Distress In Patients Research Articles

Adaptations of interpersonal psychotherapy in psycho-oncology and its effects on distress, depression, and anxiety in patients with cancer: a systematic review

ObjectivePatients with cancer experience significant psychosocial distress. Stressors include interpersonal difficulties like loneliness, isolation, thwarted belongingness, communication impediments, and conflicts. Interventions are required that address their specific psychosocial needs. Interpersonal Psychotherapy (IPT) is a promising concept for the treatment of psychosocial distress associated with cancer because it addresses patients’ interactions and role transformations. This review aims to provide an overview of the current evidence regarding interventions for patients with cancer based on IPT.MethodsA systematic review following PRISM guidelines was conducted, including randomized controlled trials of IPT-based interventions in patients with cancer, assessing effects on distress, depression, and anxiety.ResultsEight studies were included, sampling 390 patients in total. Seven out of eight studies assessed exclusively women with breast cancer. Two studies described IPT interventions and showed stronger improvement in depression and anxiety compared to TAU and equal improvement in depression compared to other psychotherapy interventions. Six studies described remote Interpersonal Counselling (IPC). One found remote IPC to be superior to control conditions regarding depression, and one found remote IPC to be superior to attention control, but not active control conditions. No study found remote IPC to be superior to control conditions regarding distress.DiscussionThere are few randomized controlled trials of IPT for patients with cancer. Results regarding depression and anxiety are promising for in-person IPT, but mixed for remote IPC.ConclusionThe review suggests in-person IPT, but not remote IPC, may yield benefits for patients with cancer. Research on the subject is scarce, and to inform implementation of IPT interventions, research with diverse groups of patients with cancer is required.Systematic trial registrationPROSPERO, Identifier CRD42023410687.

Adult cancer patients’ barriers to and satisfaction with care at a National Cancer Hospital in Vietnam

Study objective This study assessed the overall satisfaction with oncological care, including barriers to care, and identified its associated predictors among adult cancer patients in Vietnam. Methods In this cross-sectional study, we enrolled 300 adult cancer patients receiving inpatient care at a large urban oncological hospital between June and July 2022. Multivariable linear regression analyses examined associations between patient experiences and overall satisfaction ratings with cancer care. Results The mean overall satisfaction with oncological care was 8.82 out of 10, with 98.0% recommending this facility to their friends and family. In an adjusted model, being female (β = 0.29, 95%CI: 0.04, 0.53), endorsing satisfaction with patient-nurse communication (β = 0.33, 95%CI: 0.13, 0.53), patient-doctor communication (β = 0.40, 95%CI: 0.11, 0.70), and psychoeducation about oncological medication management (β = 0.30, 95%CI: 0.14, 0.45) were positively associated with overall ratings. In contrast, individuals with delays in treatment scheduling reported lower overall satisfaction with oncological care (β = -0.38, 95%CI: -0.64, -0.13). Patients perceived health system, social/environmental, and individual barriers to care: worries about income loss due to attending treatment (43.3%); fear, depression, anxiety, and distress (36.8%); concerns about affordability of treatment (36.7%) and transportation problems (36.7%); and excessive waiting times for appointments (28.8%). Conclusion This study showed high overall patient satisfaction with cancer care quality. Patient-centered communication strategies and psychoeducation about oncological medication management may be targeted to further enhance the cancer inpatient experience. Raising awareness about treatment options and services, and integrating mental health awareness into oncological care may ameliorate patient distress and facilitate greater satisfaction with oncological treatment processes.

Thirst Distress in Palliative Care Patients.

