End Of Active Treatment Research Articles

A return-to-work intervention protocol directed at cancer patients (self-assessment, tailored information & lifestyle management for returning to work among cancer patients, START): A multi-center, randomized controlled trial

PurposeThis study describes the protocol for the design and evaluation of a self-assessment based educational program supporting cancer patients’ return-to-work (RTW), prior to its complete and ongoing implementation. MethodsWe designed a multi-center, randomized controlled trial with three follow-up points. The study population (N = 239) includes recently diagnosed cancer patients who plan to receive active treatment at two university hospitals in Korea. A pre-test is conducted at the point of enrollment for both groups. The intervention group receives a leaflet clarifying misconceptions about RTW and is shown a video clip of patient interviews concerning RTW. The control group receives a booklet about cancer and nutrition, and is not provided with further intervention. After active treatment, the intervention group receives a one-time, face-to-face education session with an oncology nurse. Following the education session, both groups receive three follow-up phone calls. The first follow-up call occurs at the end of intervention and at the end of active treatment for intervention and control groups, respectively. The next two follow-up calls will be conducted one month and a year following the post-test. The primary outcome is whether the patient has RTW or has plans to RTW, and the secondary outcome is knowledge of RTW. ResultsAs of April 2020, 239 patients have been enrolled in the trial. Statistical analyses will be conducted upon trial completion in December 2020. DiscussionWe hypothesize that the provision of RTW education near diagnosis will not only enhance patients’ intentions to RTW, but also effectively encourage them to RTW.

The support and information needs of adolescents and young adults with cancer when active treatment ends

BackgroundThe end of active treatment is a period of high stress for young people with cancer, but limited literature exists about their information and support needs during this phase. This study aimed to understand the needs of young people with cancer, how these needs are currently being met, and how best to provide information and support at the end of active treatment.MethodsThis was a multi-stage, mixed methods study exploring the end of treatment experience from the perspectives of young people, and the healthcare professionals caring for them. Semi-structured interviews were undertaken with healthcare professionals, which informed a survey administered nationally. Subsequently, semi-structured interviews were conducted with young people. These combined results informed a co-design workshop to develop recommendations.ResultsTelephone interviews were conducted with 12 healthcare professionals and 49 completed the online survey. A total of 11 young people aged 19–26 years (female = 8; 73%) were interviewed. The stakeholder workshop was attended by both healthcare professionals (n = 8) and young people (n = 3). At the end of treatment young people experience numerous ongoing physical issues including pain, fatigue and insomnia; in addition to a range of psychosocial and emotional issues including anxiety, fear of recurrence and isolation. The top three priorities for end of treatment care were: earlier provision and preparation around on-going impact of cancer and cancer treatment; standardised and continued follow-up of young people’s emotional well-being; and development of more information and resources specific to young people.ConclusionThe access and availability of appropriate information and sources of support at the end of treatment is variable and inequitable. Young people’s needs would be more effectively met by timely, structured and accessible information, and support provision at the end of treatment to both prepare and enable adaptation across their transition to living with and beyond cancer. This will require both organisational and practical adjustments in care delivery, in addition to a renewed and updated understanding of what the ‘end of treatment’ transition process means.

Bridging the gap: identifying and meeting the needs of lung cancer survivors

There is a growing population of lung cancer survivors who may have unmet physical, psychological, and practical needs as they transition from active treatment into recovery. The specific needs and best ways to meet them are unclear in this population. This paper describes the development and outcomes of a program aimed to transition patients to survivorship. Patients with early-stage lung cancer were assessed for the presence and severity of unmet physical, psychological, and practical needs at the end of active treatment. Patients also attended a multidisciplinary clinic visit to create an individualized survivorship care plan and provide appropriate referrals. They were surveyed 3 months later to assess effectiveness of the program. Eighty-four participants were enrolled in the program. All reported at least one unmet need, with a mean of seven unmet needs, particularly related to breathing, fatigue, pain, and fear/anxiety. Following program participation, there were fewer and/or less severe needs. The Bridge program identified and decreased the number and severity of unmet needs through connecting survivors to local resources. Challenges to program implementation included hesitancy of providers to refer, time constraints of survivors and staff, and lack of community resources, especially for identified mental health needs.

