Cancer Distress Research Articles

Featured Article: The Relationship Between Parent and Child Distress in Pediatric Cancer: A Meta-Analysis

Parents and children affected by pediatric cancer are at risk for psychological distress, including depression, anxiety, and post-traumatic stress. A link is believed to exist between parent and child distress; however, no systematic analysis of this relationship has occurred. A meta-analysis was conducted to assess the relationship between parent and child distress among families affected by pediatric cancer. A systematic review and meta-analysis was conducted using EBSCO (searching PsycINFO, MEDLINE, Academic search Premiere, and Health Source: Nursing/Academic Edition) and PubMed. The initial search yielded a total of 29,118 articles. Inclusion criteria were that studies assessed the relation between parent and child distress in the context of pediatric cancer, were written in English, and were published in peer-reviewed journals. 28 articles met inclusion criteria. A statistically significant association was found between overall parent and child distress (r = .32, p < .001), such that increased parent-reported distress was associated with increased distress in their children. Significant relationships were also present among each type of parental distress (i.e., depression, anxiety, post-traumatic stress, and global distress; rs = .31-.51, ps < .001) and overall child distress. Moderation analyses via meta-regression indicated that parent proxy-report of child symptoms was associated with a stronger relationship between parent and child distress than child self-report of their own distress. Aligned with the social-ecological framework, familial factors appear to be highly relevant in understanding distress following pediatric cancer diagnosis. Indeed, greater parent distress was associated with greater child distress.

Distress Screening in Adolescents and Young Adults with Cancer: Development of Cut-Points for the Cancer Distress Scales-Adolescent and Young Adults.

Purpose: Distress is an important issue facing adolescent and young adults (AYA) with cancer due to their stage of development. Metrics are necessary to help improve psychosocial outcomes in this population. This study determined cut-points for the newly developed Cancer Distress Scales (CDS)-AYA. Methods: The CDS-AYA is a new patient-reported outcomes measure that comprises five independently functioning scales, including the following: Impact of Cancer (12 items), Physical (12 items), Emotional (11 items), Cognitive (8 items), and Cancer Worry (5 items). Canadian AYA with cancer 15-39 years of age completed the CDS-AYA and the Hospital Anxiety and Depression Scale (HADS), as part of the CDS-AYA field test. Only patients who had completed responses to the CDS-AYA and HADS were included in these analyses. Receiver operating characteristic (ROC) curve analysis was used to generate cut-points for five CDS-AYA scales based on distress defined by the HADS anxiety and HADS depression scale. Results: In total 453 of 515 respondents had complete data for the CDS-AYA and HADS were included in analyses. Area under the curve (AUC) in the ROC analyses ranged from 0.75 to 0.85. The CDS-AYA Emotional scale had the greatest AUC. The cutoff value for the Emotional scale was 27 based on the HADS anxiety scores (78.3% and 78.9%). Conclusions: The five CDS-AYA scales had fair to good accuracy when classifying the none/low and moderate/severe distress categories based on HADS anxiety and depression scales. For screening purposes, it is recommended that the Emotional scale or Impact of Cancer scale be utilized.

Exploring emotion regulation as a mediator of the relationship between resilience and distress in cancer.

Distress in patients with cancer is a significant problem that affects up to 32% of patients. Yet research indicates that 35% of cancer patients do maintain high levels of well-being. Resilience is one psychological factor implicated as being protective against distress; however, the mechanisms for this relationship are currently unknown. The present study aimed to explore emotion regulation as a potential mediator of the relationship between resilience and distress. A cross-sectional survey examining emotional regulation, resilience, and distress was completed by 227 patients from two hospitals with heterogeneous cancer types. Measures included the Difficulties in Emotion Regulation Scale (DERS), the Connor Davidson Resilience Scale, and the Depression, Anxiety, Stress Scale. Difficulties in emotion regulation and resilience explained 33.2% of the variance in distress. Resilience had a significant direct effect on distress, accounting for 15.8% of the variance. However, this effect was no longer significant when difficulties in emotion regulation were controlled for. The indirect effect through difficulties in emotion regulation was significant, b=0.009, 95% CI [-0.013,-0.007], suggesting that the effect of resilience on distress was fully mediated by emotion regulation. Parallel mediation analyses also examined the differential effects of the six DERS subscales on the relationship between resilience and distress. These findings suggest that emotion regulation is an important mediator of resilience in cancer. Hence, in patients with cancer, difficulties in emotion regulation (and the DERS specifically) might be a useful focus for screening for patients at risk of distress.

