Assessment of Psychological Distress and its Effect on Quality of Life and Social Functioning in Cancer Patients.
TL;DR: Psychosocial stress associated with cancer and its treatment can impact the QOL and social functioning of the patient and needs to be addressed along with the cancer-directed therapy.
Abstract: Purpose: The diagnosis of cancer and its treatment can make patients psychologically distressed. The purpose of this study is to evaluate the level of psychological distress and social functioning in cancer patients and to assess the association of these parameters with the quality of life (QOL) experienced by the patient. Patients and Methods: All cancer patients attending palliative care clinic who can understand and speak English or Tamil language were taken into the study. An interview technique with a questionnaire is used for data collection after informed consent. The questionnaire consisted of four sections, namely, demographic variables, general health questionnaire, WHO QOL-BREF, and SCARF social functioning index. All questionnaires were translated into the Tamil Language and were evaluated by the experts for content validity. Results: The median scores obtained are psychological distress = 44 (11–98), WHO QOL = 64 (36–117), and social function = 51 (29–79). Out of 251 patients, 30% had severe psychological distress, 25.6% had poor QOL, and 23.2% were with severely affected social function. Skilled laborers had better scores compared to unskilled laborers (P < 0.05). Family size (<2 children) had a positive impact on the QOL (P = 0.008). Patients from urban locales had better social functioning than rural counterpart (P = 0.047), but no difference was observed in distress level or QOL. Increased growth hormone distress score of the patients had a negative impact on both QOL (r = −0.522) and social function (r = −0.244). QOL correlated positively with social function (r = +0.247). Conclusion: Psychosocial stress associated with cancer and its treatment can impact the QOL and social functioning of the patient and needs to be addressed along with the cancer-directed therapy. Decreasing the symptom burden and distress level by palliative care intervention might improve the QOL and social function.
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TL;DR: Although these results demonstrate that SBRT does not cause worse QOL deteriorations compared to 3DCRT, larger randomized investigations are recommended to corroborate these findings.
Abstract: BACKGROUND/AIM
This was a prespecified secondary analysis of a randomized trial, which analyzed quality of life (QOL), fatigue, and emotional distress following stereotactic body radiotherapy (SBRT) versus conventional three-dimensional conformal radiotherapy (3DCRT) as part of palliative management of painful spinal metastases.
MATERIALS AND METHODS
Fifty-five patients were enrolled in this single-institutional randomized exploratory phase II trial (NCT02358720). Participants were randomly assigned to receive SBRT (single-fraction 24 Gy) or 3DCRT (30 Gy/10 fractions). QOL (EORTC QLQ-BM22), fatigue (EORTC QLQ FA13), and emotional distress (QSC-R10) at the end of radiotherapy, along with 3- and 6-month follow-up were assessed.
RESULTS
At all recorded time points, there were no significant QOL differences between cohorts, including painful sites, pain characteristics, functional impairment, or psychosocial aspects (p>0.05 for all). There were also no differences in all dimensions of fatigue between groups at each recorded time point (p>0.05 for all). Emotional distress was also similar at three (p=0.248) and six months (p=0.603).
CONCLUSION
Although these results demonstrate that SBRT does not cause worse QOL deteriorations compared to 3DCRT, larger randomized investigations are recommended to corroborate these findings.
23 citations
TL;DR: This is the first meta-analysis to examine the effects of exercise interventions on cognitive functioning among prostate cancer patients and shows an overall beneficial effect of exercise on social functioning and cognitive functioning in men with prostate cancer when compared to controls.