1998-P: Waist Circumference Change in the First Year of the Look AHEAD Trial Is Associated with Risk for Cardiovascular Morbidity and Mortality

Look AHEAD found no difference between intensive lifestyle intervention (ILI) for weight loss and diabetes support and education (DSE; control) in cardiovascular (CVD) outcomes among individuals with overweight or obesity and type 2 diabetes (T2DM). This secondary analysis evaluated the association between change in weight and waist circumference (WC), a possible proxy for visceral adiposity, and risk for CVD outcomes. We classified Look AHEAD participants (n=4590) into one of four categories based on change in weight and WC from baseline to Year 1 (increase/increase, etc.) to examine the association between the categories and primary (myocardial infarction, stroke, hospitalized angina, CVD death) and secondary (primary outcomes and CABG/PTCA, hospitalized congestive heart failure, carotid endarterectomy, PVD, and total mortality) CVD outcomes from Year 1 to end of active treatment (median of 9 years). Cox proportional-hazards regression models were used to 1) compare ILI participants in the four categories to DSE and 2) evaluate the four categories within treatment groups using the group that decreased WC and weight as the reference. Compared to DSE, individuals in ILI who increased WC and weight and individuals who increased WC but decreased weight both had greater risk of secondary CVD outcomes (HR[95%CI]: 1.95 [1.33, 2.86] and 1.35 [1.02, 1.80] respectively). In analyses stratified by randomization group, DSE participants did not differ in cardiovascular events across categories. Individuals in ILI who gained WC (regardless of weight loss or gain), had increased risk of primary and secondary CVD outcomes compared to individuals in ILI who decreased weight and WC. Increased WC during weight loss treatment, regardless of weight loss or gain, is associated with greater risk for CVD outcomes in individuals with T2DM. This emphasizes the importance of measuring WC in clinical practice and testing interventions focused on decreasing WC. Disclosure K.L. Olson: None. R.H. Neiberg: None. M. Espeland: Other Relationship; Self; Boehringer Ingelheim International GmbH, Ironwood Pharmaceuticals. K.C. Johnson: None. W.C. Knowler: None. A.E. Staiano: None. L.E. Wagenknecht: None. R.R. Wing: None. Funding National Institutes of Health

Evaluation of the quality-of-life (QOL) and socio-demographic characteristics of patients with leukemia and lymphoma: Comparison with sibling and control group.

e22524 Background: Pediatric cancer patients have increased survival rates with intensive and effective treatment methods which causing some chronic health problems and lower quality of life in long term follow up. In our study, patients in their active treatment period compared to patients who have completed their treatment in recent 5 years and more than 5 years groups, besides compared with their own siblings and healthy control group,evaluated in terms of quality of life ( QOL). Methods: This study has been daone in the Department of Pediatric Hematology-Oncology, Ankara University School of Medicine. A total of 191 children were included in the study, including 36 sibling, 76 children with leukemia (n:31) and lymphoma (n:45) besides 79 healthy children. The Turkish translation of the PedsQL questionnaire was used to evaluate the patients' quality of life. IBM SPSS-25 package program was used for statistical analysis. Results: When the sociodemographic characteristics of the patient, sibling and control group were examined; we determined that the patients, siblings and control groups were similar in age, age and gender. However, we found that the education level for the patient group was statisticaly signicantly lower then the siblings and the control group. In addition, physical and mental functionning and friendship capasity scores were lower in patient group than the other two groups. According to timing of the treatment; patients and parents quality of life scores were significantly lower than the patients that finished their treatment in recent 5 years or more than 5 years. QOL scores were higest in survivors and parents group that were in more than 5 years after completed the treatment. The risk of lower QOL in patients under treatment was 7.48 times higher than the children who had ≥5 years of treatment (OR = 7,48; p < 0,05), and 2.64 times higher than those who were treated < 5 years (OR = 2,64; p > 0,05). In this study, there were no independent variables that had an impact on QOL of the sibling group. Conclusions: The QOLof patients diagnosed with leukemia and lymphoma is significantly lower than siblings and healthy group. No statistically significant difference was found between the sibling group and the healthy control group. After the end of active treatment, the QOL of the patients was reflecting important increase by the time .