Associations of uncertainty with psychological status and quality of life (QoL) among 527 older patients with advanced cancer.

11544 Background: Older patients with advanced cancer face considerable uncertainty related to their disease and treatment. The aim of our study was to evaluate the associations of uncertainty with psychological status and QoL. Methods: This is a secondary analysis of baseline data from a national geriatric assessment (GA) cluster randomized trial (URCC 13070; PI: Mohile). Patients aged ≥70 years with ≥1 GA domain impairment (e.g., function, cognition) and advanced cancer who were considering or receiving any line of cancer treatment were enrolled (n=541). Uncertainty was measured using the modified 9-item Mishel Uncertainty in Illness (MUIS), where respondents with higher scores perceive more uncertainty (range 9-45). QoL and psychological measures consisted of Functional Assessment of Cancer Therapy-General (FACT-G), emotional wellbeing (EWB; FACT-G subscale), distress (distress thermometer), anxiety (Generalized Anxiety Disorder-7), and depression (Geriatric Depression Scale-15). Multiple linear regressions were used to evaluate the associations of MUIS scores with each measure, adjusted for demographics, cancer type, and number of impaired GA domains. Results: Mean age was 77 years (SD 5, range 70-96); 26% had gastrointestinal cancer and 26% had lung cancer. Mean number of GA domain impairments was 4 (SD 1, range 1-7). Mean MUIS score was 20 (SD 5, range 9-37). On multivariate analyses, higher MUIS score was associated with lower QoL (β=-1.08, SE=0.11) and EWB (β=-0.29, SE=0.03), as well as higher distress (β=0.12, SE=0.02), anxiety (β=0.11, SE=0.04), and depression (β=0.09, SE=0.03; all P&lt;0.01). Conclusions: Distress associated with uncertainty was common in a vulnerable population of frail older patients with advanced cancer and ≥1 GA domain impairment. A higher degree of uncertainty was associated with poorer psychological health and QoL. Our results underscore the important role that uncertainty plays in older patients' psychological status. Previous tested uncertainty management interventions (mainly including information and coping strategies) could be revised, tailored and tested to meet the unique needs of older patients with cancer. Clinical trial information: NCT02107443.

Patient reported outcomes and predictors of distress.

6559 Background: ASCO/NCCN guidelines recommend screening for multifactorial distress in cancer patients. Understanding predictors of cancer related distress can lead to early intervention and improve clinical outcomes, symptom management, and operational efficiency. Through electronic distress screening (EDS), patient reported outcomes (PRO) were collected across 42 practice locations. Methods: EDS has 39 questions related to cancer related distress including: distress, cancer symptoms/side effects, malnutrition, depression, anxiety, social/family support, financial, and spiritual concerns. 27,106 patients completed screens between 2017-2018. Multivariate analysis and logistic regressions determined predictors of distress for completed screens overall, registry matched, and within 60 days of diagnosis. Results: Median age was 59 (IQR 18-101) and 65% were female. Five symptoms consistently predicted clinically significant distress ≥ 4: anxiety, fatigue, pain, poor emotional coping, and sleep. Diagnosis (dx), staging at time of dx, and timing of screen did not independently predict distress. Factors predicting clinically significant distress varied across geographic regions. Conclusions: In large patient population, five key PROs are predictive of clinically significant distress and could potentially impact clinical outcomes. Early PROs predictive of distress were consistent along the continuum, thus the importance of early symptom identification. EDS can help custom tailor supportive oncology programs to mitigate symptoms related to cancer distress. [Table: see text]

Does social support reduce distress and worry among Aboriginal and Torres Strait Islander people with cancer?