Abstract: Exercise is beneficial for prostate cancer patients’ physical functioning; however, effects on social and cognitive functioning are inconsistent. This meta-analysis of exercise interventions for prostate cancer patients had two aims: the primary aim was to evaluate the effects of exercise interventions on social functioning; the secondary aim was to consider additional outcomes of cognitive functioning as well as adverse events. Electronic databases (Embase, MEDLINE, PubMed, PsycINFO, and the Chinese database Airti Library) were searched for relevant papers (1987–2019), which included hand searching. After careful inspection, 10 relevant randomized controlled trials were analyzed using Comprehensive Meta-Analysis software; pooled means determined social and cognitive functioning. Meta-analysis of summary scores (fixed-effects model) showed an overall beneficial effect of exercise on social functioning (Hedges’ g = 0.35, 95% CI [0.193, 0.515], p < 0.001) and cognitive functioning (Hedges’ g = 0.35, 95% CI [0.123, 0.575], p < 0.01) in men with prostate cancer when compared to controls. Intervention durations of 12–16 and 24–48 weeks that provided supervised aerobic exercise combined with resistance exercise sessions had a small to medium effect on social functioning compared to controls. One exercise group experienced one serious, but non-fatal, adverse event due to a higher exercise intensity (50–75% VO2max). To the best of our knowledge, this is the first meta-analysis to examine the effects of exercise interventions on cognitive functioning among prostate cancer patients. We suggest further research be conducted to confirm these findings.
12 citations
TL;DR: Findings bear clinical relevance for designing GI male-centered group formats that endorse men’s needs and facilitate their accessibility to group support interventions.
Abstract: Purpose Gastrointestinal (GI) cancer patients often suffer high rates of distress and social isolation, partially due to symptoms that are embarrassing or difficult to discuss with family or friends. Group support therapies mitigate illness-related stigma and standardization; however, men, in particular, are more averse to joining. Through an ongoing men-only GI cancer support group, this study sought to understand who joined the groups, what facilitated group uptake, and explore men's reasons for enrolling in the group. Methods A mixed-methods study design and analysis were used. A qualitative design utilizing open-ended, semi-structured interviews and thematic analysis were used; Theory of Planned Behavior (TPB) directed the inquiry towards facets of group uptake. Standardized measures were also used to assess distress, coping, and quality of life (QoL) and compared with normative values for cancer and general population. Data from qualitative and quantitative findings were triangulated. Results Participants included 35 male GI cancer patients, aged 28-72, at varying stages of illness and treatment. Themes related to group uptake and enrollment were endorsement; composition; and attitudes, and reasons for joining were learning new coping techniques and affiliations with similar others. Men's QoL and psychological distress scores were on par with cancer patient norms. The scores obtained from quantitative scales corroborated with our qualitative findings. Conclusions Despite psychosocial, demographic, and clinical variations, participants were keen on joining a male-only Supportive-Expressive Therapy (SET) group to address their emotional, informational, and supportive care needs and express their solidarity for other patients. Implications for cancer survivors Findings bear clinical relevance for designing GI male-centered group formats that endorse men's needs and facilitate their accessibility to group support interventions.
10 citations
Cites background from "Assessment of Psychological Distres..."
...Studies have shown that 1 in 3 metastatic GI cancer patients experience psychological distress with a negative impact on overall functioning, quality of life, and treatment adherence [3, 4]....
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TL;DR: In developing countries, there is need for longitudinal studies of psycho-social experiences, develop interventions that are culturally appropriate, along with enhanced use of information technology along with evaluation of interventions.
Abstract: Purpose of review Psycho-oncology has completed 25 years. There is growing recognition of the psychosocial needs of persons living with cancer and the role of sociocultural factors in addressing the needs. This review addresses the research in developing countries relating to distress associated with living with cancer and psychosocial care. Recent findings There is growing recognition of the emotional needs, understanding of the sociocultural aspects of the emotional responses of persons, caregivers, role of resilience and posttraumatic growth and spirituality in cancer care. Psychosocial aspects of cancer are largely influenced by social, economic, cultural, religious and health systems. A number of innovative approaches to care like use of yoga, financial and material support and involvement of caregivers have been implemented. A positive development is the increasing professional attention to document and develop innovative care programmes. Summary A significant proportion of the general population are living with cancer. There are significant psychosocial needs largely influenced by social, economic, cultural, religious aspects of the communities. There are a wide range of interventions from self-care to professional care to address the needs. In developing countries, there is need for longitudinal studies of psycho-social experiences, develop interventions that are culturally appropriate, along with enhanced use of information technology along with evaluation of interventions.