Palatal changes in crossbite patients treated with rapid maxillary expansion vs untreated ones: A geometric morphometric study.

The present study aimed to analyse palatal changes due to rapid maxillary expansion (RME) by using modern geometric morphometric analysis (GMA) on 3D models. Forty children with posterior crossbite and maxillary deficiency were selected for this study. Twenty children were treated with RME (mean age 7.4±0.8years), whereas 20 children were not treated (mean age 7.2±1.1years). In the treated group, RME screw was activated until overcorrection was achieved and the RME appliance remained in place for 11months. Digital dental casts were recorded before treatment and 1year after the end of active treatment. GMA was performed to compare shape and dimensional variations among groups (between-group principal component analysis). All children in the treated group achieved crossbite correction. None of the control group children achieved crossbite self-correction. No significant shape and dimensional changes were noted in the control group after 1year. On the other hand, significant shape and dimensional changes were noted in the treated group after 1year (P<.05). Most of the shape changes in the treated group were similar but more pronounced compared to those observed in the control group. All major changes in palatal morphology occurred on the lateral sides of the palatal vault (widening) and at the height (shortening). Some shape changes were observed in the treated group alone. Application of GMA to evaluate the effects of RME in crossbite patients revealed significant changes in palatal morphology compared with the absence of changes in the control group.

Results of the long-term observational noninterventional prospective study BODYGUARD in psoriasis patients

Introduction. Currently there is insufficient data regarding routine use of various topical treatments for plaque psoriasis outside from randomized clinical trials, their efficacy, cost-effectiveness and perception by dermatologists and patients. The primary rationale for this study was local data generation for the long-term (up to 52 weeks) treatment of body psoriasis in Russian patients’ population with fixed-dose combination of calcipotriol and betamethasone dipropionate in the formulation of gel to evaluate patient’s adherence to the therapy and their satisfaction level.Materials and methods. Primary study objectives were evaluation of the long-term (up to 52 weeks) treatment success of body psoriasis with fixed-dose combination of calcipotriol and betamethasone dipropionate gel by Physician (Physician Psoriasis Global Assessment (PsGA, 5-point scale)) and by patient (Patient’s Global Psoriasis Assessment (PaGA, 5-point scale) and overall patient’s satisfaction using 4-point scale), patient’s satisfaction with the treatment via Patient Preference Questionnaire (PPQ), patients’ adherence to the treatment using Questionnaire of Adherence, impact of treatment on patients’ quality of life using DLQI questionnaire, and patients’ readiness to buy topical therapy product out of pocket based on consumption of the study medication during follow up period. Patients received treatment with topical calcipotriol/betamethasone gel which was prescribed as a routine medication without connection to the study purposes for up to 8 weeks. After the treatment patients were followed up for up to 52 weeks; during this period they were allowed to continue treatment with either maintenance or intermittent schedule. 128 dermatologists participated in the study, 612 patients with body plaque psoriasis (mean age 42.0 ± 13.30 years) were included; from this sample 544 (88.7 %) patients underwent follow up.Results. All 612 included patients received initial therapy with calcipotriol/betamethasone gel; during follow-up period 410 (76.1 %) patients received treatment by any schedule (out of 539 assessed). Overall treatment success based on average PsGA score: initially 3.0 ± 0.54, after appr.8 weeks — 1.3 ± 0.80 and after appr.52 week 1.1 ± 0.96; based on average PaGA score — initially 3.0 ± 0.54, after appr.8 weeks — 1.5 ± 0.88 and after appr.52 week 1.1 ± 0.99. The proportion of patients which described their overall satisfaction with the treatment as “satisfied” or “absolutely satisfied” equaled 92.3 % at visit at the end of active treatment and 93.1 % at visit up to 52 weeks afterwards. Also at visit at the end of active treatment 93.8 % of patients considered their current treatment as “more effective” than previous topical treatment they received. Patients’ adherence to the therapy was satisfactory — average application rate of calcipotriol/betamethasone (should be applied daily) gel at the last 7 days of treatment at visit at the end of active treatment comprised 5.6 ± 2.6 days, which means that 6 out of 7 days of the treatment were not missed. Initial DLQI score was 13.6 ± 5.95 and it reduced down to 3.89 ± 5.95 at visit at the end of active treatment (p &lt; 0.001) reflecting positive impact of successful therapy on patients’ psychosocial wellbeing.Discussion. Results of this study provides additional information regarding routine topical therapy in patients with plaque psoriasis. These findings demonstrate that the therapy of body plaque psoriasis with calcipotriol/betamethasone gel is effective both in short and long term according to the evaluation by dermatologists and by patients themselves. This therapy provides good rate of adherence and patients’ satisfaction as well as affects positively at patients’ psychosocial wellbeing assessed by DLQI score.