AbstractBackgroundConnections to people and place are particularly important for Indigenous Australians. It is currently unknown what role social support plays in helping this population cope with a diagnosis of cancer.AimsThis study describes components of social support available for Indigenous Australians with cancer and investigates its association with distress and/or worry.Methods and resultsSecondary data of a cross‐sectional study involving 248 Aboriginal and Torres Strait Islander cancer patients was used to map out social support dimensions (structural, functional, and appraisal) using Cheng et al's27 social support framework. Distress was measured by the distress thermometer and worry by the worry chart. Overall, 67% of participants reported significant distress, and 49% worry about their cancer. In the functional dimension of social support, participants who had someone caring for them during diagnosis and treatment had increased odds of reporting worry. In the appraisal dimension, participants with unmet social support needs had significantly increased odds of reporting distress and worry compared with participants who were satisfied with the support received. Components in the structural dimension were not associated with distress or worry.ConclusionWhile many aspects of social support did not appear to affect cancer distress or worry, having a carer or having unmet social support needs had a negative impact on these outcomes. Health professionals should consider the worries of the bonded relationship and monitor patients' needs and their satisfaction with the support provided as an integral part of cancer care.

Distress andneoangiogenesis in ovarian cancer patients

Background.Previous pre-clinical and clinical trials showed that distress experienced by cancer patients can activate the sympathetic nervous system, resulting in the elevation of the level of catecholamines in tumor tissue. catecholamines activate tumor neoangiogenesis via binding to the adrenergic receptors of tumor cells and cells of tumor microenvironment. Vascular endothelial growth factor a(VEgF a) plays a key role in tumor neoangiogenesis.Objective.To evaluate the correlation between serum VEgF alevel and distress in ovarian cancer patients.Material and methods.The prospective cross-sectional study included 100 patients with stage i–iV ovarian cancer. the median age of the patients was 56 ± 9,56 years. Enzym-linked immunosorbent assay was used for the assessment of serum VEgF alevel. distress thermometer (validated self-reported questionnaire) was used for distress diagnosis.Results.The median serum VEgF alevel was 325.77 pg/ml. aclinically significant distress was diagnosed in 54 % of patients. We found the correlation between the serum VEgF alevel and distress level in ovarian cancer patients (spearman’s rho=0.33; 95 % ci, 0.11–0.52; р&lt; 0.004). We also found the correlation between the serum VEgR alevel and disease stage (rho=0.30; 95 % ci0.02–0.53; p&lt;0.05). However, there was no correlation between distress and disease stage. the regression analysis method revealed that distress was an independent factor of serum VEgF aelevation in ovarian cancer patients (p&lt;0.05).Conclusion.Assessment and early diagnosis of cancer-related distress was shown to be important for the appropriate management of ovarian cancer.

Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: which groups specifically benefit? Secondary analyses of a randomized controlled trial

PurposeStepped care (SC), consisting of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy/medication is, compared to care-as-usual (CAU), effective in improving psychological distress. This study presents secondary analyses on subgroups of patients who might specifically benefit from watchful waiting, guided self-help, or the entire SC program.MethodsIn this randomized controlled trial, head and neck and lung cancer patients with distress (n = 156) were randomized to SC or CAU. Univariate logistic regression analyses were performed to investigate baseline factors associated with recovery after watchful waiting and guided self-help. Potential moderators of the effectiveness of SC compared to CAU were investigated using linear mixed models.ResultsPatients without a psychiatric disorder, with better psychological outcomes (HADS: all scales) and better health-related quality of life (HRQOL) (EORTC QLQ-C30/H&N35: global QOL, all functioning, and several symptom domains) were more likely to recover after watchful waiting. Patients with better scores on distress, emotional functioning, and dyspnea were more likely to recover after guided self-help. Sex, time since treatment, anxiety or depressive disorder diagnosis, symptoms of anxiety, symptoms of depression, speech problems, and feeling ill at baseline moderated the efficacy of SC compared to CAU.ConclusionsPatients with distress but who are relatively doing well otherwise, benefit most from watchful waiting and guided self-help. The entire SC program is more effective in women, patients in the first year after treatment, patients with a higher level of distress or anxiety or depressive disorder, patients who are feeling ill, and patients with less speech problems.TrialNTR1868.

