Psycho‐Oncology最新文献

Introduction: While surgery is considered a standard treatment for patients diagnosed with early-stage lung cancer, it often brings significant challenges for patients including functional limitations and post-operative symptoms. Family caregivers play a critical role in care coordination, post-operative management, and addressing emotional distress often with limited preparation and support. Despite their importance, few studies have assessed the interrelationship between patient and caregiver outcomes during the peri-operative period.

Methods: This study is a secondary analysis of data from a randomized controlled trial involving 190 patient-caregiver dyads who participated in a dyadic multimedia self-management intervention. Structural equation modeling (SEM) was used to evaluate the impact of various sociodemographic variables and psychosocial mediators on dyadic outcomes.

Results: Self-efficacy was a consistent predictor, with positive effects on preparedness and quality of life (QOL) and negative effects on psychological distress. While activation and knowledge were positively associated with self-efficacy and preparedness, they showed minimal effects on caregiver burden and distress. When evaluating the interdependent relationship, higher patient QOL was associated with improved caregiver preparedness and reduced burden. Caregiver distress significantly predicted greater patient distress and lower patient QOL.

Conclusions: The results of this study support the interdependent, bi-directional associations of patient and caregiver well-being. Further multi-media interventions in the peri-operative period focused on self-efficacy and promoting emotional resilience among caregivers may substantially improve post-operative outcomes for both members of the dyad.

Introduction: Patients with cancer increasingly engage in online health information seeking (OHIS), yet the impact thereof on their anxiety and uncertainty remains unclear. This study aimed to: (1) examine how, when, and why patients engage in OHIS before and after oncological consultations; (2) identify patient characteristics (sociodemographic, medical, psychological) associated with OHIS; and (3) explore the relationship between OHIS, state anxiety, and uncertainty.

Methods: Patients with various cancer diagnoses and at various phases-of-care completed three self-report questionnaires: before (T0), directly after (T1), and 2 weeks after (T2) their outpatient consultation.

Results: Half (50%) of patients (n = 281) engaged in OHIS. Commonly sought topics included physical complaints (T0: 57%, T2: 51%), chances of recovery after treatment and life expectancy (T0: 48%, T2: 47%), and common treatments (T0: 43%, T2: 33%). A stronger monitoring coping style, higher levels of trait anxiety, higher educational levels, and early phase-of-care were significantly associated with OHIS (all p < 0.01). Age, gender, health literacy, or uncertainty intolerance were not associated with OHIS (all p > 0.05). Seekers reported more uncertainty than non-seekers (p < 0.001), but OHIS was not significantly associated with state anxiety (p = 0.642).

Conclusion: One in two patients engaged in OHIS, particularly those who are recently diagnosed, highly educated, generally anxious or have a stronger monitoring coping style. Clinicians should not be concerned that patients' OHIS will increase patients' anxiety, as this study found no such association. As OHIS was associated with uncertainty, future research should explore whether addressing OHIS in consultations reduces uncertainty.

Objective: Sarcoma is a rare cancer with complex treatment phases, leaving people with sarcoma and their carers with unmet information and support needs. This review provides an evaluation of sarcoma websites internationally to inform the development of online resources for the SUN-SHINE sarcoma project, aimed at addressing the unmet needs of people with a sarcoma diagnosis.

Methods: A review of sarcoma information websites was conducted via Google search, with the first 3 pages of results of 19 searches undergoing eligibility screening. Of 95 websites yielded by the initial screening, 40 were eligible for assessment using the Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) Index, and Flesch-Kincaid Reading Ease (FRE) for readability, and the Patient Education Materials Assessment Tool (PEMAT) for understandability and actionability. Readability was assessed against the Australian recommendation of grade 8 reading level for health information and higher PEMAT scores indicated greater understandability and actionability.

Results: The 40 websites reviewed were based in Europe (n = 13), Oceania (n = 12), North America (n = 10), and Asia (n = 4), with one multinational site. Websites generally contained pages on sarcoma definitions, diagnosis, and treatments, but lacked information on supportive and psychosocial care. Readability assessments exceeded (were less readable than) the general population reading level (M = 10.5; SD = 2.0). PEMAT scoring of websites revealed understandability averaging 70.7% (SD = 14.8), but lower actionability (M = 29.1%; SD = 26.4).

Conclusions: Limited sarcoma supportive care information exists, with no caregiver-focused websites and little tailoring for specific populations. Websites contained some components to support their readability, such as sub-headings and summaries, but more inclusive and accessible websites are warranted.

Objective: Lymphomas are one of the primary cancers that affect adolescents and young adults (AYAs). We examined the feasibility of two group-based interventions-one meditation-based and one education-based-for AYAs with lymphoma. We also explored their potential benefits for reducing psychological distress and cancer-related symptom burden.

Methods: Patients aged 18-39 years with lymphoma undergoing chemotherapy were randomized to either the meditation or psychoeducation intervention. Both received 5 weekly sessions (60 min each) delivered in a group setting via videoconferencing. Participants were assessed at baseline (T1), 6 weeks (T2), and 12 weeks (T3).

Results: Participants were randomized to the meditation (n = 28) or psychoeducation intervention (n = 32) with a consent rate of 51.4%. Session attendance was similar across interventions, with 60.7% in the meditation intervention and 56.3% in the psychoeducation intervention attending all 5 sessions (χ²(4) = 0.65). Assessment completion rates in the meditation intervention were 75% at T2 and 64% at T3; in the psychoeducation intervention, rates were 78% at both time points. From T1 to T3, the psychoeducation intervention showed significant improvements in cancer-related symptom severity (mean difference = 0.75, p = 0.041) and interference (mean difference = 1.07, p = 0.028).

Conclusions: Videoconference-delivered, group-based supportive care for AYAs with lymphoma during active cancer treatment appears feasible and may help reduce symptom burden or prevent further worsening of quality of life. Virtual delivery enhances accessibility and scalability across diverse clinical settings. Strategies to improve adherence and retention are needed to optimize engagement in this population.

Clinical trial registration: ClinicalTrials.gov Identifier NCT04270266.

Background: Professional grief refers to the emotional response healthcare professionals may experience following patient deaths. Although likely relevant in clinical practice, this phenomenon has been overlooked in research-particularly among psycho-oncologists. This study examined the emotional impact, coping strategies, and support needs related to professional grief in a German sample of psycho-oncologists.

Methods: A cross-sectional online survey was disseminated via professional associations and randomly selected cancer centers in Germany. Eligible participants were working in psycho-oncology and had experienced at least one patient death. The survey included two established instruments (Texas Revised Inventory of Grief-Present Feelings [TRIG-D], Professional Bereavement Scale [PBS-D]) and self-developed items on emotional responses, coping behaviors, and support needs.

Results: 258 participants (91% female; mean age 48 years) were included. Participants reported an average of three patient deaths per month and moderate overall distress (scale 0-10, M = 5.02, SD = 2.14). Scores on both grief scales were in the low to moderate range. Most participants reported positive effects of professional grief on for example their sense of purpose, with minimal impact on relationships. Common coping strategies included adopting an accepting stance and peer support. Unmet support needs were identified, particularly regarding professional training and timely communication about patient deaths.

Conclusion: This study offers the first quantitative insight into professional grief among psycho-oncologists in Germany. Professional grief levels were low to moderate. The reported positive changes suggest that patient deaths may even pose a chance for professional growth. Future research should explore relevant risk and protective factors to guide targeted support.

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.