Objective: It has been reported that chronically critical patients and patients at high risk of death have moderate to high levels of thirst distress. It was planned as a descriptive and cross-sectional study to determine thirst distress in palliative care patients. Methods: A Patient Information Form, the Thirst Severity Form, and the Thirst Distress Scale were used for data collection. The research was carried out between March 2023 and July 2023 with 157 patients hospitalized in the palliative care services of a state hospital and a training and research hospital in Istanbul, Turkey. Results: Of the patients, 51.6% were female. The mean thirst distress score of the patients was 23.96 ± 5.096. Of the patients, 0.6% had no thirst distress; 7.6% had mild, 48.4% had moderate, 38.9% had high, and 4.5% had severe thirst distress. Thirst scores of patients who were illiterate and did not smoke or drink alcohol were high (P < .05). The thirst distress score of patients fed with percutaneous endoscopic gastrostomy was higher than that of patients fed with total parenteral nutrition. There was a positive weak correlation between age and thirst distress score, a negative very weak correlation between fluid balance and thirst distress score, and a positive moderate correlation between Visual Analog Scale and thirst distress. Conclusion: Thirst distress was found to be at moderate and high levels in palliative care patients. In patients, thirst should be routinely assessed, and necessary interventions should be planned.

The psychological distress of gastrointestinal cancer patients and its association with quality of life among different genders

BackgroundPsychological distress is a prevalent unpleasant experience faced by many cancer patients. However, the psychological distress among gastrointestinal (GI) cancer patients is scarcely explored. Moreover, the association between psychological distress and quality of life in different genders has yet to be explored.AimsTo explore the psychological distress among GI cancer patients and examine its association with quality of life among different genders.MethodsThis study was a cross-sectional study. A total of 237 gastrointestinal cancer patients completed the distress thermometer and the Functional Assessment of Chronic Illness Therapy-General.ResultsThe mean score of psychological distress of the participants was 3.04 (SD = 2.90). A greater proportion of female gastrointestinal cancer patients (52.8%) had clinically relevant psychological distress compared to males (35.9%). The quality of life was negatively associated with their psychological distress (B =  − 1.502, 95%CI: − 2.759 to − 0.245, p = 0.019) among gastrointestinal cancer patients. Such association was stronger among males compared to females in gastrointestinal cancer patients (Interaction term, B =  − 1.713, 95%CI: − 3.123 to − 0.303, p = 0.017).ConclusionsThese findings suggest that healthcare providers should attach their attention to gastrointestinal cancer patients’ psychological distress, especially females. Longitudinal studies could adopted to track the changes in psychological distress and its association with quality of life over time among different genders. In future intervention studies, the focus of psychological interventions needs to be gender-specific.

A Systematic Review of Trajectories of Clinically Relevant Distress Amongst Adults with Cancer: Course and Predictors.

To improve interventions for people with cancer who experience clinically relevant distress, it is important to understand how distress evolves over time and why. This review synthesizes the literature on trajectories of distress in adult patients with cancer. Databases were searched for longitudinal studies using a validated clinical tool to group patients into distress trajectories. Twelve studies were identified reporting trajectories of depression, anxiety, adjustment disorder or post-traumatic stress disorder. Heterogeneity between studies was high, including the timing of baseline assessments and follow-up intervals. Up to 1 in 5 people experienced persistent depression or anxiety. Eight studies examined predictors of trajectories; the most consistent predictor was physical symptoms or functioning. Due to study methodology and heterogeneity, limited conclusions could be drawn about why distress is maintained or emerges for some patients. Future research should use valid clinical measures and assess theoretically driven predictors amendable to interventions.

Health locus of control and symptom distress: The mediating role of illness acceptance and symptom severity in acute leukemia patients

ObjectiveThis study aims to explore the multiple mediating roles of illness acceptance and symptom severity between health locus of control and symptom distress in acute leukemia patients. MethodsFrom June 2022 to March 2023, a convenience sampling method was used to recruit 208 acute leukemia patients in the inpatient center of a hospital in Hebei. The Chinese versions of Multidimensional Health Locus of Control Scale, Illness Acceptance Scale, and Anderson Symptom Assessment Scale was used in the cross-sectional study. ResultsAll participants reported the presence of symptom distress. Symptom distress was significantly correlated with chance health locus of control, illness acceptance, and symptom severity (P＜0.05). Illness acceptance alone played a mediating role in the relationship between chance health locus of control and symptom distress in acute leukemia patients (β=0.087, 95%CI 0.030–0.167). The indirect role of chance health locus of control on symptom distress through symptom severity alone was also statistically significant (β=0.131, 95%CI 0.008–0.252). Furthermore, the multiple mediating role of chance health locus of control and symptom distress through illness acceptance and symptom severity combined was verified (β=0.027, 95%CI 0.001–0.089). The alternative model is also valid, indicating bidirectional relationships between symptom severity, illness acceptance, and chance health locus of control, collectively influencing symptom distress. ConclusionThere is a positive relationship between chance health locus of control and symptom distress; additionally, increasing social psychological interventions for illness acceptance and strengthening the management of core symptoms will help alleviate the impact of health chance locus of control on symptom distress in acute leukemia patients. Longitudinal studies are needed to confirm the causal relationships among the variables explored within the model. Impact on nursing practiceIt is recommended that healthcare professionals pay attention to the assessment of health locus of control in patients, identify patients with health chance locus of control in a timely manner, take measures to enhance their disease acceptance, and strengthen the management of core symptoms, thereby reducing their level of symptom distress.

