Psycho‐Oncology最新文献

Background: People living longer with metastatic non-small cell lung cancer (mNSCLC) experience heightened psychological distress and decrements in quality of life. Therefore, we developed LiveWell, an 8-session adapted dialectical behavioral therapy skills training (DBT-ST) protocol delivered one-on-one via telehealth to reduce psychological distress.

Aim: To conduct a single-arm pilot trial examining the feasibility and acceptability of LiveWell and explore change in outcome variables.

Methods: Patients receiving systemic therapy for mNSCLC with at least mild distress participated. Outcomes were feasibility (accrual N = 30 in 18 months, > 80% sessions attended, < 25% attrition) and acceptability (> 80% participant satisfaction). Distress (depression and anxiety symptoms; primary outcomes), intolerance of uncertainty, emotion regulation, illness acceptance, symptoms (e.g., fatigue, dyspnea, pain), skill use, and quality of life (secondary outcomes) were assessed at baseline, post-intervention (primary endpoint), and 1-month post-intervention and examined with paired sample t-tests.

Results: Thirty participants (M_age = 63 years, 77% female) consented and completed the baseline assessment. LiveWell met feasibility (accrual N = 30 in 8 months, 93% sessions attended, 87% retention at post-intervention) and acceptability (96% satisfaction) benchmarks. Participants demonstrated reductions in distress (depression d = 0.35, anxiety d = 0.22) from baseline to post-treatment. Intolerance of uncertainty (d = 0.71), emotion regulation (d = 0.49), and illness acceptance (d = 0.45) improved. Fatigue and pain remained stable or improved (d's 0.07-0.38). Skill use increased (d = 0.65) and quality of life improved (d = 0.21). Improvements were maintained or enhanced at 1-month follow-up.

Conclusions: LiveWell was feasible and acceptable, and participants demonstrated promising improvement in primary and secondary outcomes. Findings support a larger randomized efficacy trial.

Trial registration: ClinicalTrials.gov Identifier: NCT04973436.

Objective: This study aims to integrate existing qualitative research, consolidate the dynamic experiences of parents of adolescent cancer patients regarding fertility preservation (FP), and highlight the influencing factors of parents' decisions on FP.

Methods: The following 11 databases, namely PubMed, Web of Science, Embase, PsycINFO, CINAHL, The Cochrane Library, WanFang, VIP, SinoMed, CNKI and OpenGrey, were searched for materials published up to November 2024. The results were reported using the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). Quality was assessed with the Critical Appraisal Skills Program tool. Data synthesis was conducted using thematic analysis. The confidence of the obtained evidence was analyzed by using the CERQual analysis.

Results: A total of 10 studies was included and synthesized into three themes: (1) value cognition and ethical trade-offs of FP; (2) factors influencing FP decision-making; and (3) suggestions for FP professional consulting. The review results indicated the complexity and significance of parents' decision-making process regarding FP, as well as the unmet support demands behind it.

Conclusions: This review summarizes parents' macro-level perceptions of FP in adolescent cancer patients and factors influencing their decision-making. A multidisciplinary team approach is crucial for guiding parents through this complex decision-making process. Future research should focus on clarifying the long-term outcomes of FP, aiming to provide these families with more comprehensive and tailored support.

Background: Exercise has been shown to improve mental well-being and health-related quality of life (HRQoL) in breast cancer survivors. However, there is no evidence on the effects of online interventions tailored using heart rate variability (HRV).

Aims: This study analyzed the effects of online high-intensity interval and strength training, guided daily by autonomic modulation, compared to pre-planned moderate to high-intensity concurrent training and control, on HRQoL, pain, fatigue, anxiety, depression, life satisfaction, self-esteem, and fear of movement in breast cancer survivors.

Methods: A 16-week randomized controlled trial was conducted with 54 participants assigned to HRV-guided exercise, pre-planned exercise, or usual care. Participants trained aerobic and strength three times per week under real-time online supervision. Intensity was adjusted based on HRV for the HRV-guided group. HRQoL, anxiety, depression, life satisfaction, self-esteem and fear of movement were assessed pre- and post-intervention.