Impact of informal cancer caregiving across the cancer experience: A systematic literature review of quality of life.

Informal caregiving may likely increase as the number of cancer survivors grows. Caregiving responsibilities can impact caregivers' quality of life (QOL). Understanding the current state of the science regarding caregiving QOL could help inform future research and intervention development. A systematic literature review in PubMed/Medline examined research on QOL among informal cancer caregivers and related psychosocial health outcomes. Original research articles in English, published between 2007 and 2017 about caregivers (aged >18 years) of adult cancer patients in the United States were included. Abstracted articles were categorized according to caregiving recipient's phase of survivorship (acute, middle to long-term, end of life/bereavement). Of 920 articles abstracted, 60 met inclusion criteria. Mean caregiver age ranged from 37 to 68 with the majority being female, non-Hispanic white, with at least a high school degree, and middle income. Almost half of the studies focused on caregivers who provided care for survivors from diagnosis through the end of active treatment. Studies examined physical health, spirituality, psychological distress, and social support. Differences in QOL were noted by caregiver age, sex, and employment status. Additional research includes the examination of the needs of diverse cancer caregivers and determines how additional caregiver characteristics (e.g., physical functioning, financial burden, etc.) affect QOL. This includes studies examining caregiver QOL in the phases following the cessation of active treatment and assessments of health systems, support services, and insurance to determine barriers and facilitators needed to meet the immediate and long-term needs of cancer caregivers.