Sexual Dysfunction in Human Papillomavirus Positive Females during Reproductive Age

Objective: Female sexual dysfunction (FSD) has been reported 40% of women of all ages and has important and unique effect on quality of life. We aimed to examine sexual function of patients with positive Human Papillomavirus (HPV) test results and investigate whether HPV has any impact on female sexual functioning since it has become a risk and distress of cancer. Methods: In Turkey, since 2014, women aged 30-65 years are screened for free by Family Health Centers with HPV-DNA test for cervical cancer. Sexually active, with at least basic literacy reproductive aged women who applied to oncology department of gynecology with HPV positive test results were included the study. History of systemic, chronic disease, including psychiatric disease or on psychiatric medication, pelvic organ prolapse, history of pelvic surgery (known to cause female sexual dysfunction), pregnant, body mass index (BMI)>30), and premature menopause women were excluded. Female sexual dysfunction index (FSFI) was used to assess FSD. A score of less than 26 indicated sexual dysfunction. HPV negative healthy women created control group. The groups were matched for age, BMI, parity, socio demographic and educational levels. The demographic, obstetric and gynecologic history of all patients was recorded. Results: A total of 119 women were recruited. Among patients, 54 had HPV positive test results while 65 had negative as controls. There was no significant difference between in mean scores of age, partner’s age, duration of marriage and BMI. The two groups were comparable with respect to number of children, education level and occupational status. The mean score on FSFI was 22.3 ± 6.6 points in HPV positive women and 26.3 ± 4.6 in healthy controls. Except for desire, other domains of FSFI (arousal, lubrication, orgasm, satisfaction, and pain) were statistically significantly lower in HPV positive women compared to controls in our study. Conclusion: Female sexual dysfunction was prevalent among women with HPV infection. These patients are needed to be routinely checked for sexual dysfunction.

Meaning and Purpose (MaP) therapy I: Therapeutic processes and themes in advanced cancer.

Understanding the way therapy works is a complex undertaking. Historically, such enquiry has been dominated by "outcomes" leading to a lack of discourse about clinical processes. In the cancer setting, identifying clinical process can be even more complex because of the added challenges of an ongoing illness. This study investigated the therapeutic processes used in a meaning-based intervention developed for the advanced cancer setting: Meaning and Purpose therapy. Four sessions of therapy were delivered to 24 participants. Transcribed sessions (n = 96) of the intervention were analyzed by two independent researchers to describe participant themes, therapeutic processes, and patterns of change related to common points in the intervention.ResultAlthough both suffering and meaning were present in all sessions, when we tracked the focus of the content across sessions, there was a clear progressive shift toward meaning-centered content for all participants. This finding is in spite of the fact that all participants had progressive disease and were living with ongoing challenges.Significance of resultsProcesses such as focusing on meaning, reflecting a sense of significance, joining with participants to explore their unique meaning, and directing them away from a preoccupation with suffering were identified as clear influences of a shift toward a meaning-based focus. These processes offer a fresh focus on meaning and a buffer to the distress of advanced cancer.

Screening for psychosocial distress among patients with cancer: implications for clinical practice, healthcare policy, and dissemination to enhance cancer survivorship.

Accreditation standards are at the forefront of evolving healthcare systems, setting metrics for high-quality care. Healthcare outcomes (health, experience, cost, provider satisfaction/burn out) are becoming mutual goals of the patient, provider, payer, and healthcare system. Achieving high-quality outcomes in cancer care necessitates collaboration among interdisciplinary teams of clinical providers, administrators, patient advocates, caregivers, and researchers. Dissemination and implementation science provides necessary frameworks to organize the efforts of these implementation teams, inclusive of identifying facilitators and barriers to implementation of accreditation standards. Since 2015, cancer distress screening has been mandated for continued cancer center accreditation by the American College of Surgeon's Commission on Cancer. Cancer centers have thus become real world implementation laboratories. We present the current context of distress screening, highlighting prior research and key areas of future research. We consider multiple levels of cancer care delivery and the use of interdisciplinary teams to help cancer center teams adopt, implement, and maintain efficient distress screening programs. Finally, we present a case study to identify methods for successful implementation of distress screening at one cancer center and then describe efficiencies that can be introduced using elements from human factors engineering, e- and m-health screening platforms, and community partnerships.

