Psycho‐Oncology最新文献

Objective: People's beliefs about cancer can affect the actions they take to prevent and detect the disease. We investigated socio-economic inequalities in beliefs about cancer and its causes in the general population.

Methods: We analyzed data from the representative probabilistic Spanish Oncobarometer survey (N = 4769, 2020) and the non-probabilistic weight-corrected Spanish Cancer Awareness Survey (N = 1029, 2022). Beliefs about cancer, recognition of cancer symptoms, and recognition of risk factors were measured with the Awareness and Beliefs about Cancer questionnaire. Endorsement of mythical causes was measured with the CAM-Mythical Causes questionnaire. The effects of socio-economic status (SES) were investigated in multiple regression analyses adjusted for age, sex, and personal and family cancer history.

Results: Individuals with lower SES were more likely to endorse pessimistic beliefs (e.g., "cancer is a death sentence"), and less likely to endorse optimistic beliefs about cancer (e.g., "people with cancer continue with normal activities"). Individuals with lower SES also recognized fewer cancer symptoms and risk factors and endorsed more mythical causes of cancer. The gap in knowledge regarding cancer causes was wider among people with low SES, who were more likely to endorse several mythical causes than some established risk factors included in cancer prevention recommendations.

Conclusions: Socio-economic inequalities in beliefs about cancer are robust and multidimensional and indicate worse preparedness to act against the disease among lower socio-economic groups. Differences in beliefs about disease outcomes and causes are likely one of the multiple contributors to cancer disparities and should be targeted and monitored in prevention efforts.

Objective: A recent randomized trial of a group psychosocial telehealth intervention (STRIDE) improved anxiety, depression, quality of life (QOL), symptom distress, coping, and self-efficacy to manage symptoms related to taking adjuvant endocrine therapy (AET) in women with non-metastatic hormone receptor-positive breast cancer. This study examined whether changes in coping and self-efficacy mediated intervention effects on anxiety, depression, QOL, and symptom distress.

Method: Women (N = 100) were recruited between 10/2019-06/2021 from Massachusetts General Hospital and were randomized to STRIDE or to the medication monitoring control group. Participants completed self-report measures of anxiety and depression (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-Breast Cancer scale), symptom distress (Breast Cancer Prevention Trial Symptom Scale), coping (Measure of Current Status-Part A), and self-efficacy (Self Efficacy for Managing AET Symptoms) at baseline and 24-week follow-up. Mediated regression models tested whether changes in coping ability and self-efficacy mediated the intervention effects on anxiety, depression, QOL, and symptom distress, controlling for key variables.

Results: Improvements in coping across the 24-week study period mediated the effect of STRIDE on anxiety symptoms (indirect effect, B = -0.61, SE = 0.28, 95% CI: -1.28, -0.17), depressive symptoms (indirect effect, B = -0.50, SE = 0.21, 95% CI: -0.97, -0.15), and QOL (indirect effect, B = 3.80, SE = 1.25, 95% CI: 1.54, 6.49), but not symptom distress. Changes in self-efficacy did not mediate improvements in any of the proposed outcomes.

Conclusion: Coping is an essential component of a brief group psychosocial intervention that drives improvements in mood and QOL for women with non-metastatic hormone receptor-positive breast cancer taking AET.

Clinical trial registration: NCT03837496.

Objective: The Worries About Recurrence or Progression Scale (WARPS) was recently validated in four common chronic illnesses other than cancer, after a rigorous development process based on the COSMIN criteria. Available measures of fear of progression or fear of cancer recurrence (FCR) have been criticised for not meeting all COSMIN criteria. Therefore, this study aimed to explore the psychometric properties of the WARPS in a cancer sample to assess its applicability to measure FCR.

Methods: We recruited 346 participants living with or beyond cancer for an online survey. The psychometric properties of the WARPS were examined using a confirmatory factor analysis. Convergent validity was assessed against the current gold standard questionnaires and constructs related to FCR. Some participants completed a follow-up survey 2 weeks later, to assess the test-retest reliability. Finally, a Receiver Operating Characteristics analysis was conducted to determine clinical cut-offs for the WARPS.