Abstract PO2-12-09: Insomnia, Pain, Anxiety, Distress, Fatigue, and Functional Impairment in Patients with Breast Cancer

Abstract Background: SPPADE symptoms (Sleep disturbance, Pain, Physical function impairment, Anxiety, Depression/distress, and Energy deficits/fatigue) may result from cancer and its treatment. The aim of this analysis was to characterize SPPADE symptoms in patients with breast cancer. Methods. SPPADE data were drawn from the Enhanced, EHR-facilitated Cancer Symptom Control (E2C2) study, a stepped-wedge pragmatic cluster-randomized trial designed to evaluate a symptom management intervention in routine practice (NCT03892967). Symptom severity was measured on a 0-10 scale via a survey administered by patient portal, in-clinic tablet, or interactive voice response system (by phone) prior to, during, or soon after an outpatient oncology encounter. Scores of 4-6 were categorized as “moderate” and ≥7 as “severe.” In this analysis, only the data from each patient’s initial survey were included. Results. A total of 9,651 patients with breast cancer completed an initial E2C2 survey between March 2019 and January 2023. The proportion of patients with moderate or severe SPPADE symptoms were as follows: 22% moderate and 10% severe for insomnia; 18% moderate and 7% severe for pain; 17% moderate and 7% severe for anxiety; 15% moderate and 5% severe for emotional distress; 25% moderate and 12% severe for fatigue; and 22% moderate and 8% severe for impaired physical function. Table 1 presents score means and standard deviations by demographic subgroup. Conclusions. SPPADE symptoms are common in patients with breast cancer. These observations warrant routine implementation of symptom surveillance and management in breast oncology. Funding acknowledgement: The Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium is a Cancer Moonshot Research Initiative under the authorization of the 2016 United States 21st Century Cures Act. This research was supported by the National Cancer Institute of the NIH, UM1CA233033 (Mayo Clinic, Rochester, MN). Insomnia, Pain, Anxiety, Distress, Fatigue, and Functional Impairment in Patients with Breast Cancer Citation Format: Kathryn Ruddy, Veronica Grzegorczyk, Deirdre Pachman, Sandra Mitchell, Bolun Liu, Deanne Smith, Ciara O'Sullivan, Shawna Ehlers, Jeph Herrin, Parvez Rahman, Andrea Cheville. Insomnia, Pain, Anxiety, Distress, Fatigue, and Functional Impairment in Patients with Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-09.

Abstract PO4-10-07: Understanding Psychological distress in patients prior to breast cancer diagnosis:Mixed Methods Study