Validity and feasibility of the Arabic version of distress thermometer for Saudi cancer patients.

BackgroundThe distress thermometer (DT) has been studied and validated as an effective screening instrument for identifying distress among cancer patients worldwide. This study aims to evaluate the validity of the Arabic version of the DT in Saudi cancer patients, to define the optimal cutoff point of the Arabic DT for detecting clinically significant distress and to determine whether there is any correlation between clinically significant distress and other demographic and Problem List variables.MethodsThe original form of the DT was translated to Arabic using a forward and backward translation method. Then, a group of 247 cancer patients who were followed up at the Outpatient Oncology Clinic at King Saud Medical City in Riyadh, Saudi Arabia, completed a socio-demographic and clinical status questionnaire, the DT and the Problem List scale, and the Hospital Anxiety and Depression Scale (HADS).ResultsReceiver operating characteristic (ROC) curve analyses picked out an area under the curve of 0.76 when compared with a HADS cutoff score of 15. The DT had the best sensitivity (0.70) and specificity (0.63) with cutoff score of 4. A DT score of 4 or more was found to have a statistically significant correlation with female gender, advanced cancer stages and most of the Problem List items, including child care, work or school, treatment decision, dealing with children and partners, depression, fears, nervousness, sadness, loss of interest in usual activity, religious concerns, appearance, bathing/dressing, breathing, diarrhea, fatigue, feeling swollen, fever, getting around, indigestion, memory and concentration, nausea, dry nose, pain, and sexual problems. In contrast, a multivariate regression analysis confirmed only advanced cancer stages, treatment decision, depression, fear, sadness, worry, breathing, feeling swollen, fever, indigestion, memory and concentration, dry nose and congestion, pain and sleep as independent factors associated with distress in cancer patients.ConclusionsWe found the Arabic version of the DT to be a valid instrument for screening distress in Saudi patients with cancer. Our study proposes using a cutoff score of 4 as an indicator of clinically significant distress in this population.

Institutional adherence to National Comprehensive Cancer Network (NCCN) guidelines in neoadjuvant treatment of breast cancer and its correlation to outcomes.

47 Background: The aim of the study is to assess the adherence to National Comprehensive Cancer Network (NCCN) guidelines in the neoadjuvant treatment of breast cancer and evaluate its correlation to outcomes. Higher adherence rates correlate with improved survival and are a potential measure of the quality of care. Methods: We screened patients who were treated with neoadjuvant chemotherapy at our institution for the years 2015 &amp; 2016, a total 46 patients met the criteria. To evaluate adherence we tabulated 8 adherence categories per NCCN. We then screened patients who were only eligible to receive the treatment specific to a certain adherence category. A total adherence rate was calculated by dividing the number of categories for which they underwent intervention by the total number of eligible adherence categories. Rates of pathologic complete response (PCR) and Breast Conservation surgery (BCS) were calculated to measure the outcomes. Results: We had 9 triple negative breast cancer (TNBC), 28 Her2 overexpression (Her2+) and 17 triple positive patients. We had 100% adherence in categories such as, appropriate pre-chemotherapy evaluation {total eligible patients, n = 46}, completeness of histopathology report (n = 46), use of anti-Her2 antibody drug in patients with Her2 overexpression positive by IHC or FISH (n = 28) and adjuvant radiation therapy (n = 39). In the following categories, adherence rates were as follows, 70% (n = 33) genetic consult, 69% (n = 32) reconstructive surgery, 65% (n = 46) cancer distress screen performed. We could not assess the adherence to reproductive gynecology consult. Our median total adherence rates were 85% for all of the adherence categories in eligible patients. We had PCR and BCS rates of 39% &amp; 41% respectively. Further analysis showed PCR &amp; BCS rates of 46% &amp; 39% in Her2+ patients, 33% &amp; 44% in TNBC patients, 35% &amp; 38% in Doxorubicin treatment and 46% &amp; 39% in anti-Her2 antibody treatment group respectively. Conclusions: Our study shows adherence to NCCN guidelines leads to improved outcomes. To improve quality of care, institutions should closely monitor the adherence to NCCN or other alternative national guidelines.