Results: Significant time-by-group interactions were found for HRQoL functional domains (physical p = 0.004, role p = 0.005, emotional p = 0.013, social p = 0.001) and symptoms (fatigue p < 0.001, pain p < 0.001, dyspnea p = 0.004, insomnia p = 0.012, constipation p = 0.014), as well as depression (p < 0.001), anxiety (p = 0.002), life satisfaction (p = 0.003), self-esteem (p = 0.024), and fear of movement (p = 0.015). HRV-guided exercise led to greater improvements, while the control group worsened. Moreover, the exploratory analysis suggested a higher degree of interconnected changes in the HRV-guided group, and that dyspnea and fatigue might be the variables most strongly connected with anxiety, depression, and functioning-related variables.

Conclusion: Individualized online concurrent exercise, especially autonomic modulation-guided, improves HRQoL and mental health in breast cancer survivors, representing a promising personalized rehabilitation strategy.

Background: Adolescents and young adult cancer patients (AYACP) with terminal diagnoses face the challenge and additional burden of planning their end-of-life (EoL) care. Although AYACP receive a standard-of-care at EoL, the care they receive may not align with their goals. As such, the characteristics of their goals-of-care are poorly understood.

Aims: This systematic review aimed to describe AYACP desired level and nature of involvement in EoL goals-of-care decision-making and determine their barriers and facilitators.

Methods: To address this, an extensive search across PsycINFO, Web of Science, PubMed, and Scopus databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, yielding 23 studies from an initial 4211. The Mixed Methods Appraisal Tool was used to assess quality and risk of bias, while a thematic analysis was conducted to conceptualise AYACP EoL goals-of-care, which were presented through a narrative synthesis.

Results: Four key themes of AYACP EoL goals-of-care emerged: (1) preference for comfort-based care, (2) preference for life-prolonging interventions, (3) understanding disease prognosis and involvement in legacy-building, and (4) choosing not to decide and delegation of decision-making. AYACP reported that limited knowledge of available options was a barrier to decision-making, while exposure to interventions and EoL care information facilitated EoL goals-of-care discussions with family and healthcare professionals.

Conclusion: This review emphasises the diverse and evolving nature of AYACP goals-of-care and invites healthcare professionals to integrate early and regular discussions along with advance care planning to enhance quality of life and informed EoL decision-making.

Background: Depression significantly impacts quality of life and prognosis in subjects with cancer. Despite the evidence supporting the role of pharmacotherapy, real-world data on the effectiveness and tolerability of different antidepressant classes in cancer populations remain limited.

Objective: To assess the effectiveness and tolerability of antidepressant classes and individual agents in oncology patients with major depressive disorder (MDD), and to investigate antidepressant prescription trends.

Methods: This 6-month retrospective observational study was conducted in 170 oncology outpatients with MDD. Patients received monotherapy with tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or a multimodal antidepressant class including only vortioxetine. Psychiatric symptoms were evaluated at baseline and after 1 and 6 months. Evaluation included rates of response, remission and changes in rating scales assessing depression, anxiety, suicidality, and agitation.

Results: All antidepressant classes showed comparable effectiveness and capability of reducing depression, anxiety, and suicidal ideation over time. Vortioxetine showed a favorable tolerability profile, with no reported adverse effects, whereas SSRIs and SNRIs had higher dropout rates due to side effects. SSRIs were the most prescribed class, followed by multimodal agents. Vortioxetine was the most frequently prescribed individual antidepressant, particularly among patients undergoing chemotherapy.

Limitations: The small sample size and the lack of stratification by cancer type limit the generalizability of the results.

Conclusion: Antidepressants were equally effective in treating depression among cancer patients. Vortioxetine emerged as a well-tolerated and preferred option for chemotherapy patients. These findings emphasize the importance of tolerability and drug-interaction profiles in oncology care.