Abstract Purpose:While the association between diagnosis of breast cancer and post-diagnosis psychological distress has been well documented, data regarding pre-diagnosis psychological distress in the breast cancer population are limited. The purpose of the current study is to measure the distress levels of patients prior to breast cancer diagnosis, to identify the categories of distress they have, and describe the experience of distress of patients before diagnosis. Methods: This study uses a mixed research method of cross-sectional survey and qualitative interviews. In the quantitative part, a cross-sectional survey of 118 patients with completed breast biopsies awaiting pathological diagnosis was conducted using the National Comprehensive Cancer Network’s (NCCN’s) Distress Thermometer(DT) and Problem List (PL), In the qualitative part, 15 patients were invited using convenient and purposive sampling. Data was collected using a semi-structured face-to-face interview and recorded. The transcribed text was analyzed using Colaizzi's phenomenological method. Results: The results reveal that 63.6% of patients reported a higher level of psychological distress (n=75, scoring≥4).Most patients had emotional (98%) or physical (64%) problems. Among these, worry or anxiety (47.5%), fear (33.1%), finances (21.2%), sadness and depression(18.6%), and grief or loss(15.3%) were the most frequently reported problems. Multivariate logistic regression analysis showed that the factors associated with psychological distress before the diagnosis of breast cancer patients were age, education level. The experience of patients before diagnosis emerged five themes: Very high psychological distress index; Strong uncertainty; The demand of information; Guilt for the family; Hoped for psychological support from the health care team. Conclusions: Psychological distress is prevalent prior to breast cancer diagnosis and may merit early intervention. Understanding patients’ distress may help guide future psychosocial needs assessments and interventions to promote patient quality of life. Table 1 Sample characteristics (n=118). Table 2 Univariate analysis of predictors associated with psychological distress Table 3 The binary logistic regression model of psychological distress Citation Format: Yan Gao, Jinnan Gao. Understanding Psychological distress in patients prior to breast cancer diagnosis:Mixed Methods Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-10-07.

Patient-centered communication’s association with trust, satisfaction, and perception of electronic health records use among newly diagnosed patients with cancer

IntroductionThe diagnosis of cancer creates immediate psychosocial distress for patients. New cancer patients are required to make important decisions about their treatment. Thus, it is essential to investigate their communication needs. This study examines the association between patient-centered communication and newly diagnosed cancer patients’ trust in their healthcare providers, satisfaction with the care visits, and perception of technology use during the visits.MethodsWe collected data from the Hackensack Meridian Health between February 2021 and May 2022. One hundred thirty-five participants were included in the study.ResultsThe findings captured the significant effect of patient-centered communication on the trust in doctors and satisfaction with care services. However, no association was noticed with the perception of EHR use among this population.DiscussionIn the first visits after cancer diagnosis, patients need to build strong communication with their doctors to build trust in them. Future studies should focus on testing the hypotheses longitudinally to validate the findings in other phases of the cancer care continuum.

Порівняльний аналіз субклінічного тривожно-депресивного синдрому в пацієнтів із гострим інфарктом міокарда з елевацією сегмента ST до та під час активних бойових дій у Харківській області

The aim – to assess subclinical emotional distress in patients with ST-Elevation Myocardial Infarction (STEMI) before and during the ongoing conflict in the Kharkiv Region. Materials and methods. The study encompassed 242 patients exhibiting subclinical emotional distress and hospitalized with STEMI at «L.T. Malaya TNI of NAMSU» before active conflict, compared with 65 patients during the conflict. Adherence to ethical standards was ensured, in line with the 1964 Helsinki Declaration, and the protocol received approval from the local ethics committee (Protocol № 8, dated 29.08.2016, and Protocol № 4, dated 12.05.2022). Participants completed the DASS-21 questionnaire, reflecting their emotional state 10–14 days prior, and received STEMI treatment as per current guidelines.Results. We showed that anxiety more frequent appeared during the active hostilities (p=0.0218). Depression had the influence on excessive smoking (p=0.0199), LV EF decrease (p=0.0057), LDL-C increase (p=0.0393). Anxiety and stress intrude into hypertension frequency (p=0.0171, p=0.0489) consequently as well as anxiety – on LDL-C increase (p=0.0068). All data of subclinical emotional distress during active hostilities associate with the frequency of smoking increase: p=0.0422 for depression, p=0.0275 for anxiety and p=0.0199 for stress. Depression associates with LVEF decrease (p=0.0267), the leucocytes count increase (p=0.0467), high frequency of hypertension (p=0.0410). Anxiety associates with higher heart rate (p=0.0277), depression and stress – with younger age (p=0.0369).Conclusions. Our research demonstrates close associations between the data of subclinical emotional distress both in patients with STEMI before and during the active hostilities in Kharkiv Region. Data were assessed with DASS-21 questionnaire on 10 –14 day prior the event. These results should be undertaken during general practitioner’s appointment to prevent further cardiovascular event.