CN47 - Young people’s experiences when active cancer treatment ends

BackgroundThe end of active treatment is known to be a period of high stress in young people’s cancer timeline but little is known about young people’s experiences in this transition phase. This study aimed to understand the experiences and needs of young people at the end of treatment (EoT), how these are currently being met, and how best to provide support to young people. MethodsThis was a multi-stage, mixed methods study, conducted from January to December 2018, exploring the EoT experience from the perspectives of young people and healthcare professionals caring for them. This paper reports on the EoT experiences of young people (n=11), all within 12 months of EoT, who participated in semi-structured telephone or face-to-face interviews. Interviews were transcribed and analysed using thematic analysis. ResultsThree key themes emerged from the data relating to young people’s experience of ending active treatment: 1) Challenges with social reintegration; 2) Expectations versus the reality of ending treatment; 3) Sudden loss of the safe “bubble” of treatment. Some young people reported feeling isolated from their peers after they finished treatment, feeling they no longer belonged to previous peer groups. Young people reported challenges in managing both their own expectations and expectations of others about how they would feel at the end of treatment, versus the reality of how they actually felt both physically and psychosocially. They did not expect to experience onerous ongoing physical issues including pain, nausea and fatigue. Additionally, young people experienced a range of conflicting emotions: excitement, happiness, nerves, fear, shock, surprise and uncertainty. They described realising they were no longer regularly surrounded by healthcare professionals, and feared the loss of the familiar routine of regular hospital visits. ConclusionsEnd of treatment is a transition that results in changed relationships, routines, assumptions and roles. Young people often lacked awareness of and were under prepared for this. Having a better understanding of the unpredictable and ongoing nature of both physical and psychosocial issues they may face at the EoT would be beneficial, as would reassurance that challenges during this transition period are both acceptable and expected. Legal entity responsible for the studyUniversity College London Hospitals NHS Foundation Trust. FundingTeenage Cancer Trust. DisclosureAll authors have declared no conflicts of interest.

The Efficacy of Hypnosis as a Treatment for Anxiety: A Meta-Analysis

This meta-analysis quantifies the effectiveness of hypnosis in treating anxiety. Included studies were required to utilize a between-subjects or mixed-model design in which a hypnosis intervention was compared with a control condition in alleviating the symptoms of anxiety. Of 399 records screened, 15 studies incorporating 17 trials of hypnosis met the inclusion criteria. At the end of active treatment, 17 trials produced a mean weighted effect size of 0.79 (p ≤ .001), indicating the average participant receiving hypnosis reduced anxiety more than about 79% of control participants. At the longest follow-up, seven trials yielded a mean weighted effect size of 0.99 (p ≤ .001), demonstrating the average participant treated with hypnosis improved more than about 84% of control participants. Hypnosis was more effective in reducing anxiety when combined with other psychological interventions than when used as a stand-alone treatment.

Marital and Parent-Child Relationships during Treatment for Adolescent Depression: Child-Driven and Bidirectional Effects.

Adolescent depression can be a stressor for parents and families. This study evaluated how treating adolescent depression affects marital and parent-child relationships. We examined whether marital adjustment and parent-child conflict improved over the course of active treatment of depressed adolescents (36-week visit) and long-term follow-up (one year after discontinuation of treatment) in a sample of 322 clinically depressed youth participating in the Treatment for Adolescents with Depression Study (TADS). We also explored the bidirectional influences of adolescent depression and family relationships. Results indicated that marital adjustment was stable during active treatment but declined during long-term follow up. A structural equation model (SEM) examining the bidirectional relation between adolescent depression and marital adjustment indicated that higher adolescent depression at the conclusion of maintenance treatment (24-week visit) predicted a deterioration of marital adjustment at the end of active treatment (36-week visit). Parent-child conflict was unchanged during treatment and follow up. SEM analyses examining the bidirectional relationship between youth depression and parent-child conflict revealed that reduced depressive symptoms at the end of the active treatment period predicted improvement in parent-child conflict at subsequent time points. These findings suggest that youth depression and its treatment may influence long-term family functioning.

Caloric vestibular stimulation for the management of motor and non-motor symptoms in Parkinson's disease

IntroductionA recent case study showed that repeated sessions of caloric vestibular stimulation (CVS) relieved motor and non-motor symptoms associated with Parkinson's disease (PD). Here we sought to confirm these results in a prospective, double-blind, randomized, placebo treatment-controlled study. Methods33 PD subjects receiving stable anti-Parkinsonian therapy completed an active (n = 16) or placebo (n = 17) treatment period. Subjects self-administered CVS at home twice-daily via a portable, pre-programmed, solid-state ThermoNeuroModulation (TNM™) device, which delivered continually-varying thermal waveforms through aluminum ear-probes mounted on a wearable headset. Subjects were followed over a 4-week baseline period, 8 weeks of treatment and then at 5- and 24-weeks post-treatment. At each study visit, standardized clinical assessments were conducted during ON-medication states to evaluate changes in motor and non-motor symptoms, activities of daily living, and quality of life ratings. ResultsChange scores between baseline and the end of treatment showed that active-arm subjects demonstrated clinically-relevant reductions in motor and non-motor symptoms that were significantly greater than placebo-arm subjects. Active treatment was also associated with improved scores on activities of daily living assessments. Therapeutic gains were still evident 5 weeks after the end of active treatment but had started to recede at 24 weeks follow-up. No serious adverse events were associated with device use, and there was high participant satisfaction and tolerability of treatment. ConclusionThe results provide evidence that repeated CVS can provide safe and enduring adjuvant relief for motor and non-motor symptoms associated with PD.

