Patient-reported Anxiety Research Articles

Patient and Parent Reported Psychosocial Concerns in Children and Adolescents With Turner syndrome

Background: Pediatric patients with Turner syndrome (TS) are reported to have a higher incidence of anxiety, depression and social isolation but there is minimal data on self-reported measures. Methods: We utilized the validated PROMIS (Patient Reported Outcomes Measurement Information System) question bank to develop 4-question short forms to assess patient and parent self-reported scores in the domains of depression, anxiety, and peer relationships in our TS cohort. Completed PROMIS short forms from TS patients seen in the multidisciplinary TS clinic between 1/1/2019 and 6/1/2020 were retrospectively analyzed. Clinical data were also abstracted from medical records and correlated with the measures of depression, anxiety, and peer relationships. Descriptive analyses of the T-scores were completed using a non-parametric Wilcoxon rank-sum test and the dyad results were analyzed for agreement between parent and patient reporting. Results: Data from 26 patients (mean age 13y, range 4.6-20.6y) were included in the analysis: 3.9% were clinically referred for depression/anxiety after psychology assessment, 15% had developmental delays and 15% had an individualized education plan. Nearly 77% had short stature (<5%ile), 58% had received growth hormone and 54% were on estrogen therapy. Median scores were not statistically different from population norms for patient (N=22) or parent (N=25) reports in the 3 domains and did not vary by age, estrogen supplementation or stature. Internal reliability of the questionnaires measured by overall Cronbach alpha for each domain were acceptable (0.73-0.93). While parent and patient reported anxiety scores were correlated (R=.452, p=.040.), the depression and peer relationship scores were not correlated. Parent-reported peer relationship scores were negatively correlated with patient-reported anxiety (R=-0.46, p=0.04) and parent reported anxiety (R=-0.43, p=0.04) scores. Parent perceived depression and anxiety measures were also correlated (R=0.77, p< 0.001) as were patient reported scores in these domains (R=0.6, p=0.003). Conclusions: In contrast to existing literature in TS indicating a higher incidence of psychosocial concerns, the patient and parent self-reported scores on depression, anxiety and peer relationship were not statistically different from the population normative data, and parent and patient perceived scores were not correlated in all domains. While the small number of patients in this pilot study may be insufficiently powered to detect a small difference in scores in these domains, the data underscores the need to develop a TS-specific validated psychosocial questionnaire that more adequately assesses the psychosocial concerns in this population.

Feasibility of Breast Radiation Therapy Video Education Combined With Standard Radiation Therapy Education for Patients With Breast Cancer.

To determine the feasibility of incorporating a brief animated educational video shown during the radiation therapy (RT) consultation appointment for patients with breast cancer and to collect preliminary quality-of-life data. 20 participants with breast cancer were recruited from an outpatient radiation oncology facility in the southeastern United States. This single-arm, pre- and post-test feasibility study aimed to assess feasibility and preliminary outcomes of patient-reported anxiety, distress, and RT concerns. The video intervention demonstrated feasibility, as evidenced by meeting or exceeding benchmarks set for recruitment, retention, and feasibility measured scores. The difference in means of total patient-reported scores comparing pre- to postintervention decreased. The intervention proved feasible. In addition, the decrease in total mean scores suggests the video may have a positive effect on reducing patient distress, anxiety, and RT concerns.

Cost-effectiveness of feedback-informed psychological treatment: Evidence from the IAPT-FIT trial