Medicinal Cannabis (MedCan 3): a randomised, multicentre, double-blind, placebo-controlled trial to assess THC/CBD (1:20) to relieve symptom burden in patients with cancer-a study protocol for a randomised controlled trial.

Distressing symptoms are common in advanced cancer. Medicinal cannabinoids are commonly prescribed for a variety of symptoms. There is little evidence to support their use for most indications in palliative care. This study aims to assess a 1:20 delta-9-tetrahydrocannabinol/cannabidiol (THC/CBD) cannabinoid preparation in the management of symptom distress in patients with advanced cancer undergoing palliative care. One hundred and fifty participants will be recruited across multiple sites in Queensland, Australia. A teletrial model will facilitate the recruitment of patients outside of major metropolitan areas. The study is a pragmatic, multicenter, randomised, placebo-controlled, two-arm trial of escalating doses of an oral 1:20 THC/CBD medicinal cannabinoid preparation (10mg THC:200mg CBD/mL). It will compare the efficacy and safety outcomes of a titrated dose range of 2.5mg THC/50mgCBD to 30mg THC/600mg CBD per day against a placebo. There is a 2-week patient-determined titration phase, to reach a dose that achieves symptom relief or intolerable side effects, with a further 2weeks of assessment on the final dose. The primary objective is to assess the effect of escalating doses of a 1:20 THC/CBD medicinal cannabinoid preparation against placebo on change in total symptom distress score, with secondary objectives including establishing a patient-determined effective dose, the effect on sleep quality and overall quality of life. Some patients will be enrolled in a sub-study which will more rigorously evaluate the effect on sleep. MedCan-3 is a high-quality, adequately powered, placebo-controlled trial which will help demonstrate the utility of a THC:CBD 1:20 oral medicinal cannabis product in reducing total symptom distress in this population. Secondary outcomes may lead to new hypotheses regarding medicinal cannabis' role in particular symptoms or in particular cancers. The sleep sub-study will test the feasibility of using actigraphy and the Insomnia Severity Index (ISI) in this cohort. This will be the first large-scale palliative care randomised clinical trial to utilise the teletrial model in Australia. If successful, this will have significant implications for trial access for rural and remote patients in Australia and internationally. ANZCTR ACTRN12622000083796 . Protocol number 001/20. Registered on 21 January 2022. Recruitment started on 8 August 2022.

Let’s talk about sex! Why should healthcare professionals address sexual distress in breast cancer patients and survivors?

PurposeSexual distress impacts the quality of life (QoL) of breast cancer patients but is often overlooked in standard care pathways. This study evaluated the prevalence and factors of sexual distress among Dutch breast cancer patients, compared them to the general population, and explored how sexual distress is discussed in clinical settings from the perspectives of patients and healthcare professionals (HCPs). MethodsQuestionnaires containing the Female Sexual Distress Scale (FSDS) and demographic variables were distributed to women with breast cancer. The effect of breast cancer on sexual distress was assessed with a Mann-Whitney U test. Multivariable linear regression was used to analyze variables associated with FSDS. The Sexuality Attitudes and Beliefs Survey (SABS) was sent to HCPs. ResultsBreast cancer patients reported significantly higher sexual distress compared to a Dutch non-breast cancer cohort, respectively 16.38 (SD 11.81) and 23.35 (SD 11.39). Factors associated with higher sexual distress were psychological comorbidities, the body image scale, and being diagnosed >10 years ago. Sexual distress was not discussed as often as patients needed. Barriers to addressing sexual distress were time constraints, HCPs’ confidence in their ability to address sexual distress, and uncertainty about who is responsible for initiation. ConclusionsBreast cancer patients showed significantly higher sexual distress compared to the Dutch population. However, it was not frequently addressed in the consultation room. While some barriers have been identified, this study highlights the importance of further exploring obstacles to integrating discussions about sexual distress into routine care to improve QoL of breast cancer patients.