Results: Confirmatory factor analysis confirmed that the WARPS has one underlying factor, fear of recurrence or progression (FRP), with adequate model fit. The WARPS demonstrated excellent internal consistency, test-retest reliability and showed convergent validity. ROC analysis revealed a cut-off of 54 for moderate, and 65 for severe FCR on the WARPS.

Conclusions: The WARPS demonstrated good psychometric properties in a cancer sample. It has the capacity to be used as a screening tool to identify clinical levels of FCR. The WARPS was developed consistent with the COSMIN criteria and overcomes some of the limitations of existing measures.

Purpose: This study examined the feasibility and acceptability of a three-session, psychological-based intervention to improve intimacy and sexuality outcomes among women with breast and gynaecologic cancer in Singapore.

Method: Patients from outpatient oncology clinics completed screeners for marital and sexual distress. Those who endorsed either marital or sexual distress were invited into the study, and were randomized to receive the intervention immediately or be waitlisted. Intervention feasibility (i.e., reach, adherence) and acceptability (i.e., satisfaction, cultural sensitivity, willingness to pay) and marital, sexual, and body image outcome changes were examined.

Results: 1101 patients completed the screener; 24% of patients with breast or gynaecologic cancer reported marital or sexual distress. Forty-six patients who were eligible participated in the study. The majority (88%) of participants who started the intervention completed all 3 sessions. All (100%) participants who completed the intervention reported satisfaction and the majority (97%) reported they would recommend the intervention to a friend. The majority of participants found the intervention to be culturally sensitive (93%) and reported being willing to pay either out of pocket or through their national medical MediSave account (76%). Outcome changes were in expected directions with small effect sizes (0.24-0.42). Several themes emerged from open-ended feedback on what participants found useful and how the intervention can be improved.

Conclusions: Approximately one quarter of breast or gynaecologic cancer patient who are partnered in Singapore reported marital or sexual distress. Despite the low reach, we found good adherence and high acceptability of the psychological-based intervention. Our findings suggest there is room to improve awareness and delivery of sexuality-related care in an oncology setting.

Trial registration: Number and date: NCT03420547, April 10, 2018.

Background: Advancements in precision oncology have led to a growing community of adults with advanced cancer who live longer but face prognostic uncertainty, with corresponding fears of the future. Their worst future fears related to cancer remain understudied, hindering support efforts.

Aims: This study aimed to characterize the presence, content, and predictors of imagined future worst-case scenarios related to cancer (WCS) among distressed adults with advanced cancer.

Methods: Two hundred fifteen distressed adults with advanced solid tumor cancer (mixed type) responded to survey questions regarding the presence (Yes/No) of a WCS related to cancer and if yes, to briefly describe it. Mixed methods were used to assess WCS prevalence, thematic content, and sociodemographic, psychological, and medical predictors.

Results: Two thirds (66.5%) of advanced cancer survivors endorsed having a WCS. Content reflected four major themes of Death (52.2%), Suffering and Deterioration (47.1%), Cancer Progression and Future Uncertainty (28.7%), and Concern about Family (18.4%). WCS often contained more than one major theme, further distinguished by additional themes and sub-themes that revealed distinct fears. Higher anxiety and lower life meaning/peace predicted the presence of a WCS whereas sociodemographic characteristics, depression, time since diagnosis, and physical symptom burden did not. Younger age and living with children predicted a WCS focused on loved ones.

Conclusions: WCS are prevalent and diverse in content among distressed adults with advanced cancer. Assessing WCS offers a quick and straightforward way to solicit advanced cancer survivors' most intense fears about the future with cancer, thereby facilitating patient-provider communication and support efforts.