Meta-Analysis of Anxiety in Parents of Young People with Chronic Health Conditions.

Chronic health conditions are often associated with uncertainty and threats which may cause anxiety in the family members. The present meta-analysis analyzed whether parents of children with chronic physical diseases and/or sensory/physical disabilities show higher anxiety levels than parents of healthy/nondisabled children or test norms. The databases PSYCINFO, MEDLINE, Google Scholar, CINAHL, and PSYNDEX were searched for relevant studies. In total, 486 studies were identified that fulfilled the inclusion criteria. We found moderate elevations of anxiety symptoms in parents of young people with chronic conditions (g = .54 standard deviation units). About 16% of the parents fulfilled the criteria for an anxiety disorder. Parents of young people with neuromuscular disorders, HIV-infection/AIDS, and cancer during active treatment showed large elevations of anxiety symptoms. Elevations of anxiety symptoms were smaller in the cases of longer lasting chronic conditions, longer time since the end of active treatment, in families of older children, in samples with lower percentages of mothers, and in studies from economically developed countries compared to less developed countries. Measures for preventing and reducing anxiety symptoms in parents of young people with neuromuscular disorders, HIV-infection/AIDS, and those undergoing cancer treatments are particularly needed.

S29. EXECUTIVE COGNITIVE TRAINING VS. PERCEPTUAL COGNITIVE TRAINING FOR SCHIZOPHRENIA-SPECTRUM DISORDERS: TREATMENT OUTCOMES AND PREDICTORS OF RESPONSE

Neurocognitive impairments are the best predictors of community functioning for individuals with schizophrenia-spectrum disorders. Cognitive remediation is a psychological intervention designed to improve neurocognitive abilities and community functioning. However, different theoretical approaches have developed without any studies directly comparing them. Additionally, with a movement towards personalizing cognitive enhancing techniques, greater emphasis is being placed on determining predictors of treatment response. The current study is the first to compare the two dominant approaches to cognitive remediation (training of executive skills and training of perceptual skills) and examine predictors of treatment response. 70 outpatients with schizophrenia-spectrum disorders were randomized to receive either 6 weeks of executive training (ET) or perceptual training (PT). Electrophysiological activity, neurocognition, functional competence, case-manager rated community functioning, clinical symptoms, and self-report measures were assessed at baseline, post-treatment, and 12-weeks post-treatment. There were minimal differences between groups at the post-treatment visit. PT improved EEG mismatch negativity amplitude significantly more than ET immediately post-treatment (d = 0.64), however, the effect did not persist at 12-week follow-up (d = 0.01). Examining long-term effects, at 12-week follow-up, ET increased EEG theta power during an n-back working memory task (d = 1.01), neurocognition (d = 0.64), functional competence (d = 0.67), and case manager rated community functioning (d = 0.53) to a greater extent than PT. Larger P300 amplitude (B = .47) and theta power during a working memory task (B = .34) at baseline were significantly associated with larger improvements in neurocognition post-treatment. Baseline mismatch negativity amplitude was not significantly associated with treatment response (B = .17), and no baseline EEG measures predicted functional outcomes. Both PT and ET improved neurophysiological mechanisms specific to their domains of intervention, however, only ET resulted in improvement in neurocognition and functioning. Improvements in favor of ET did not appear immediately post-treatment but emerged 12 weeks after the end of active treatment. Training executive functioning may prime further cognitive and functional improvements. Executive functions may be more functionally relevant than other cognitive domains and when addressed in treatment lead to better outcomes. Greater P300 amplitude and theta power may be associated with learning-related processes which are important for acquisition and retention of skills during cognitive training programs.