Prevalence of Psychological Distress, Anxiety and Depression in Metastatic Breast Cancer Patients

Background: Cancer patients experience high levels of cancer-related distress, which may negatively impact on their clinical outcomes, such as survival and quality of life. Distress involves a range of feelings from vulnerability and sadness to depression, anxiety, adjustment disorders, panic and isolation. Importantly, pervasive severe distress has impact on cancer progression. This type of distress dysregulates the hypothalamic pituitary adrenal (HPA) axis and activates the sympathetic nervous system (SNS), impacting the cardiovascular, immune, and endocrine systems. These alterations contribute to biologic activities (e.g., changes in circadian cortisol levels, catecholamine production, activation of proinflammatory cytokines, regulation of leukocyte and tumor cell gene expression, and cellular immune suppression) that can promote cancer growth and metastasis. International standards for quality in cancer care recommend that distress should be recognized, regularly monitored, and treated promptly at all stages of disease, to optimize patients' clinical outcomes. Aim: As part of a larger study, Distressbrain, which aims to examine the associations between psychosocial variables, alterations in specific brain regions, and alterations on HPA axis, SNS activation and proinflammatory cytokines production, the present investigation was conducted to examine specifically the prevalence of distress, anxiety, depression and psychological morbidity in metastatic breast cancer (MBC) patients. Methods: We used the Distress Thermometer (DT), the Hospital and Anxiety Depression Scale (HADS), Brief Symptom Inventory (BSI) for the assessment of these variables. Results: The study is now running with the recruitment of 100 eligible MBC patients under treatment at the Breast Unit, Champalimauld Clinical Center, Lisbon, Portugal. We will present preliminary data about the levels and prevalence of psychological distress, anxiety, depression and psychological morbidity in this population. Conclusion: The results of this study will help to better understand the psychosocial needs of this population for better planning of care and inform cancer policy to allocate human resources to provide it.

Identifying and predicting distinct distress trajectories following a breast cancer diagnosis - from treatment into early survival

ObjectiveMost longitudinal studies on distress in breast cancer (BC) patients reported a continuous decrease after diagnosis, however masking individual variations in patterns of adjustment. We sought to identify distinct trajectories of distress during primary treatment into survivorship and to identify variables that are determinants of which patient follows which type of adjustment trajectory. MethodsPsychological distress was measured at four significant time points (after surgery/biopsy, at treatment completion, two and six months thereafter) among 181 newly diagnosed BC patients. A latent growth mixture modeling approach was used to identify distinct distress trajectories. ResultsFour distress trajectories were identified: a ‘resilient’ pattern (73.1%), a ‘high-remitting’ (7.7%) trajectory, a ‘delayed’ increase in distress (7.9%), and a constantly high ‘chronic’ distress (11.3%) pattern. High perceived burden from physical symptoms at treatment completion encompassed a higher chance for the ‘high-remitting’ and ‘chronic’ distress trajectory. High self-efficacy at baseline increased chances for the ‘high-remitting’ pattern. Neither type of treatment, demographic or medical characteristics, nor baseline distress reliably predicted distress trajectories. ConclusionThe majority of BC patients adjust well through a demanding treatment period. High patient-perceived burden from physical symptoms, and high coping self-efficacy is suggesting a transient, self-limiting distress trajectory, while patients experiencing constant ‘chronic’ distress, and those developing distress following treatment completion only cannot be identified by a single, initial assessment. Only systematic tracking with repeated measurement extending into survivorship can eliminate this problem. Interventions should aim at reducing the impact of symptom burden on women's every-day life and on strengthening coping-self efficacy.