Study objective: To assess the impact of a personalized integrative medicine (IM) intervention on healthcare providers (HCPs) expressing war-related emotional/spiritual and physical concerns.

Methods: Physicians, nurses, para-medical and other HCPs from 5 hospital departments in northern Israel underwent IM treatments provided by IM-trained practitioners working in integrative oncology (IO) care settings. The two main HCP-reported concerns were scored (from 0 to 6) before and following the intervention using the Measure Yourself Concerns and Wellbeing questionnaire. Post-intervention narratives were examined for emotional/spiritual keywords (ESKs).

Results: Of 190 participating HCPs, 121 (63.7%) expressed ESKs in post-treatment narratives (ESK group), with 69 not expressing ESKs (nESK group). Both groups had similar demographic and professional backgrounds, and reported improved measure yourself concerns and well-being (MYCAW) QoL-related concerns immediately post-intervention. However, between-group analysis found significantly greater improvement in the ESK group for the first (p < 0.001) and second (p = 0.01) MYCAW concerns, as well as emotional/spiritual concerns (p < 0.001). Pain-related concerns improved similarly in both groups, with improved scores continuing to 24-h post-treatment.

Conclusions: HCPs with war-related emotional/spiritual and physical QoL-related concerns showed significant improvement following the IM intervention. This was more significant among those reporting ESKs for their two major and emotional/spiritual concerns, with pain scores improving similarly in both groups. Future research needs to explore specific and non-specific effects of IM intervention provided by IO practitioners working outside their "comfort zone", fostering collaboration between IM and mental health providers to address HCP wellbeing and resilience during a time of national crisis.

Background: Providing supportive services to patients and their caregivers is essential to quality cancer care, yet the depth, availability, and infrastructure underlying these services remains unknown in community practice. We assessed these factors among practices within the National Cancer Institute Community Oncology Research Program (NCORP) to guide priorities for comprehensive supportive service(s) development and inform implementation of evidence-based interventions in clinical practice.

Methods: Supportive care leaders at NCORP practices completed online surveys regarding availability of services to patients and caregivers within seven domains, service infrastructure (e.g., staffing, technology), and implementation recommendations for caregiver-specific services. Primary outcomes were the proportion of practices offering at least one service in each domain to both populations and the proportion offering caregiver training/education.

Results: Of the 103 participating practice groups, only 15.5% offered at least one service in each domain to both populations; 21.4% offered caregiver training/education. Psychological (83.5%) and spiritual/religious (75.7%) services were most widely available to both; health promotion (28.2%) services were least available to both. Services offered were largely available on-site with dedicated staff; caregiver-specific services were nearly always off-site and typically self-pay. Practices most often used the patient health portal to communicate with patients and caregivers (54.4%). Only 28.9% provided bilingual staff for services. Social workers (35.7%) and navigators (34.7%) were recommended to support caregiver services.

Conclusions: To meet national recommendations for supportive service provision, practices should invest in caregiver education/training programs, expand health promotion programs, and increase interpretation services. Future interventions should leverage existing resources (e.g., recommended staff, patient portal).

Objective: The diagnosis of a mood-related psychiatric disorder (MRPD) among patients with cancer has been associated with decreased quality of life and lower cancer survival. This study aimed to understand the risk of a new MRPD after cancer diagnosis by individual risk behaviors, with a specific focus on tobacco use and the presence of a human papillomavirus (HPV)-associated cancer.

Methods: Single-center retrospective cohort study of 11,712 patients diagnosed with cancer between 2009 and 2020. We identified predictors of a new MRPD after cancer diagnosis using a time-to-event analysis and Cox proportional hazards model including demographics, disease characteristics, and tobacco use and HPV-associated tumors.

Results: Univariate analyses revealed lower hazard ratios (HRs) of a new MRPD among individuals that identified as Asian/Pacific Islanders and among the older age groups (> 51 years). Univariate analyses additionally demonstrated higher HRs of MRPD among females; sexual minorities; former and current smokers; individuals with HPV-associated cancers; and individuals diagnosed at later stages. These relationships were observed in the multivariate model when adjusting for covariates. Shorter time-to-MRPD was observed when stratifying by individual behavioral risk factors, with active smokers and individuals with an HPV-associated cancer being at the highest risk.

