Psycho‐Oncology最新文献

Purpose: Marriage is associated with better health-related quality of life (HRQOL) among cancer survivors, but it is unclear whether these benefits generalize across sexual orientation and gender identities (SOGI). We examined whether marriage is associated with better HRQOL among cancer survivors with diverse SOGI.

Methods: We analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 to 2023 among U.S. adults aged 18 and older who self-reported a cancer diagnosis and completed the optional SOGI module (N = 220,896). HRQOL was assessed using the CDC HRQOL-4, including self-rated general health, frequent mental or physical distress, and activity limitation (each defined as ≥ 14 days in the past 30 days). Logistic regression models estimated adjusted odds ratios for HRQOL outcomes by marital status (married, unmarried couple, not married) within SOGI subgroups, controlling for sociodemographic and healthcare access factors.

Results: Marriage was consistently associated with better HRQOL among heterosexual men and women. Among SGM survivors, gay men and transfeminine individuals showed the clearest marriage-related benefits, including lower odds of mental distress and activity limitation. No consistent benefit was observed among lesbian or bisexual women, bisexual men, or transmasculine individuals. Unmarried couples did not consistently show similar protective effects in any group, though small cell sizes limit precision.

Conclusion: The health benefits of marriage vary across SOGI subgroups, challenging assumptions of a universal marriage advantage in survivorship.

Implications for cancer survivors: Survivorship care should account for relational and structural differences in support networks, especially among SGM individuals who may not benefit equally from legal marital status.

Objective: This study identified psychological empowerment profiles of women with breast cancer to provide a clinical care framework.

Methods: This multicenter cross-sectional qualitative study used an interpretative phenomenological approach with semi-structured in-depth interviews. Participants were selected from five tertiary hospitals in northeast (Harbin and Shenyang), east (Nanjing), and northwest (Xi'an) China. Each participant underwent a face-to-face interview lasting 30-60 min. Data were collected between September and December 2024 and thematically analyzed. Forty-six women (33-72 years old) with breast cancer were interviewed; the rehabilitation timeframe spanned three days after surgery to 19 years after initial diagnosis.

Results: The psychological empowerment profile comprised 25 subthemes and six themes. Themes 1 (Informed and Stress) and 2 (Ambivalence and Distress) reflect the negative profile; Theme 3 (Challenge and Confrontation) marks the turning point between negative and positive coping modes; Themes 4 (Adjustment and Buffer), 5 (Rationality and Acceptance), and 6 (Insight and Growth) reflect positive profiles. Participants receiving treatment (n = 36) showed higher counts in Themes 1, 3, and 4. Those from Harbin and Shenyang had higher counts across themes than those from Nanjing and Xi'an. Survivors (n = 10) dominated Theme 6, with Nanjing survivors exhibiting greater counts across themes than their Xi'an counterparts.

Conclusions: Women with breast cancer showed a negative-positive psychological empowerment trajectory during rehabilitation. Geographic differences revealed the impact of healthcare infrastructure and culture, with northeastern cities (Harbin/Shenyang) engaging more themes (5/6) than eastern and northwestern cities (Nanjing/Xi'an), indicating the need for regional support programs.

Objective: Depression is common among patients with lung cancer, but evidence from large, population-based studies is limited. This study examined antidepressant use and hospital-diagnosed depression before and after lung cancer diagnosis in Denmark.

Methods: We conducted a nationwide registry-based study including all patients diagnosed with lung cancer from 1998 to 2022 and a comparison cohort (1:4 ratio) matched on age, sex, municipality, and marital/cohabiting status. Data on hospital diagnoses and redeemed antidepressant prescriptions were obtained from Danish national registries.

Results: Among 73,930 patients with lung cancer and 293,892 matched comparison subjects, antidepressant use was already higher among lung cancer patients two years before diagnosis (12.7% vs. 9.9%) and increased markedly after diagnosis (23.7% vs. 11.9% 2 years post-diagnosis, p < 0.001). Among individuals without prior antidepressant use, 8.4% of patients with lung cancer initiated antidepressants within the first year and 13.7% within the second year, compared with 1.9% and 3.4% of controls (p < 0.001). Hospital-diagnosed depression occurred in 2.1% of lung cancer patients versus 0.8% of controls, with higher rates among females.

Conclusions: Antidepressant use is prevalent before, and rises further after, a lung cancer diagnosis. The difference relative to the comparison cohort was most evident among individuals with no history of antidepressant use. These findings underscore the need for systematic psychosocial assessment and integrated mental health support throughout the lung cancer care pathway.

Objective: This study aims to develop a brief screening questionnaire for early identification of radiotherapy mask-related anxiety in patients with head and neck cancer.

Methods: A cross-sectional study recruited 512 patients undergoing radiotherapy between April 2016 and February 2021. Participants completed a screening questionnaire assessing mask-related anxiety and were assessed for anxious response during CT or MRI planning scans. A subgroup completed the Claustrophobia Questionnaire (CLQ) for comparison. Data were analyzed using multivariate logistic regression and discriminant validity was evaluated using the area under the ROC curve (AUROC).