From evidence to implementation: The global challenge for psychosocial oncology.

The human dimensions of medical care were highlighted by such pioneering figures as Cicely Saunders, Elizabeth Kubler-Ross, and Jimmie Holland and their tireless advocacy helped to build an evidence base for psychosocial and palliative interventions. In that spirit, we studied physical and psychological distress in advanced cancer and modeled pathways to distress in this population. We considered acute stress disorder as the prototype for psychological disturbances following the acute onset of life-threatening disorders, showing that it occurred in one-third of patients after the diagnosis of acute leukemia. To treat and prevent these symptoms, we developed Emotion and Symptom-focused Engagement (EASE), an integrated psychotherapeutic and early palliative intervention. We showed that EASE reduced both traumatic stress and physical suffering in these patients and a large multi-center trial is now underway. We also identified symptoms of depression and hopelessness n one quarter of patients with metastatic and advanced cancer, with worsening toward the end of life. To alleviate this distress, we developed a brief supportive-expressive therapy, referred to as Managing Cancer and Living Meaningfully (CALM). We showed in a large RCT that CALM improves depression, distress related to dying and death, and preparation for the end of life. We have now launched a global initiative involving 20 sites to date across North and South America, Europe, Australia, and Asia to have CALM implemented routinely in cancer care. Such initiatives are needed to move psychosocial care in cancer from evidence to implementation and to fulfill the dream of Jimmie Holland that cancer care be as humanistic as it is effective.

Changes in Cortisol Levels before and after Supportive Psychotherapy in Patients with Comorbid Cervical Cancer Distress with Depression Type

Objective: To prove the success of supportive psychotherapy thatwas provided as a distress therapy on advanced cervical cancer.Knowing the prevalence of distress type of depression in patientwith epithelial cervical cancer, proving the benefits of psychotherapysupportive for distress can decreasing cortisol level in cervicalcancer patient, can assess distress thermometer score, HAM-D17score and scoring incident predictors of distress with depressiontype.Methods: There were 32 subjects from 71 advanced cervical cancerpatients had mild-moderate depression. Then randomizationblocking was performed to determine a subject who entered thetreatment group (n = 16) who got supportive psychotherapy orcontrol group who got common psychotherapy (n = 16). All ofparticipants assessed the distress level with cortisol value, distressthermometer score, and HAM-D17 score before and after they gotsupportive psychotherapy.Results: After the intervention of psychotherapy in the treatmentgroup decreased HAM-D17 score, the average decline 7.53 (SB 3.34).The mean decreasing in the control group was 3.98 (SB 2.85). Thereis a significant difference in mean reduction in HAM-D17 scores ontreatment and control groups with p = 0.003 (p &lt;0.005). There wasdecreasing blood cortisol level in the treatment group amounted to39.43, while the control group there was a drop of 1.59. The reductionof cortisol level in the treatment group and the control has a pvalue0.302. After got supportive psychotherapy, found a decreasingthe average value of the thermometer distress in the treatmentgroup 3.02 and the control group 2.51, with a p value more than0.492.Conclusion: There were 45% of cervical cancer patients in the clinicexperiencing distress disorder with depressive type. The bloodcortisol level could be decreased by giving supportive psychotherapywith a mean decrease of 39.43 nmol/l. There was a significantreduction in the level of depression (HAM-D17 score) of 7.53 pointsand distress thermometer impairment by 3 points after givensupportive psychotherapy. Obtained scoring predictors for theoccurrence of distress type of depression in patients with advancedcervical cancer with a sensitivity of 46.15% and a specificity of89.47%.[Indones J Obstet Gynecol 2018; 6-3: 179-187]Keywords: cervical cancer, cortisol, distress, distress thermometer,HAM-D17 score

