Psycho‐Oncology最新文献

Background: Adolescent and young adult (AYA) females are vulnerable to psychological sequelae following cancer diagnosis and treatment. Fear of cancer recurrence (FCR) is well-documented in cancer survivors, however AYA survivors of breast and gynaecological cancers are less well-studied. Moreover, little is known about scan-related fears and anxiety ('scanxiety') in survivors of any age group.

Aims: This study aimed to assess demographic, medical, and quality-of-life correlates of FCR and scanxiety in AYA female breast and gynaecological cancer survivors post-treatment. Additionally, we explored potential shared mechanisms of FCR and scanxiety, including intolerance of uncertainty, bodily threat monitoring, and perceived stress.

Methods: AYA breast and gynaecological cancer survivors (N = 115) completed measures of FCR, scanxiety, intolerance of uncertainty, bodily threat monitoring, perceived stress, and quality of life. Bivariate associations and a structural equation model explored relationships between these variables.

Results: Both FCR and scanxiety were prevalent, with 84% reporting clinically meaningful FCR and 38% reporting severe FCR. Higher FCR and scanxiety were both associated with poorer quality of life. FCR and scanxiety were moderately associated but not entirely overlapping. Intolerance of uncertainty, bodily threat monitoring, and perceived stress were significantly correlated with both FCR and scanxiety. The structural equation model indicated that bodily threat monitoring is a plausible intermediate variable linking intolerance of uncertainty and FCR, but not scanxiety.

Conclusions: FCR and scanxiety are common in AYA survivors of breast and gynaecological cancers, with potentially distinct underlying mechanisms. Interventions targeting intolerance of uncertainty and bodily threat monitoring may reduce FCR, while further research is needed to identify therapeutic targets for scanxiety.

Objective: Women with or at risk of hereditary breast- and ovarian cancer (HBOC) often live a surveillance-focused life from young adulthood. As they navigate a life of heightened medical vigilance, or a "cancer surveillance life," we explore how women with HBOC, as well as their partners and families, experience this particular kind of living through a thorough literature review of existing qualitative research.

Methods: We performed Boolean searches in PubMed, EMBASE, EBSCOhost, PSYCHinfo, Scopus, and Web of Science from April-May 2022, identifying 506 relevant articles. After eliminating duplicates and quantitative studies, we systematically analyzed 53 articles. Articles examining all aspects of living with HBOC were eligible for inclusion. Following quality assessment by a verified appraisal tool, 28 articles were included in this review. We undertook an "a-lines-of-argument synthesis," and identified key similarities across studies to highlight generalizable aspects of living with HBOC.

Results: We discovered five central themes which capture the ambivalences experienced by women living with HBOC: (1) an unresolved balancing act regarding genetic testing (2) burdens of relaying genetic information within the family (3) experienced risk discrepancies (4) preservation of the self and: (5) unsettled reproductive feelings.

Conclusions: Living with HBOC is filled with ambivalences, which are critical for decision making concerning disclosing risks to family members and children, choosing between risk-reducing surgeries or surveillance, and family planning. Healthcare professionals should be aware of these findings when counseling women and families with HBOC to provide the best support possible in navigating their unique kind of living.

Objective: To identify the feasibility, acceptability, and effectiveness of web-based acceptance and commitment therapy (ACT) on health-related outcomes in patients with lung cancer.

Methods: A feasibility, prospective, parallel, individual-based, assessor-blinded randomized controlled trial was designed. This study was conducted at a third-level hospital in Sichuan Province, China. A total of 101 participants were enrolled and randomly assigned to usual care group or 7-weekly web-based acceptance and commitment therapy group. The primary outcome was feasibility and acceptability of the intervention, and the secondary outcomes including quality of life, psychological flexibility, anxiety, depression, fatigue, and sleep disturbance. Generalized estimating equations were used to evaluate the group differences. All analyses followed the principle of intention-to-treat.

Results: Web-based ACT presented good feasibility and acceptability in this study, with an attrition rate of 13.86%, a median compliance rate of 71.43%, and a satisfaction rate of 65.9%. Compared with control group, participants in intervention group reported statistically significant increases in quality of life (MD = 15.10, 95% CI: [10.09, 20.11], d = 0.37), psychological flexibility (MD = -8.42, 95% CI: [-10.81, -6.03], d = -1.47), anxiety (MD = -1.27, 95% CI: [-2.50, -0.05], d = -0.44), depression (MD = -2.11, 95% CI: [-3.28, -0.95], d = -0.76), and sleep disturbance (MD = -1.85, 95% CI: [-3.10, -0.59], d = 0.13) at postintervention, however, the improvement in fatigue was not statistically significant (MD = -2.02, 95% CI: [-9.02, 4.98], d = -0.12).

Conclusions: Web-based ACT was an approach with good feasibility and acceptability, and it could effectively improve quality of life, psychological flexibility, anxiety, depression, and sleep disturbance in patients with lung cancer. In order to achieve better results, there is a need to design a more tailored intervention plan and a more operational platform.