Results: The study developed the Radiotherapy Mask Anxiety Questionnaire (R-MAQ), consisting of four items, derived from the screening questionnaire, which showed good model fit (Hosmer-Lemeshow p = 0.92) and predictive accuracy (AUROC = 0.78). Of the 410 participants (mean age 62), 27.3% presented an anxious response to the immobilization mask during planning exams. The R-MAQ demonstrated comparable or superior validity to the CLQ and effectively identified patients at risk of radiotherapy mask-related anxiety.

Conclusions: The R-MAQ is a valid and efficient tool for identifying patients at risk of mask-related anxiety during radiotherapy for head and neck cancer. It offers a clinically relevant, context-specific method for early intervention, potentially improving treatment adherence and outcomes. Future research should explore its broader applicability and impact on treatment efficacy.

Objective: Despite the importance of follow-up care for childhood cancer survivors (CCS), adherence remains below recommended levels. Potential barriers include geographical distance. We aimed to improve our understanding of the accessibility of survivorship follow-up care at a Long Term Survivor Clinic (LTSC).

Methods: Questionnaire data on health status of CCS enrolled in a LTSC in Calgary, Canada (collected between 2021 and 2024) was linked to CCS' medical records and the Canadian Index of Multiple Deprivation via postal codes. Linear, logistic, and negative binomial regression models were conducted to explore the association between health status and travel time, and between health status and socio-economic situation, and demographic and treatment-related factors.

Results: We included 203 CCS (48% female; mean age = 23 years; mean time after diagnosis = 14 years). Most CCS (75%) lived less than 1 hour away from the LTSC and traveled from within the province. Travel time was not significantly associated with health status. Health status was significantly associated with sex, time since diagnosis, and certain socioeconomic factors. Females reported more current health problems than males (IRR = 2.170; p < 0.001) and higher anxiety scores (β = 4.109; p = 0.011). Socio-economic factors were associated with reporting more depressive symptoms (β = 3.835; p = 0.040) and fear of second cancers (OR = 2.375; p = 0.022) and a more recent diagnosis with fear of cancer recurrence (OR = 0.873; p < 0.001).

Conclusions: Instead of travel time, individual factors were associated with health status, providing opportunities for targeted interventions to ensure continued attendance. Enhancing general LTFU access through location-appropriate services and addressing underlying socio-economic inequalities are crucial to ensure engagement in LTFU care and improve health outcomes for CCS.

Objective: In the context of cancer, pain demands interpretation. Our research has found that fear of cancer recurrence (FCR) is associated with the tendency to interpret ambiguous information as health-related. We aimed to determine whether we could modify these interpretation biases to improve FCR, and pain outcomes.

Methods: We conducted a double-blind randomized controlled trial comparing two fully automated Cognitive Bias Modification for Interpretation (CBM-I) programs to a matched sham. We randomized 174 people with breast or ovarian cancer to one of three groups (pain-related CBM, cancer-specific CBM or sham). Participants completed four training sessions, and outcomes were assessed before and after intervention and 2 weeks later. We nominated co-primary outcomes as FCR and fear of progression (FoP) so that measures were suited to those with and without active disease and measured pain outcomes and other secondary psychosocial outcomes.

Results: We analyzed data using mixed-model linear regression and intention-to-treat. Results indicated that both the cancer-specific and pain-related training groups showed significant improvements in FCR (F_(2,440) = 17.19, p < 0.0005) and FoP (F_(2,440) = 15.03, p < 0.0005) over time compared to sham. Both versions of CBM were associated with benefits in pain intensity (F_(2,440) = 6.14, p < 0.0005) and pain interference (F_(2,440) = 5.223, p = 0.001) compared to sham. No other secondary outcomes improved.

Conclusion: CBM for interpretation is an efficacious treatment for FCR, FoP and pain outcomes in ovarian and breast cancer. This intervention was delivered wholly online, had high completion rates (80%) and therefore is highly scalable. CBM-I could be part of a stepped care model to meet the large unmet need for people who are living with and beyond cancer.

Background: Depression is a common psychological disorder in patients with cancer. Exercise intervention has been demonstrated as an effective non-pharmacological intervention for improving depression. However, the relative efficacy of different types of exercise interventions remains uncertain.

Objective: To compare the effectiveness of different types of exercise interventions in patients with cancer.

Methods: Seven databases were systematically searched. Two reviewers independently conducted the data extraction and quality assessment. The random effects model was used for the meta-analysis. Traditional pairwise meta-analysis and network meta-analysis were performed via STATA software.

Results: Forty-nine studies with 4738 participants were included. The interventions were categorized as mind-body exercise, aerobic exercise, anaerobic exercise, resistance exercise, combined exercise, and progressive muscle relaxation. Network meta-analysis consistently revealed the greatest therapeutic benefits of aerobic exercise (SUCRA: 68.4%), followed by combined exercise (SUCRA: 66.4%) and resistance exercise (SUCRA: 55.7%).

Conclusions: Exercise has potential benefits for relieving depression in patients with cancer, and it is poised to serve as a valuable complementary or alternative therapy. Large-scale and more rigorous RCTs are needed to evaluate the long-term effects of exercise interventions and examine intervention characteristics related to better intervention outcomes.