Physician estimate of inflammation vs global assessment in explaining variations in swollen joint counts in rheumatoid arthritis patients

Abstract Objective To analyze patients with rheumatoid arthritis (RA) for inflammatory activity by physician estimate of global assessment (DOCGL) vs an estimate of inflammatory activity (DOCINF) to explain variation in swollen joint count (SJC). Methods Patients with RA were studied at routine care visits. Patients completed a multidimensional health assessment questionnaire (MDHAQ), and the physician completed a 28-joint count for swollen (SJC), tender (TJC) and deformed (DJC) joints, and a RheuMetric checklist with a 0–10 DOCGL visual numeric scale (VNS), and 0–10 VNS estimates of inflammation (DOCINF), damage (DOCDAM) and patient distress (DOCSTR). Disease activity score 28 (DAS28-ESR), clinical disease activity index (CDAI) and routine assessment of patient index data (RAPID3) were calculated. Individual scores and RA indices were compared according to Spearman correlation coefficients and regression analyses. Results 104 unselected patients were included, with median age and disease duration of 55.0 and 5 years respectively. Median (IQR) DAS28-ESR was 2.89 (1.64), indicating low activity. DOCINF was correlated significantly with DOCGL (rho= 0.775). Both DOCGL and DOCINF were correlated significantly with most other measures; correlations with DOCGL generally were higher than with DOCINF other than for SJC. In regression analyses, DOCINF was more explanatory of variation in SJC than DOCGL and other DAS28-ESR components. Conclusions Variation in SJC is explained more by a 0–10 DOCINF VNS than the traditional DOCGL or any other measure in routine care RA patients. DOCINF on a RheuMetric checklist can provide informative quantitative scores concerning inflammatory activity in RA patients monitored over long periods.

Frequency of Myoclonus and its Countermeasures in Terminally Ill Patients with Cancer: A Single-Center Retrospective Study

Myoclonus is a relatively rare involuntary movement that is often observed in palliative care settings and that can cause patient distress. The purpose of this study is to investigate the occurrence of myoclonus and countermeasures against it in terminally ill patients with cancer diagnosed by palliative care specialists at Komaki City Hospital, Japan. We retrospectively reviewed patients with terminal cancer who received palliative care consultations between January 2018 and May 2019 and who were diagnosed with myoclonus by palliative care specialists, using electronic medical records. Patient demographics, time from onset of myoclonus to death, daily opioid use, countermeasures, and outcome of myoclonus were assessed. Of 360 patients examined during this period, 45 (12.5%) were diagnosed with myoclonus. Median age was 71 (range, 43–88) years; median time from onset of myoclonus to death was 8 days (range, 0–56); opioid usage was present in 39 patients (morphine, oxycodone, and fentanyl: n = 6, 21, and 12, respectively); and median oral morphine equivalent at onset of myoclonus was 60 mg (range, 12–336 mg). Myoclonus treatment was administered to 21 patients (opioid dose reduction, opioid switching, and others: n = 14, 3, and 4, respectively). Myoclonus is a common complication in patients with terminal cancer.

Digital Therapeutic (Mika) Targeting Distress in Patients With Cancer: Results From a Nationwide Waitlist Randomized Controlled Trial.

Distress is highly prevalent among patients with cancer, but supportive care needs often go unmet. Digital therapeutics hold the potential to overcome barriers in cancer care and improve health outcomes. This study conducted a randomized controlled trial to investigate the efficacy of Mika, an app-based digital therapeutic designed to reduce distress across the cancer trajectory. This nationwide waitlist randomized controlled trial in Germany enrolled patients with cancer across all tumor entities diagnosed within the last 5 years. Participants were randomized into the intervention (Mika plus usual care) and control (usual care alone) groups. The participants completed web-based assessments at baseline and at 2, 6, and 12 weeks. The primary outcome was the change in distress from baseline to week 12, as measured by the National Comprehensive Cancer Network Distress Thermometer. Secondary outcomes included depression, anxiety (Hospital Anxiety and Depression Scale), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and quality of life (Clinical Global Impression-Improvement Scale). Intention-to-treat and per-protocol analyses were performed. Analyses of covariance were used to test for outcome changes over time between the groups, controlling for baseline. A total of 218 patients (intervention: n=99 and control: n=119) were included in the intention-to-treat analysis. Compared with the control group, the intervention group reported greater reductions in distress (P=.03; ηp²=0.02), depression (P<.001; ηp²=0.07), anxiety (P=.03; ηp²=0.02), and fatigue (P=.04; ηp²=0.02). Per-protocol analyses revealed more pronounced treatment effects, with the exception of fatigue. No group difference was found for quality of life. Mika effectively diminished distress in patients with cancer. As a digital therapeutic solution, Mika offers accessible, tailored psychosocial and self-management support to address the unmet needs in cancer care. German Clinical Trials Register (DRKS) DRKS00026038; https://drks.de/search/en/trial/DRKS00026038.