Background: Spirituality is an important domain of well-being for cancer survivors, yet we know little about the different trajectories of survivors' spiritual well-being across the transition from active treatment to survivorship. Further, the specific psychosocial resources and coping efforts that might predict distinct trajectories of spiritual well-being have yet to be identified.

Aims: In this study, we characterized trajectories of survivors' spiritual well-being (peace, meaning, faith) across the first year of survivorship and examined whether social support and coping strategies predicted these trajectories.

Methods: Participants (N = 482) completed five surveys over the course of a year following a diagnosis of breast (63.5%), prostate (25.7%), or colorectal cancer (10.8%). We used latent class linear mixed modeling to identify spiritual well-being trajectory classes (FACIT-Sp) and employed multinomial logistic regression models to examine whether social support and specific coping styles predicted class membership.

Results: While the majority of our sample had moderate levels of spiritual well-being, over one-third reported very low levels of peace. Distinct latent classes for peace (four classes), meaning (five classes), and faith (five classes) were identified among adult cancer survivors transitioning from treatment to survivorship. Higher social support and adaptive coping predicted greater likelihood of belonging to classes that maintained higher levels of peace, meaning, and faith following cancer treatment.

Conclusions: Cancer survivors show unique trajectories of spiritual well-being as they transition from active treatment to survivorship. Social support and coping may be important resources for maintaining spiritual well-being during this critical transition period.

Objective: Cancer places a psychological burden on both patients and their relatives. Perceived social support influences the extent of psychological distress. Our aim was to investigate associations between positive support, detrimental interactions, depression and anxiety in patient-relative dyads in the initial period after diagnosis.

Methods: Patients with a solid tumor and their relatives participated in this prospective, multicenter observational study. Participants answered validated measures including the Illness-specific Social Support Scale (SSUK-8), the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder Scale (GAD-7). We analyzed cross-sectional data from the initial time following diagnosis with paired t-tests and actor-partner interdependence models.

Results: A total of 347 dyads of patients (mean age 59.9 years) and their relatives (mean age 56.7 years) participated. Compared to their relatives, patients reported significantly higher levels of depression (patients: M = 6.31, SD = 4.94; relatives: M = 5.44, SD = 4.77) and lower levels of anxiety (patients: M = 4.40, SD = 4.10; relatives: M = 4.98, SD = 4.47) as well as more positive support (patients: M = 14.31, SD = 2.07; relatives: M = 12.46, SD = 3.29) and a lower frequency of detrimental interactions (patients: M = 3.21, SD = 2.97; relatives: M = 3.66, SD = 2.93). Intrapersonal effects: Positive support was associated with lower distress only for relatives, whereas detrimental interactions were associated with higher distress for both patients and relatives (all p < 0.05). Interpersonal effects: More positive support and fewer detrimental interactions experienced by relatives were associated with lower patient distress (all p < 0.05).

Conclusions: Better support for relatives may not only reduce their own distress, but also patients' distress. Relatives experience similar levels of distress and poorer social support than patients.

Background: The LGBTQI+ population makes up at least 7.6% of the US population. LGBTQI+ populations are at increased risk of experiencing LGBTQI+-related discrimination and cis-heteronormativity in healthcare leading to poorer health outcomes throughout the cancer care continuum. We aimed to explore LGBTQI+ cancer survivors' perspectives of how cancer has changed their perceptions of self and relationships using data from OUT: The National Cancer Survey.

Methods: We conducted an inductive qualitative content analysis of responses to four open-ended questions from OUT: The National Cancer Survey. Data were collected from September 2020 to April 2021. Eligible participants were 18 years of age or older at time of survey, had been previously diagnosed with cancer, identified as LGBTQI+, and currently lived in the US. Open-ended survey questions asked about the impact of cancer on LGBTQI+ cancer survivors' perceptions of self and relationships. To maximize inter-rater reliability, 20% of the survey responses were double coded. Chi-squared tests assessed differences in changes across the life-course.

Results: Of the participants in the OUT survey (N = 2382), 86.9% (N = 2069) provided responses to at least one of the four open-ended questions. The content analysis sample participants were primarily aged 40-59 (39.3%) and 60-79 (49.4%), gay (54.7%), cisgender men (59.4), White (89.7%), and not on active treatment (77.4%). A total of 5179 codes were applied to the 2069 responses. A total of 5 overarching categories and 18 sub-categories were identified. Themes included: (1) changes in perceptions of self; (2) changes to relationships; (3) changes to health and (4) LGBTQI+ specific unmet needs. The most commonly reported categories were changes in perceptions of self (77%, n = 1593) and changes to health (47%, n = 972). Most cancer-related changes were more frequently reported by young adult survivors.

Conclusions: This content analysis illuminates the unique challenges that the LGBTQI+ population faces while navigating through the cancer care continuum.

Purpose: The aim of this study was to examine the themes acting as barriers or facilitators, from diagnosis and sickness absence (SA) to RTW and work retention, after a cancer-related SA from the perspectives of all stakeholders in the Spanish setting.

Methods: Descriptive qualitative approach with a socio-constructivist perspective. Theoretical sampling was carried out until saturation. Six discussion groups (4-8 people/group) were conducted: three groups of people with a cancer-related SA in Catalonia (Spain), one with oncology care professionals, and two with company representatives. An additional individual interview was conducted with a primary care physician. The sessions were held virtually and were recorded, transcribed verbatim, and analyzed using thematic analysis and mixed coding.