Objective: Despite strong evidence supporting universal psychosocial risk screening in pediatric cancer implementation remains inconsistent. Factors at organizational, provider, and patient/family levels impact implementation. Potential differing perspectives regarding risk screening among multidisciplinary providers may influence uptake. This study describes perceived barriers and facilitators in implementing the Psychosocial Assessment Tool (PAT), a psychosocial risk screener and examines differences by discipline.

Methods: One hundred seventeen healthcare providers (HCPs) representing medical, social work, and psychology from 18 pediatric cancer programs completed two scales from PAT Implementation Questionnaire (PIQ). Item scores (1-4 scale) were ranked and differences tested by discipline.

Results: Barriers were perceived as "minor" and facilitators as "significant" and overall PIQ scale scores did not differ by discipline. PIQ-B had a significantly lower mean score (M = 2.03) than PIQ-F (M = 3.08), p < 0.001). Barriers and facilitators rated most impactful (highest mean scores) were: Barriers: "Language barriers/cultural considerations" (M = 2.37) and "Integrating results in EHR" (M = 2.26); and Facilitators: "Promotes psychosocial care for all families" (M = 3.31) and "Promotes positive psychosocial outcomes" (M = 3.25). Significant differences were found in the rank ordering of barriers and facilitators by discipline, between social workers and psychologists, with the former noting time constraints associated with screening.

Conclusions: Multidisciplinary HCPs generally agree on the benefits and challenges in implementation of screening with the PAT. Subtle variations in perceived impact of barriers and facilitators between social workers and psychologists highlight the importance of interdisciplinary collaboration and communication to facilitate implementation.

Background: Self-advocacy is essential for cancer patients to obtain high-quality care. However, existing self-advocacy assessment tools-developed by Western scholars-are poorly aligned with the cultural and healthcare context of China.

Aim: The study aimed to develop and validate a new self-advocacy scale tailored to Chinese cancer patients.

Methods: In phase I, an item pool was formulated through a literature review, qualitative interviews with 14 cancer patients, and focus group discussions. In phase II, the scale's domains and items were revised based on feedback from two rounds of Delphi consultation involving 16 experts. In phase III, a cross-sectional survey was administered to a convenient sample of 257 cancer patients, and item analysis and exploratory factor analysis were used to explore the scale's structure. In Phase IV, the scale's validity and reliability were comprehensively evaluated using data from a convenience sample of 311 cancer patients. Finally, the Cancer Patient Self-Advocacy Scale (CPSAS) was developed.

Results: The newly developed scale comprised 21 items across four dimensions: information seeking, autonomous decision-making, active communication, and informational support. The scale demonstrated adequate convergent and discriminant validity supported by average variance extracted and composite reliability, good criterion validity through significant correlations with quality of life and treatment adherence, and excellent internal consistency and split-half reliability.

Conclusions: The CPSAS is a valid, reliable, and efficient tool for assessing self-advocacy in Chinese cancer patients, suitable for both outpatient and inpatient settings. Additional research is necessary to evaluate the psychometric properties of the scale.

Background: Sarcopenic obesity (SO)-excess adiposity with low muscle strength and mass-is a concern in oncology as it may exacerbate functional decline and cancer-related fatigue (CRF). The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recently proposed diagnostic criteria for SO, but these remain untested in breast cancer (BC). We examined associations between SO, CRF, quality of life (QoL), and physical function in women with early BC.

Methods: Sixty-six patients (48.0 ± 9.9 years; stages I-III) underwent assessments of body mass index (BMI) and composition (DXA), waist circumference (WC), and handgrip strength. Physical function was evaluated using the timed up-and-go (TUG) and the 6-m walk test (6-MWT), while QoL and CRF were assessed using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC QLQ-C30) and the Cancer Fatigue Scale (B-CFS). The ESPEN-EASO consensus was applied to classify participants as Eutrophic (normal BMI and WC), Obesity (high BMI and/or WC with preserved muscle strength and mass), or SO (high BMI and/or WC with reduced muscle strength and mass).

Results: Global health/QoL (p = 0.03) was lower in SO (61.6 ± 7.2) and Obesity (60.4 ± 3.7) than Eutrophic (81.1 ± 6.9). Physical functioning scale/QoL was lower in Obesity (84.6 ± 2.2) than Eutrophic (97.0 ± 4.1). Mean physical and overall fatigue in both Obesity (5.3 ± 5.5 and 19.6 ± 9.9) and SO (5.0 ± 4.1 and 18.8 ± 8.6) were not statistically different from Eutrophic (2.0 ± 2.9 and 14.3 ± 7.8). TUG was worse in SO (7.5 ± 0.2 s) than both Eutrophic (6.6 ± 0.2 s) and Obesity (6.8 ± 0.1 s-p < 0.01). Comparisons were adjusted for age, menopausal status, and physical activity. SO-related traits were correlated to physical function and to domains of QoL and CRF.

Conclusions: Obesity and SO are associated with poorer QoL, while SO is also linked with worse physical function in early BC. Assessing SO traits in clinical settings will improve the management of BC, though confirmation across disease stages is needed.