BackgroundFeedback-informed treatment (FIT) involves using computerized routine outcome monitoring technology to alert therapists to cases that are not responding well to psychotherapy, prompting them to identify and resolve obstacles to improvement. In this study, we present the first health economic evaluation of FIT, compared to usual care, to enable decision makers to judge whether this approach represents a good investment for health systems. MethodsThis randomised controlled trial included 2233 patients clustered within 77 therapists who were randomly assigned to a FIT group (n = 1176) or a usual care control group (n = 1057). Treatment response was monitored using patient-reported depression (PHQ-9) and anxiety (GAD-7) measures. Therapists in the FIT group had access to a computerized algorithm that alerted them to cases that were “not on track”, compared to normative clinical data. Health service costs included the cost of training therapists to use FIT and the cost of therapy sessions in each arm. The incremental cost-effectiveness of FIT was assessed relative to usual care, using multilevel modelling. ResultsFIT was associated with an increased probability of reliable symptomatic improvement by 8.09 percentage points (95% CI: 4.16%–12.03%) which was statistically significant. The incremental cost of FIT was £15.17 (95% CI: £6.95 to £37.29) per patient and was not statistically significant. The incremental cost-effectiveness ratio (ICER) per additional case of reliable improvement was £187.4 (95% CI: £126.7 to £501.5); this confidence interval shows that the relative cost-effectiveness is between FIT being a dominant strategy (i.e. more effective and also cost-saving) to FIT being more effective at a modest incremental cost to the health system. ConclusionsThe FIT strategy increases the probability of reliable improvement in routine clinical practice and may be associated with a small (but uncertain) incremental cost. FIT is likely to be a cost-effective strategy for mental health services.

Symptom Burden in Patients Treated With Palliative Radiotherapy Before and During the COVID-19 Pandemic

Oncological care has faced several challenges during the COVID-19 pandemic, e.g. treatment delay and worsening symptoms. Patient-reported anxiety, depression and sleep quality might have changed due to these special circumstances. Therefore, we analyzed the symptom burden of patients treated with palliative radiotherapy at our center. A retrospective study was performed of 50 consecutive patients and the results were compared to those obtained in a previous pre-COVID study. The Edmonton Symptom Assessment Scale was employed to assess the preradiotherapy symptoms. The highest mean scores were reported for pain in activity (3.2) and dry mouth (3.1). Regarding anxiety, sadness/depression and sleep, the corresponding scores were 1.5, 1.2 and 2.7, respectively. Compared to the previous study, no significant increases were found. Most items had numerically lower mean values, e.g. anxiety (1.5 vs. 2.7). Both study populations had comparable median age (70.5 vs. 70 years), gender distribution and proportion of patients with bone metastases. However, there were two significant imbalances, namely a lower proportion of patients with prostate cancer (12 vs. 30%, p=0.02) and breast cancer (0 vs. 12%, p=0.02). In patients who showed up for radiation treatment planning, the suspected increase in anxiety, sadness/depression and sleep disturbance was not demonstrable. It is not known whether or not patients with substantial worries chose to decline referral to palliative radiotherapy. Therefore, comprehensive large-scale studies of patterns of care are needed to fully understand the impact of COVID-19-related measures.

Dynamic prediction of psychological treatment outcomes: development and validation of a prediction model using routinely collected symptom data

Common mental disorders can be effectively treated with psychotherapy, but some patients do not respond well and require timely identification to prevent treatment failure. We aimed to develop and validate a dynamic model to predict psychological treatment outcomes, and to compare the model with currently used methods, including expected treatment response models and machine learning models. In this prediction model development and validation study, we obtained data from two UK studies including patients who had accessed therapy via Improving Access to Psychological Therapies (IAPT) services managed by ten UK National Health Service (NHS) Trusts between March, 2012, and June, 2018, to predict treatment outcomes. In study 1, we used data on patient-reported depression (Patient Health Questionnaire 9 [PHQ-9]) and anxiety (Generalised Anxiety Disorder 7 [GAD-7]) symptom measures obtained on a session-by-session basis (Leeds Community Healthcare NHS Trust dataset; n=2317) to train the Oracle dynamic prediction model using iterative logistic regression analysis. The outcome of interest was reliable and clinically significant improvement in depression (PHQ-9) and anxiety (GAD-7) symptoms. The predictive accuracy of the model was assessed in an external test sample (Cumbria Northumberland Tyne and Wear NHS Foundation Trust dataset; n=2036) using the area under the curve (AUC), positive predictive values (PPVs), and negative predictive values (NPVs). In study 2, we retrained the Oracle algorithm using a multiservice sample (South West Yorkshire Partnership NHS Foundation Trust, North East London NHS Foundation Trust, Cheshire and Wirral Partnership NHS Foundation Trust, and Cambridgeshire and Peterborough NHS Foundation Trust; n=42 992) and compared its performance with an expected treatment response model and five machine learning models (Bayesian updating algorithm, elastic net regularisation, extreme gradient boosting, support vector machine, and neural networks based on a multilayer perceptron algorithm) in an external test sample (Whittington Health NHS Trust; Barnet Enfield and Haringey Mental Health Trust; Pennine Care NHS Foundation Trust; and Humber NHS Foundation Trust; n=30 026). The Oracle algorithm trained using iterative logistic regressions generalised well to external test samples, explaining up to 47·3% of variability in treatment outcomes. Prediction accuracy was modest at session one (AUC 0·59 [95% CI 0·55-0·62], PPV 0·63, NPV 0·61), but improved over time, reaching high prediction accuracy (AUC 0·81 [0·77-0·86], PPV 0·79, NPV 0·69) as early as session seven. The performance of the Oracle model was similar to complex (eg, including patient profiling variables) and computationally intensive machine learning models (eg, neural networks based on a multilayer perceptron algorithm, extreme gradient boosting). Furthermore, the predictive accuracy of a more simple dynamic algorithm including only baseline and index-session scores was comparable to more complex algorithms that included additional predictors modelling sample-level and individual-level variability. Overall, the Oracle algorithm significantly outperformed the expected treatment response model (mean AUC 0·80 vs 0·70, p<0·0001]). Dynamic prediction models using sparse and readily available symptom measures are capable of predicting psychotherapy outcomes with high accuracy. University of Sheffield.

Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional–behavioural dyscontrol in former NFL players: an NFL-LONG Study

ObjectivesTo examine the relationships among self-reported sport-related concussion (SRC) history and current health-promoting behaviours (exercise frequency, diet quality and sleep duration) with self-reported measures of brain health (cognitive function, symptoms...

COVID-19-related anxiety in people living with HIV: an online cross-sectional study

Background/aimThe emergence of the coronavirus disease 2019 (COVID-19) outbreak has had an enormous emotional impact on some vulnerable groups, such as people living with human immunodeficiency virus (HIV) (PLHIV). This study was planned with the aim of assessing the anxiety levels of PLHIV and the sources of their anxiety.Materials and methodsA web-based questionnaire was sent to PLHIV using the virtual snowball sampling method. The questionnaire included questions about sociodemographic status, information about HIV infection, and the Beck Anxiety Inventory (BAI). Additionally, some opinions of the participants about COVID-19 were asked.ResultsA total of 307 respondents, with a median age of 33 years, from 32 different cities, participated in the study. More than half of the respondents reported the belief that COVID-19 was not sufficiently well-known by the medical community and nearly 45% believed that they would have more complications if they contracted COVID-19. One-fourth of the participants had anxiety. Having a preexisting psychiatric disorder, perceiving that they were practicing insufficient preventive measures, not being sure about the presence of any individuals with COVID-19 in their environment, and living with a household member with a chronic disease were found to be the risk factors of PLHIV for having anxiety during this pandemic. The BAI scores were correlated with the patient-reported anxiety levels about the spread of COVID-19 in Turkey, acquiring COVID-19, transmitting COVID-19 to another person, and transmitting HIV to another person. Among the stated conditions, the most common concern was the spread of COVID-19 all over the country, while the least common was transmitting HIV to someone else.ConclusionThe results revealed that a significant proportion of the sample had anxiety, and the findings were essential for developing evidence-based strategies for decreasing the anxiety of PLHIV, especially for those who had risk factors and to provide them with better health care during this pandemic or other pandemic-like crises.

Mental Health Associated With Postoperative Satisfaction in Lumbar Degenerative Surgery Patients.