Interrelation between subjective assessment of mental state and perception of family relations by relatives caring for patients with addiction

The addictive disorder often becomes a difficult experience for the all family. Studying the factors influencing the level of psychological distress of addicted patients’ relatives is necessary to create an effective system of psychological assistance for them.Purpose: to reveal the interrelations between the subjective assessment of the mental state and the perception of family relationships among relatives of patients with pathological gambling (PG) and relatives of patients with stimulant use disorder (SUD).Materials and methods. In a cross-sectional study 100 and 41 patients’ relatives were included in the PG and SUD groups respectively. The Symptom Checklist-90-Revised (SCL-90-R) and the Family Environment Scale (FES) was used as an assessment tools. Socio-demographic and clinical data were also collected.Results. The analysis of interrelations between the severity of psychopathological symptoms and the perception of family relationships in the studied groups determined both general and specific correlations. In both groups there are multiple negative correlations between the majority of SCL-90-R scales and the “Cohesion” scale (FES). The specific interrelations included, for example, multidirectional correlations between the “Expressiveness” scale (FES) and psychopathological symptoms scales of the SCL-90-R. Increased expressiveness in the PG group was associated with less severity of psychopathological symptoms and level of distress, and, on the contrary, a greater severity of psychological distress in respondents of the SUD group. Analysis of the correlations in PG compared to SUD showed greater predictability of the connections between psychopathological symptoms and perception of family relationships in the PG group. Thus, the indicators of psychopathological symptoms and psychological distress are negatively associated with parameters reflecting the perception of family cohesion, trust in intra-family relations, social activity and family organization and, at the same time, have positive interrelations with the indicator of conflict in family relationships.Conclusion. The perception of the family cohesion function as the intrapsychic protection that facilitate the relatives’ adaptation in the emerging life situation, regardless of the form of patients’ addiction.

Strict association between development of psychological conditions and hypertension incidence: A cross‐sectional study

AbstractBackground/AimsPrevious studies indicated a significant association between mental disorders and cardiovascular diseases, including heart failure (HF) and coronary artery disease (CAD) with comorbidity hypertension (HTN), and vice versa, leading to a challenge in the final decision. To resolve this issue, we aimed to exclude comorbidities and further assessed to better find any association between mental disorders and cardiovascular diseases (CVD).MethodsThe cross‐sectional study involved 300 participants: 100 with HTN (without HF or CAD), 100 with HF (without HTN or CAD), 100 with CAD (without HTN or HF), and 100 healthy individuals as a control group. To evaluate depression, anxiety, and stress levels, the Depression, Anxiety, and Stress Scale – 21 (DASS‐21) was applied. For further analysis, the SPSS ver.20 was used.ResultsThe analysis showed that the score of depression, anxiety, and stress was higher in the HTN patients compared to the control (p &lt; 0.001), CAD (p &lt; 0.001), and HF (p &lt; 0.001) groups, respectively. However, no significant differences were observed between the other study groups. Notably, patients with HF and CAD without concurrent HTN had similar psychological distress levels to healthy participants.ConclusionThe present study emphasized the higher prevalence of psychological distress in HTN patients and suggests a requirement for further research regarding the etiology involved in this association.