Background: Fear of cancer recurrence (FCR) is a major psychological burden for breast cancer survivors, impairing daily functioning and quality of life. Fear of Recurrence Therapy (FORT), a cognitive-behavioral group intervention, has shown efficacy in Western settings. This study evaluated the effectiveness of an adapted FORT program in Turkish breast cancer survivors.

Methods: A single-blind, parallel-group randomized controlled trial was conducted between February and March 2025. Stage I-III survivors within 5 years post-treatment (N = 100) were randomized (1:1) to FORT or a CBT-based intervention. Both interventions comprised six weekly online sessions; however, the adapted version of FORT program was extended to 150 min per session, while the CBT group maintained 120-min sessions. The primary outcome was FCR (Fear of Cancer Recurrence Inventory). Secondary outcomes were anxiety and depression (HADS), distress (Emotion Thermometer), quality of life (EORTC QLQ-C30), intolerance of uncertainty (IUS-12), self-efficacy (SEMCD), and coping skills (CCQ). Analyses followed intention-to-treat (ITT) and per-protocol (PP) principles.

Results: ITT analysis showed significant reductions in FCR in both groups; the ANCOVA-adjusted mean difference favoring FORT was -5.99 points (95% CI -10.95 to -1.03, p = 0.018, partial ω² = 0.047). Between-group differences favored FORT on FCRI subscales (triggers, metacognitions, emotion-focused coping) and intolerance of uncertainty (F(1,95) = 2.174, p = 0.032). PP analysis indicated additional benefits for anxiety (F(1,84) = 5.735, p = 0.019), depression (t = -2.174, p = 0.032), and functional quality of life (z = -2.079, p = 0.038). Adherence was high, with most participants completing all sessions.

Conclusions: Adapted FORT reduced FCR and psychological distress among Turkish survivors. Its effective online delivery demonstrates feasibility and scalability, supporting integration into psycho-oncological care.

Trial registration: NCT06676228.

Background: Rural residents are more likely to be caregivers and face significant burdens in caring for cancer patients. Rural caregivers can benefit from tailored interventions addressing their unique and complex needs.

Aims: This single-arm study evaluated the feasibility, acceptability, and preliminary outcomes of an adapted social support intervention, enCompass Carolina, for caregivers of rural cancer patients.

Methods: EnCompass Carolina is an 8-week one-on-one caregiver coaching program paired with a web-based support mapping tool (Clinical Trials #NCT05828927). Caregivers were recruited via patients treated in infusion clinics. Caregiver outcomes captured at enrollment, 4 weeks, and 8 weeks included coping self-efficacy, burden, anxiety, depression, and social support. Patient outcomes captured at enrollment and 8 weeks were anxiety, depression, and distress. Feasibility was measured using caregiver participation and completion rates and acceptability ratings. Generalized estimating equation methods accounted for repeated measures per person and were used to evaluate scores over time.

Results: Of 137 invited caregivers, 59 (44%) participated. 73% were female, 79% were non-Hispanic White, and average age was 60. 52 caregivers completed the support tool and 1+ coaching session, 46 (78%) completed post-intervention measures at 4 weeks, and 44 (75%) completed post-intervention measures at 8 weeks. Average acceptability ratings were 4.6 out of 5. Caregiver coping self-efficacy, anxiety, and depression significantly improved from pre-to post-intervention. No significant effects were seen on caregiver burden, support, or patient outcomes.

Conclusions: This one-on-one caregiver coaching program is feasible and acceptable for rural cancer caregivers, and it appears to be a promising intervention suitable for efficacy testing in future larger studies.

Background: Childhood cancer is highly stressful and potentially traumatic for families. While trauma-informed care (TIC) aims to address these impacts, little is known about how pediatric oncology nurses understand and use TIC in practice.

Method: This study was conducted using a qualitative descriptive design to explore pediatric oncology nurses' perceptions of trauma and trauma-informed care. Fifteen nurses with at least 1 year of experience working in a pediatric oncology unit in a city hospital in Türkiye were recruited through purposive sampling. Data were collected between June and July 2025 through face-to-face interviews using a semi-structured interview guide based on the Trauma-Informed Care Pyramid, and analyzed using Braun and Clarke's six-phase thematic analysis approach.