Retrospective review of prospectively collected data. To assess the association between preoperative and postoperative mental health status with postoperative satisfaction in lumbar degenerative surgery patients. Poor preoperative mental health has been shown to negatively affect postoperative satisfaction among spine surgery patients, but there is limited evidence on the impact of postoperative mental health on satisfaction. Adult patients undergoing surgery for lumbar degenerative conditions at a single institution were included. Mental health was assessed preoperatively and 12 months postoperatively using Patient-Reported Outcomes Measurement Information System Depression and Anxiety scores. Satisfaction was assessed 12 months postoperatively using North American Spine Society Patient Satisfaction Index. The authors evaluated associations between mental health and satisfaction with univariate and multivariable logistic regression to adjust for confounders. Preoperative depression/anxiety level was corrected for postoperative depression/anxiety level, and vice versa. Statistical significance was assessed at α=0.05. A total of 183 patients (47% male individuals; avg. age, 62 y) were included. Depression was present in 27% preoperatively and 29% postoperatively, and anxiety in 50% preoperatively and 31% postoperatively. Ninteen percent reported postoperative dissatisfaction using the North American Spine Society Patient Satisfaction Index. Univariate analysis identified race, family income, relationship status, current smoking status, change in pain interference, and change in physical function as potential confounders. In adjusted analysis, odds of dissatisfaction were increased in those with mild postoperative depression (adjusted odds ratio=6.1; 95% confidence interval, 1.2-32; P=0.03) and moderate or severe postoperative depression (adjusted odds ratio=7.5; 95% confidence interval, 1.3-52; P=0.03). Preoperative and postoperative anxiety and preoperative depression were not associated with postoperative satisfaction. Following lumbar degenerative surgery, patients with postoperative depression, irrespective of preoperative depression status, have significantly higher odds of dissatisfaction. These results emphasize the importance of postoperative screening and treatment of depression in spine patients with dissatisfaction. Level III-nonrandomized cohort study.

Examining the Effect of an Animal-Assisted Intervention on Patient Distress in Outpatient Cystoscopy

Abstract Animal assisted interventions (AAI) have been shown to improve patient outcomes in some healthcare settings. Flexible cystoscopy, while minimally invasive, is associated with patient-reported pain, fear, and anxiety. Few techniques have been found to improve these adverse effects associated with cystoscopy. The purpose of this study was to extend existing research on AAI in outpatient settings to investigate the effectiveness of AAI in reducing patient distress associated with outpatient cystoscopy. Ninety-five patients (average age 55.5 years) were prospectively enrolled and randomized to receive one 15-minute AAI prior to cystoscopy (n=46), or cystoscopy performed per standard protocol (n=49). Distress was measured by Visual Analogue Scales (VAS) for fear, anxiety, and stress, systolic blood pressure, and heart rate at 3 time points: prior to intervention/prior to cystoscopy, following intervention/prior to cystoscopy, and following intervention/following cystoscopy. Pain was assessed by VAS post-cystoscopy. There were no significant differences between the AAI and control groups in changes in systolic blood pressure, heart rate, fear, and pain between any time points. There were significant between-group differences in changes in anxiety and stress prior to cystoscopy with greater reductions found in anxiety and stress following AAI. The greater reductions in stress associated with AAI were maintained after cystoscopy. This is the first study to investigate the effectiveness of AAI in reducing distress associated with cystoscopy. More research is needed to determine if AAI is a viable method for improving patient outcomes associated with this and other outpatient procedures.

Development and internal validation of a predictive risk model for anxiety after completion of treatment for early stage breast cancer

ObjectiveTo develop a predictive risk model (PRM) for patient-reported anxiety after treatment completion for early stage breast cancer suitable for use in practice and underpinned by advances in data science and risk prediction.MethodsSecondary analysis of a prospective survey of > 800 women at the end of treatment and again 6 months later using patient reported outcome (PRO) the hospital anxiety and depression scale-anxiety (HADS-A) and > 20 candidate predictors. Multiple imputation using chained equations (for missing data) and least absolute shrinkage and selection operator (LASSO) were used to select predictors. Final multivariable linear model performance was assessed (R2) and bootstrapped for internal validation.ResultsFive predictors of anxiety selected by LASSO were HADS-A (Beta 0.73; 95% CI 0.681, 0.785); HAD-depression (Beta 0.095; 95% CI 0.020, 0.182) and having caring responsibilities (Beta 0.488; 95% CI 0.084, 0.866) increased risk, whereas being older (Beta − 0.010; 95% CI -0.028, 0.004) and owning a home (Beta 0.432; 95% CI -0.954, 0.078) reduced the risk. The final model explained 60% of variance and bias was low (− 0.006 to 0.002).ConclusionsDifferent modelling approaches are needed to predict rather than explain patient reported outcomes. We developed a parsimonious and pragmatic PRM. External validation is required prior to translation to digital tool and evaluation of clinical implementation. The routine use of PROs and data driven PRM in practice provides a new opportunity to target supportive care and specialist interventions for cancer patients.