Conclusions: Individual behavioral risk factors increase risk of new MRPD after being diagnosed with cancer. These findings build on past studies by linking tobacco use and HPV-associated cancers with MRPD risk in oncology and can be used to identify patients at risk of developing new MRPDs post-cancer diagnosis and engaging them in treatment.

Objective: This study aims to explore the variations and dynamics in the mental states of young patients with early breast cancer across different perioperative periods and to analyse how different surgical methods impact these patients' psychological well-being.

Methods: A prospective observational study was conducted on young patients with early breast cancer who underwent surgery from March 2021 to March 2022. Mental status questionnaires were administered at four key time points: preoperatively, 1 month, 6 months and 1 year postoperatively. The collected data were statistically analysed to discern the psychological shifts in these patients throughout the perioperative timeline. The patients were categorized into either the breast-conserving or mastectomy group based on their surgical procedure, and their mental state scores during each phase were analysed to investigate the effects of different surgical methods on their psychological health.

Results: During the study period, 149 young patients with early breast cancer completed the four-phase questionnaire. Statistically significant differences were observed in self-evaluation, self-esteem, physiological state, fear of death, economic stress, negative emotion, and anxiety and depression among these patients across different periods. The baseline data revealed differences in marital status, place of residence and prior tumour history between the two surgical groups. Significant differences in self-evaluation, depression, self-esteem and positive emotions were found between the breast-conserving group and mastectomy groups.

Conclusion: Breast cancer presents significant physical and psychological challenges from diagnosis through treatment. Our findings indicate that young patients with early breast cancer experience varying degrees of psychological distress during the entire perioperative period, influencing their surgical choices and postoperative recovery. This study found that the psychological state of patients undergoing breast-conserving surgery is more favourable compared with that of patients who received mastectomies, particularly in terms of self-assessment, self-esteem, positive affect and depression levels.

Background: Patients' sociodemographic factors, clinical characteristics, distress factors, perceived shame and stigma may give rise to psychological distress in cancer patients that bring about further psychosocial impact.

Aims: (1) to determine the degrees of shame and stigma towards cancer and psychological distress among cancer patients in Malaysia and (2) to examine the clinical and psychosocial predictors of psychological distress.

Methods: This cross-sectional study recruited a total of 217 cancer patients. The participants were administered the sociodemographic and clinical characteristics questionnaires, the Malay version of the Shame and Stigma Scale (SSS-M) to assess for the degree of cancer shame and stigma, and the Malay version of the Distress Thermometer and Problem List to assess for presence of psychological distress and identify its sources.

Results: There was a significant level of shame and stigma among cancer patients with the total mean SSS-M score of 12.08 (SD = 6.09). Anger (adjusted odds ratio [AOR] = 11.97, 95% confidence interval [CI] = 2.96-86.8, p = 0.001), loss of interest or enjoyment (AOR = 14.84, 95% CI = 2.93-75.20, p = 0.001), loneliness (AOR = 8.10, 95% CI = 1.13-58.02, p = 0.001), feeling of worthlessness or being a burden (AOR = 6.24, 95% CI = 1.32-29.59, p = 0.021), fear (AOR = 4.52, 95% CI = 1.79-11.43, p = 0.001), pain (AOR = 4.07, 95% CI = 1.53-10.82, p = 0.005), financial constraint (AOR = 2.95, 95% CI = 1.22-7.13, p = 0.016), and having regret (AOR = 1.89, 95% CI = 1.03-3.79, p = 0.039) increased the odds of developing psychological distress.

Conclusion: Treating clinicians should monitor for and provide psychosocial interventions for the biopsychosocial factors which may worsen psychological distress among cancer patients.