9 citations
TL;DR: Applying the cancer diagnosis disclosure strategies and psychological intervention were essential to improve cancer patients’ and caregivers’ quality of life.
9 citations
References
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TL;DR: In this article, a shorter, 28-item General Health Questionnaire (GHQ) consisting of four subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression was proposed.
Abstract: This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
4,485 citations
Journal Article•
TL;DR: The factor structure of the symptomatology of the General Health Questionnaire when it is completed in a primary care setting is found to be very similar for 3 independent sets of data.
Abstract: This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.
4,434 citations
"Assessment of Psychological Distres..." refers methods in this paper
...Section 2: It is the general health questionnaire-28[10] and was used to measure the psychological distress of the cancer patients....
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TL;DR: The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants to find that physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.
Abstract: The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.
2,756 citations
"Assessment of Psychological Distres..." refers background in this paper
...Several studies have shown the stress associated with cancer treatment might have a role in progression of cancer[1-4] and cancer-related death....
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TL;DR: Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality, and suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.
Abstract: Background : Abnormal circadian rhythms have been observed in patients with cancer, but the prognostic value of such alterations has not been confirmed. We examined the association between diurnal variation of salivary cortisol in patients with metastatic breast cancer and subsequent survival. We explored relationships between cortisol rhythms, circulating natural killer (NK) cell counts and activity, prognostic indicators, medical treatment, and psychosocial variables. Methods Salivary cortisol levels of 104 patients with metastatic breast cancer were assessed at study entry at 0800, 1200, 1700, and 2100 hours on each of 3 consecutive days, and the slope of diurnal cortisol variation was calculated using a regression of log-transformed cortisol concentrations on sample collection time. NK cell numbers were measured by flow cytometry, and NK cell activity was measured by the chromium release assay. The survival analysis was conducted by the Cox proportional hazards regression model with two-sided statistical testing. Results Cortisol slope predicted subsequent survival up to 7 years later. Earlier mortality occurred among patients with relatively "flat" rhythms, indicating a lack of normal diurnal variation (Cox proportional hazards, P =. 0036). Patients with chest metastases, as opposed to those with visceral or bone metastases, had more rhythmic cortisol profiles. Flattened profiles were linked with low counts and suppressed activity of NK cells. After adjustment for each of these and other factors, the cortisol slope remained a statistically significant, independent predictor of survival time. NK cell count emerged as a secondary predictor of survival. Conclusions Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality. Suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.
1,028 citations
"Assessment of Psychological Distres..." refers background in this paper
...Indian Journal of Palliative Care ¦ Volume 24 ¦ Issue 1 ¦ January-March 2018 76 association between dysregulations in diurnal cortisol secretion and diminished QOL, greater functional disability, fatigue, and poorer outcomes in breast cancer patients.[15-17] Thus, the above-mentioned studies indicate that the stress experienced by the patients can affect the outcome of cancer....
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TL;DR: Supportive-expressive group therapy does not prolong survival in women with metastatic breast cancer, but it improves mood and the perception of pain, particularly in women who are initially more distressed.
Abstract: Background Supportive–expressive group therapy has been reported to prolong survival among women with metastatic breast cancer. However, in recent studies, various psychosocial interventions have not prolonged survival. Methods In a multicenter trial, we randomly assigned 235 women with metastatic breast cancer who were expected to survive at least three months in a 2:1 ratio to an intervention group that participated in weekly supportive–expressive group therapy (158 women) or to a control group that received no such intervention (77 women). All the women received educational materials and any medical or psychosocial care that was deemed necessary. The primary outcome was survival; psychosocial function was assessed by self-reported questionnaires. Results Women assigned to supportive–expressive therapy had greater improvement in psychological symptoms and reported less pain (P=0.04) than women in the control group. A significant interaction of treatment-group assignment with base-line psychological scor...
833 citations
"Assessment of Psychological Distres..." refers background in this paper
...The role of psychosocial intervention in decreasing pain and anxiety,[18] improving QOL,[19-21] and ability to complete the therapy has been shown but whether it can affect cancer progression and survival has not been established....
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