Results: Five major themes were identified: (1) family- and child-centered communication and care, (2) understanding the health effects of trauma, (3) interprofessional collaboration, (4) understanding one's own history and reactions, and (5) screening and evaluation processes. Additionally, metaphor analysis revealed that nurses frequently described trauma as destructive objects, dark colors, natural disasters, harsh seasons, and bitter tastes underscoring perceptions of trauma as overwhelming and difficult to endure. These findings highlight both the potential for TIC integration and the current gaps in systematic training and organizational support.

Conclusion: Pediatric oncology nurses recognize the effects of trauma and the need for psychosocial care, yet structured TIC practices remain limited. Integrating TIC principles into nursing education, strengthening team collaboration, and implementing systematic screening are key to improving holistic, family-centered care.

Aims: To explore patterns of medical service and medication use for mental health in women with breast cancer (BC) pre- and post-diagnosis.

Methods: Population-based South Australian Cancer Registry linked with medical services and medication prescriptions data for all women with BC diagnosed between April/2013 and March/2014. The patterns of medication and medical service use for mental health were examined in 1-yearly intervals between 1-year before and 5-years after BC diagnosis. Generalised estimating equations models with binary logistic distribution were used to examine characteristics associated with medication and medical service use for mental health.

Results: Data of 1143 women were analysed. The proportion of people who had a prescribed medication for mental health increased from 23% 1-year pre-diagnosis to 29% in the first year of diagnosis and remained stable at 29%-30% throughout 5 years post-diagnosis. The prevalence of medical service use for mental health increased from 7% 1-year pre-diagnosis to 13% in the first year of diagnosis, although the percentage decreased gradually over time post-diagnosis. A higher burden of comorbidity and time period after BC diagnosis were associated with increased likelihood for medication and medical service use for mental health, while older age, residing outside of major cities and receipt of radiotherapy were associated with decreased likelihood of mental health service use.

Conclusion: There is an apparent increase in medical service and medication use for mental health in the first year of BC diagnosis. These findings support the importance of early mental health screening to identify at-risk individuals for targeted intervention.

Aim: This study aimed to identify individual variability in day-to-day physical activity (PA) and sedentary behavior (SB) as well as effects of pain, fatigue, and well-being among patients with head and neck cancer (pwHNC) on both movement behaviors.

Methods: A total of 52 pwHNC (age ≥ 18 years, participation rate 73.2%) consented to wear an accelerometer during waking hours for seven consecutive days and to answer questionnaires. Applying a predefined accelerometer protocol resulted in a final analysis sample of 41 pwHNC. A dynamic structural equation modeling approach (DSEM) was employed that combines time series modeling and multilevel modeling. At the within-person level, autoregressive and bidirectional relationships between PA and SB were analyzed. At the between-person level, moderator effects of pain, fatigue, and well-being on these relationships were analyzed.

Results: A proportion of 87.8% among the pwHNC were men, mean age 65.8 years, and 72.2% had finished curative care. The average accelerometer wear time was 710.2 ± 153.1 min/d. Of this time, an average of 461.3 ± 151.0 min/d was spent in SB and 248.9 ± 121.6 min/d in PA. At the within-person level, PA and SB data showed no significant autoregressive relationships; that is, previous PA (or SB) did not predict PA (or SB) on the next day, respectively. No bidirectional relationships were found between PA and SB; that is, previous PA did not predict the next-day SB and vice versa. At the between-person level, neither fatigue, pain nor well-being significantly changed the slope and path parameters of PA and SB.

Conclusion: This study serves as an example of how DSEM can be used to examine how different movement behaviors interact with each other. Presumably, there is a need for more long-term assessment for the detection of consistency in the temporal information of movement behaviors in pwHNC.

Trial registration: German Registry of Clinical Trials (DRKS00028062).