important implications for future research and practice, as survivorship needs for BCS increase and notable disparities for racial and ethnic minority patients persist.

Trial registration: PROSPERO CRD42022384472.

Background: Fear of cancer recurrence (FCR) is a prevalent and distressing concern among cancer survivors. Although psychological interventions have demonstrated efficacy in reducing FCR, they often require significant resources and specialized personnel, limiting their accessibility. Remotely delivered exercise programs offer a scalable and cost-effective alternative, yet their impact on FCR remains underexplored.

Aims: To evaluate the effectiveness of a 12-week remote exercise intervention in reducing FCR among patients with cancer.

Methods: This study combines data from pilot studies assessing the feasibility of a remote exercise intervention. Patients were recruited from June 2022 to January 2024 from five Brazilian states, representing diverse geographic regions. Eligible participants were adults undergoing active cancer treatment with moderate-severe FCR (FCR-7 score ≥ 17). The intervention included a 12-week remote exercise program with weekly virtual consultations with an exercise physiologist and tailored exercise prescriptions. Primary and secondary outcomes included changes in FCR-7 and Functional Assessment of Cancer Therapy-General (FACT-G) scores. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and mixed-effects modeling.

Results: A total of 149 patients with moderate-severe FCR were included; 86.5% adhered to the program. The mean FCR-7 score decreased significantly from 20.2 (SD = 4.6) at baseline to 12.8 (SD = 4.6) at 12 weeks (p = 0.001, Cohen's d = 1.6). FACT-G scores improved significantly from 84.4 (SD = 11.5) to 95.6 (SD = 9.2) (p = 0.001, Cohen's d = 1.0). Mixed-effects modeling confirmed a significant reduction in FCR-7 scores over time (F = 377.176, p < 0.001), with a significant overall effect across participants (F = 2210.733, p < 0.001).

Conclusion: This study suggests that a 12-week remote exercise program may reduce FCR among patients with cancer. Given its accessibility and scalability, remote exercise programs should be further explored as a feasible strategy for addressing FCR in diverse populations. However, these findings are preliminary and should be confirmed in larger, controlled trials.