Effect of Yoga Therapy on Symptoms of Anxiety in Cancer Patients

Background: Many cancer patients suffer from symptoms of anxiety, depression, and fatigue. Supportive treatments are increasingly used to alleviate distress in cancer. In this study, the effects of yoga on these symptoms are examined. Methods: We performed a randomized controlled study on cancer patients with mixed diagnoses comparing yoga therapy with a waiting list control group. We measured anxiety symptoms with the General Anxiety Disorder (GAD-7) scale, depressive symptoms with the Patient Health Questionnaire-2 (PHQ-2), and fatigue with the European Organisation for Research and Treatment of Cancer Fatigue scale (EORTC QLQ-FA13). Yoga therapy was carried out in weekly sessions of 60 min each for 8 weeks. The program provided restrained body and breathing exercises as well as meditation. The control group did not receive any yoga therapy while on the waiting list. Results: A total of 70 subjects participated in the study. Anxiety was significantly reduced by the yoga therapy in the intervention group compared to the control group (p = 0.005). However, yoga therapy did not show any significant effects on depression (p = 0.21) and fatigue (p = 0.11) compared to the control group. Conclusion: Yoga therapy may be used to alleviate anxiety symptoms in cancer patients and should be the subject of further research.

Cancer-coping profile predicts long-term psychological functions and quality of life in cancer survivors.

Cancer survivors experience significant psychosocial distress even after completion of cancer treatment. The association between cancer coping and cancer recovery is not well established. The present study investigated the cancer-coping profile and cancer outcomes in breast cancer survivors. A three-wave longitudinal study was conducted. In 2009 (wave 1), 248 breast cancer survivors completed a package of psychological inventories to evaluate cancer copying style, psychological distress, anxiety and depression, and quality of life. They received follow-up survey in 2012 (wave 2) and 2016 (wave 3). A latent profile analysis (LPA) was conducted among participants in wave 1 to identify cancer-coping class. Identified cancer-coping class was used to predict psychological and survival outcomes in waves 2 and 3. Two cancer-coping classes were identified through LPA, namely adaptive cancer coping (class I; 52%) and maladaptive cancer coping (class II; 47.8%). Demographic and clinical factors did not differ significantly between the two classes. Subsequent analyses demonstrated that the cancer-coping style in wave 1 predicted the psychological symptoms and quality of life outcomes at the two follow-ups (waves 2 and 3). Survivors in the adaptive group (class I) exhibited lower cancer distress, anxiety and depression scores, and higher quality of life scores than those in the maladaptive group did. Cancer coping were not found to be significantly associated with cancer survival or recurrence. The identified cancer-coping styles were predictive of the survivors' psychological symptoms, psychological well-being, and health-related quality of life but not cancer survival or recurrence.

Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer.

Purpose The incidence of contralateral prophylactic mastectomy (CPM) has continued to increase. We prospectively examined psychosocial outcomes before and up to 18 months after surgery in women who did or did not have CPM. Methods Women with unilateral, nonhereditary breast cancer completed questionnaires before and 1, 6, 12, and 18 months after surgery. Primary psychosocial measures were cancer worry and cancer-specific distress. Secondary measures were body image, quality of life (QOL), decisional satisfaction, and decisional regret. Results A total of 288 women (mean age, 56 years; 58% non-Hispanic white) provided questionnaire data, of whom 50 underwent CPM. Before surgery, women who subsequently received CPM had higher cancer distress ( P = .04), cancer worry ( P < .001), and body image concerns ( P < .001) than women who did not have CPM. In a multivariable repeated measures model adjusted for time, age, race/ethnicity, and stage, CPM was associated with more body image distress ( P < .001) and poorer QOL ( P = .02). There was a significant interaction between time point and CPM group for cancer worry ( Pinteraction < .001), suggesting that CPM patients had higher presurgery cancer worry, but their postsurgery worry decreased over time and was similar to the worry of patients who did not have CPM. QOL was similar between CPM groups before surgery but declined 1 month after surgery and remained lower than patients who did not have CPM after surgery ( Pinteraction = .05). Conclusion These results may facilitate informed discussions between women and their physicians regarding CPM. Fear and worry may be foremost concerns at the time surgical decisions are made, when women may not anticipate the adverse future effect of CPM on body image and QOL.