Outcomes of Immediate Total Thyroidectomy in First-Side Loss of Neuromonitoring Signal

Use of intraoperative neuromonitoring (IONM) during thyroidectomy can nearly eliminate the risk of postoperative bilateral vocal cord palsy (VCP) by indicating staged surgery in cases of loss of signal (LOS) on the first side of planned total thyroidectomy. However, aborting planned total thyroidectomy may lead to persistence of symptoms, delay in adjuvant treatment, and patient inconvenience and distress. There are few data to guide a selective approach to total thyroidectomy in patients with first-side LOS. To investigate outcomes of immediate bilateral surgery in patients undergoing total thyroidectomy with first-side LOS. This cohort study was a retrospective review of outcomes for patients undergoing thyroidectomy between January 2016 and July 2023 at an academic tertiary referral center for thyroid surgery. Consecutive patients scheduled for total thyroidectomy using IONM were included. Exclusion criteria were preoperative VCP, deliberate sacrifice of recurrent laryngeal nerve (RLN), inadvertent RLN resection, and surgery performed without IONM. Total thyroidectomy performed using IONM. Vocal mobility on first postoperative day as assessed by flexible laryngoscopy; secondary outcome measures included subjective voice assessment, other postoperative complications, and long-term vocal mobility. Among 400 patients undergoing planned total thyroidectomy (mean age, 50.5 years [range, 4-88 years]; 318 female [79.5%]), 51 (12.8%) had first-side LOS, of whom 37 (9.3%) had persistent LOS. Twenty-nine patients (56% of procedures with first-side LOS, including 18 with persistent LOS) proceeded to immediate total thyroidectomy. Postoperatively, 16 patients (55% of patients undergoing total thyroidectomy following first-side LOS, including 14 of 18 with persistent LOS) had impaired vocal mobility. One patient had bilateral VCP that did not require tracheostomy, and 2 had postoperative hypoparathyroidism. Of those whose surgery was aborted after first-side LOS, 8 of 22 (36%) underwent completion thyroidectomy at a later stage. In those undergoing completion thyroidectomy, 2 of 8 (25%) had temporary VCP after the second surgery, 2 (25%) had permanent hypoparathyroidism, and 1 (12.5%) developed inoperable cancer. Postoperative VCP was fully reversible in all but 1 patient. Among patients planned for total thyroidectomy who develop first-side LOS, immediate total thyroidectomy may be considered among those who have pressing reasons for same, and where surgical difficulties might be anticipated in a secondary surgery.

Management of Fungating Oral Cancer: A Case Report

Abstract Fungating growths are most distressing causing substantial psychological distress for patients and families. Malodor associated with fungating growth causes social isolation, yet malodor management remains suboptimal. Management of fungating cancer growth of oral cavity is unique and difficult. This paper discusses the management of malodor and infection associated with fungating wound including definitive treatment of fungating growth of an oral cavity cancer patient.

Benzydamine hydrochloride: an overview on a well-established drug with news in mechanisms of action

Pain and inflammation are the consequences of sore throat, dental and oral procedures, infections, ulcers and head and neck chemotherapy/radiotherapy, and their management is of fundamental importance to avoid distress in patients. Benzydamine hydrochloride (HCl) is a topical indolic nonsteroidal anti-inflammatory drug, endowed with analgesic and anesthetic activity, and with antimicrobial (including both gram-positive and gram-negative bacteria) and antifungal properties (targeting Candida albicans and non-albicans strains), used in odontostomatology, otorhinolaryngology, and gynecology for its properties. This molecule has a lipophilic nature, showing high affinity with cell membranes and exhibiting membrane stabilization properties, resulting in local anesthesia, an effect related also to the interaction of the drug with cationic channels. In addition, benzydamine HCl is able to inhibit the production of pro-inflammatory cytokines, with consequent analgesia. Moreover, benzydamine HCl is able to inhibit leukocyte-endothelial interactions and platelet aggregation. Unlike other non-steroidal anti-inflammatory drugs, benzydamine HCl does not inhibit cyclooxygenase or lipoxygenase. Here we review the most updated clinical data available on benzydamine HCl local application as spray, mouthwash or gargling and evidence of its effectiveness in inflammatory and/or septic conditions in the otorhinolaryngology and odontostomatology settings, with particular reference to sore throat, oral inflammation, dental plaque, tonsillitis/tonsillectomy and chemo- or radiotherapy-induced oral mucositis. Novel formulations for oral administration of benzydamine HCl are also reviewed, including in situ gelling formulations to be sprayed onto the damaged oral mucosa. Finally, novel data on the potential role of benzydamine HCl in nociceptor excitability are introduced.