Results: Barriers to RTW and work retention detected by stakeholders included insufficient information and guidance on the impact of cancer on work and SA management, lack of general knowledge and recognition of side effects, lack of consideration of job tasks by medical tribunals, and working in precarious employment. Facilitators included workplace support, psycho-oncologists, patient associations, and working for a public company.

Conclusions: Both work interruption due to an SA and RTW, are key moments for determining cancer survivors' work retention. We found a general perception of lack of involvement of the social security system, companies, and health professionals in Spain in the impact of cancer on work.

Implications for cancer survivors: Integrating the work sphere in cancer care from the beginning of cancer treatment, and by all stakeholders, could facilitate successful future RTW.

Objective: Patient reported outcome measures (PROMs) are commonly collected in melanoma research. However, they are not used to guide immediate clinical care in Australia. This study explored the views and experiences of patients with Stage III melanoma and clinic staff during implementation of an electronic Patient-Reported Outcome Measures in melanoma (ePROMs-MEL) pilot to assess distress and quality of life.

Methods: A prospective mixed-methods study in specialist melanoma clinics in Sydney, Australia between May 2021 and February 2023. Forty-two post-ePROMs implementation surveys and 17 semi-structured interviews were undertaken among patients and staff (including oncologists, melanoma nurses and clinic managers). Survey responses were tabulated using Likert scales and interview transcripts analysed thematically.

Results: Of the 31 patient survey responses, over 90% reported ePROMs were easy to complete and measured important components of their health and wellbeing. Of the 11 staff surveys, over 50% reported ePROMs to be useful when allied health referrals were accessible but found implementation disruptive to clinic workflows. Six themes about ePROMs in clinical care emerged during data analysis: (1) promoting self-reflection; (2) conversation-starters; (3) timing and setting; (4) fit for purpose questionnaires; (5) resource issues; (6) value and limitations of ePROMs.

Conclusion: Patients overwhelmingly supported the real-time collection of ePROMs for their immediate care. In contrast, staff support was conditional on resources to maximise clinical care efficiency and minimise administrative burden.

Trial registration: Australia and New Zealand Clinical Trials Registry: anzctr.org.au/ACTRN12620001149954.aspx.

Objective: To investigate the effectiveness of the Melanoma Care Programme when implemented into routine clinical practice coupled with fear of cancer recurrence (FCR) screening and a stepped-care model of intervention delivery.

Methods: Using a Type-I hybrid effectiveness-implementation design, individuals with stage 0-II melanoma and a Fear of Cancer Recurrence Inventory FCR severity score of ≥ 13 were offered the Melanoma Care Programme. The programme included a psychoeducational booklet and 3 to 5 psychotherapeutic telehealth sessions with a clinical psychologist, timed around routine dermatological appointments. Multivariable linear mixed modelling was used to analyse the effect of the intervention at 1-week post-intervention on patient-reported outcomes, including FCR severity (primary outcome), symptoms of depression, anxiety, and stress, melanoma-related knowledge, and health-related quality of life.

Results: One hundred and twelve participants completed the intervention from 146 participants screened for FCR. Adjusted multivariable linear mixed modelling demonstrated that participants who received the intervention reported a reduced FCR severity at 1-week post-intervention (mean change: -3.81 [95% CI: -4.67, -2.95], p < 0.001) compared to baseline. Participants also reported improvements in melanoma-related knowledge (mean change: 0.64 [95% CI: 0.13, 1.15], p = 0.014), depressive symptoms (mean change: -1.41 [95% CI: -1.92, -0.90], p < 0.001), anxiety (mean change: -1.05 [95% CI: -1.48, -0.61], p < 0.001), stress (mean change: -1.58 [95% CI: -2.22, -0.93], p < 0.001), and health-related quality of life (mean change: 4.05 [95% CI: 2.84, 5.26], p < 0.001).

Conclusions: The Melanoma Care Programme maintained effectiveness when implemented into routine clinical practice with the addition of FCR screening and a stepped care model of delivery.

Trial registration: This study is registered with the Australia and New Zealand Clinical Trials Register (ACTRN12621000145808).

Background: Spiritual care is a key domain of quality palliative care as defined by national palliative care guidelines.

Aims: The aim of this project was to synthesize data and research experience by the authors over 30 years related to spirituality in patients with cancer. The research objectives for this analysis were to: Describe spirituality in patients with cancer. Determine the outcomes of palliative care interventions on spirituality and related variables in patients with cancer in these studies conducted by the authors. Summarize methodological issues in conducting research related to spirituality in oncology patients.

Methods: A synthesis of 15 prior studies conducted by the authors was completed and also compared to current literature regarding spirituality in cancer and other serious illness.

Results: Findings demonstrate the broad scope of spirituality, key spiritual concerns in cancer and methodological approaches to assessing spirituality.

Conclusion: Spirituality is a major concern for patients, yet limited training has been provided for clinicians who deliver this care. Additional studies are needed to advance this important aspect of palliative care.