Soft tissue facial profile in Class III malocclusion: long-term post-pubertal effects produced by the Face Mask Protocol.

The objective of this study was to analyze soft tissue changes produced by rapid maxillary expansion and facial mask therapy in growing Class III patients. The treated group consisted of 32 Caucasian patients (15 females and 17 males) with dentoskeletal Class III malocclusion treated with the Face Mask Protocol (FMP, rapid maxillary expander, facial mask, and removable lower bite-block). All patients were evaluated before treatment (T1; mean age, 8.4 years), at the end of active treatment (T2; mean age, 10.7 years), and at a post-pubertal follow-up observation (T3; mean age, 15.8 years). The treated group was compared with a matched control group of 20 untreated subjects (10 females and 10 males) with dentoskeletal Class III malocclusion. Statistical comparisons between two groups were performed with the independent samples t-test (P < 0.05). Significant improvements were found during the long-term T1-T3 interval for profile facial angle (-5.8°), nasolabial angle (-4.4°), mandibular sulcus (-10.3°), upper lip protrusion (+0.7 mm), and lower lip protrusion (-1.1 mm) in the treated group. No significant post-pubertal effects were found in terms of lower face percentage between two groups. This study has a retrospective design and it used a historical control sample. The FMP induced positive effects on soft tissue facial profile with a good long-term post-pubertal stability.

A Randomized Controlled Trial of Executive Functioning Training Compared With Perceptual Training for Schizophrenia Spectrum Disorders: Effects on Neurophysiology, Neurocognition, and Functioning.

Cognitive remediation is an efficacious treatment for schizophrenia. However, different theoretical approaches have developed without any studies to directly compare them. This is the first study to compare the two dominant approaches to cognitive remediation (training of executive skills and training of perceptual skills) and employed the broadest assessment battery in the literature to date. Outpatients with schizophrenia spectrum disorders were randomly assigned to receive either executive training or perceptual training. Electrophysiological activity, neurocognition, functional competence, case manager-rated community functioning, clinical symptoms, and self-report measures were assessed at baseline, immediately after treatment, and at a 12-week posttreatment follow-up assessment. Perceptual training improved the EEG mismatch negativity significantly more than executive training immediately after treatment, although the effect did not persist at the 12-week follow-up. At the follow-up, executive training improved theta power during an n-back task, neurocognition, functional competence, and case manager-rated community functioning to a greater extent than perceptual training. These effects were not observed immediately after treatment. Both perceptual training and executive training improved neurophysiological mechanisms specific to their domains of intervention, although only executive training resulted in improvement in neurocognition and functioning. Improvements in favor of executive training did not appear immediately after treatment but emerged 12 weeks after the end of active treatment. Thus, short-term intervention targeting higher-order cognitive functions may prime further cognitive and functional improvement.

Residents' journal review

Residents' journal review

An exploration of the experiences of women treated with radiotherapy for breast cancer: Learning from recent and historical cohorts to identify enduring needs.

Recent decades have seen improvements in UK breast cancer services and treatments. Despite this, it is recognised that a range of patients' psychological and emotional needs remain unmet, both at the time of treatment and into survivorship. Using data from two distinct cohorts of women: those treated with radiotherapy for breast cancer historically, and women treated more recently, this study sought to identify and explore those needs and concerns that have continued to persist, despite advances in treatment and care. Data from N = 13 semi-structured interviews were analysed using Interpretative Phenomenological Analysis. An heuristic framework was applied to extract themes common to both participant cohorts. Participants' data evidenced an enduring vulnerability amongst cancer patients that has not diminished with new treatment pathways. Themes common to both cohorts highlighted the ongoing importance of personal factors such as resilience, and strategies to help retain a sense of normality. Extrinsic support was important too, especially high quality communication by healthcare professionals and having access to ongoing emotional support from others, particularly when active treatment ends. Participants' suggestions for future service development included the provision of ongoing continuity of care and greater access to emotional support services. This study highlights the psychological needs and concerns of breast cancer patients that have persisted, despite the many advances in patient-centred care. Findings are of value to nurses and other healthcare professionals in highlighting the ongoing importance of recognising, acknowledging and addressing patients' concerns and needs, even within current cancer care pathways.

A Meta-Analysis of Hypnotic Interventions for Depression Symptoms: High Hopes for Hypnosis?

This meta-analysis quantifies the effectiveness of hypnosis for treating the symptoms of depression. To be included in the meta-analysis, studies were required to use a between-subjects or mixed-model design in which a hypnotic intervention for depression was compared with a control condition in reducing depression symptoms. Of 197 records screened, 10 studies incorporating 13 trials of hypnosis met the inclusion criteria. The mean weighted effect size for 13 trials of hypnosis at the end of active treatment was 0.71 (p ≤ .001), indicating the average participant receiving hypnosis showed more improvement than about 76% of control participants. The mean weighted effect size for four trials of hypnosis at the longest follow-up was 0.52 (p ≤ .01), indicating the average participant treated with hypnosis showed more improvement than about 51% of control participants. These effect sizes are comparable to those associated with well-known psychological interventions for depression (e.g., Beck’s cognitive therapy, interpersonal therapy) and suggest hypnosis is a very effective way of alleviating the symptoms of depression. Clinicians may wish to give serious consideration to hypnosis as a treatment option when working with clients and patients who are depressed.

Quality of Life in NSCLC Survivors — A Multicenter Cross-Sectional Study

IntroductionThe objective was to assess quality of life (QoL) in lung cancer survivors, compare it to the general population, and identify factors associated with global QoL, physical functioning, emotional functioning, fatigue, pain, and dyspnea. MethodsData from NSCLC patients who had survived 1 year or longer after diagnosis were collected cross-sectionally in a multicenter study. QoL was assessed with the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and the lung cancer module QLQ-LC13 across different clinical subgroups and compared to age- and sex-standardized general population reference values. Multivariable linear regression analyses were performed to test the associations of patient-, tumor-, and treatment-related factors with the six primary QoL scales. ResultsSix hundred fifty-seven NSCLC patients participated in the study with a median time since diagnosis of 3.7 years (range, 1.0–21.2 years). Compared to the age- and sex-standardized general population, clinically meaningful differences in the QoL detriment were found on almost all domains: lung cancer survivors had clinically relevant poorer global QoL (10 points, p < 0.001). Whereas in 12 months or longer treatment-free patients this detriment was small (8.3), it was higher in patients currently in treatment (16.0). Regarding functioning and symptom scales, respective detriments were largest for dyspnea (41 points), role function (33 points), fatigue (27 points), social function (27 points), physical function (24 points), and insomnia (21 points) observed across all subgroups. The main factor associated with poorer QoL in all primary QoL scales was mental distress (β |19-31|, all p < 0.001). Detriments in QoL across multiple primary QoL scales were also observed with current treatment (β |8-12|, p < 0.01), respiratory comorbidity (β |4-5|, p < 0.01), and living on a disability pension (β |10-11|, p < 0.01). The main factor associated with better QoL in almost all primary QoL scales was higher physical activity (β |10-20|, p < 0.001). Better QoL was also observed in patients with high income (β |10-14|, p < 0.01). ConclusionsLung cancer survivors experience both functional restrictions and symptoms that persist long term after active treatment ends. This substantiates the importance of providing long-term supportive care.