Abstract 14913: The Impact of the Wearable Cardioverter-defibrillators on Quality of Life: Insights From the Vest Trial

Background: There is scant research on the effect of wearable cardioverter-defibrillators (WCDs) on quality of life (QOL). One retrospective observational study concluded that WCDs have a negative impact. The VEST Trial was a randomized controlled trial of the WCD allowing a more definitive and complete analysis of QOL among WCD users. Hypothesis: We sought to determine if the WCD impacts patient-reported QOL, including depression, anxiety, and physical activity levels. Methods: In the VEST trial, participants with severe left ventricular dysfunction (EF≤35%) after MI were randomized in a 2:1 ratio to receive a WCD plus guideline directed therapy (GDMT) versus GDMT alone. During the 3-month follow-up period, participants were asked to complete QOL assessments and health questionnaires. Results: 1524 participants were randomized to WCD plus GDMT versus 778 participants to GDMT alone. The mean age was 60.9±12.6 years and 61.4±12.3 years in the two groups, respectively. Participants were 73.5% male, had an average body-mass index of 28.4±5.5 kg/m2, and a mean EF of 28%. During a mean follow-up of 84.3±15.6 days, health questionnaires and QOL assessments were completed by 1340 participants, including 898 receiving WCD plus GDMT, and 442 receiving GDMT alone. See Table 1 for the results of QOL assessments and health questionnaires. There were no differences in QOL according to the SF-36 physical and mental component scores, and EQ-5D scores between WCD plus GDMT versus GDMT alone. There were also no differences in depression (CES-D 10), anxiety (State-Trait Anxiety Inventory), physical activity (International Physical Activity Questionnaire), or self-reported health scale between groups (all p&gt;0.05). Conclusions: In post-MI patients with low EF, the WCD does not affect QOL, depression, anxiety, physical activity, or self-reported health. Prescribers can be reassured that the WCD has no detrimental impact on patient-reported health measures.

Clinical Hypnosis in Pediatric Crohn's Disease: A Randomized Controlled Pilot Study.

The aim of this study was to implement clinical hypnosis (CH) as an adjunctive therapy for adolescents with Crohn's disease (CD) and to assess the impact of CH on quality of life (QoL), abdominal pain, psychosocial measures, and disease activity compared with standard care. Forty adolescents with CD were randomized to a hypnosis intervention (HI) or waitlist control (WC) group. The intervention consisted of 1 in-person CH session, self-hypnosis education, and recordings for home practice. Data was collected at baseline, after the 8-week intervention, and at week 16. The primary outcome was patient- and parent-reported QoL; secondary outcomes were patient-reported abdominal pain, depression, anxiety, and sleep; school absences; and disease activity by Pediatric Crohn's Disease Activity Index. Paired and independent t-tests were used to compare differences from baseline to postintervention within and between groups. Forty patients (50% girls, mean 15.8 years) were enrolled from February to May 2019. Seventy-eight percent had inactive disease, and 55% had abdominal pain. Post intervention, significant improvements were noted in HI parent-reported QoL compared with WC in total score (P = 0.05), social functioning (P = 0.01), and school functioning (P = 0.04) but patient-reported QoL was unchanged. Abdominal pain severity significantly improved in HI compared with WC (P = 0.03). School absences decreased in significantly more intervention than control patients (P = 0.01). Patients who practiced self-hypnosis consistently showed a trend toward greater QoL improvement than those who did not (P = 0.1). CH is an acceptable and feasible adjunct in CD and may improve psychosocial QoL and abdominal pain. Further research is warranted.

Longitudinal Analysis Of Quality Of Life As An Independent Predictor Of Neurocognitive Function In Brain Tumor Patients

Primary brain tumor patients experience reduced health-related quality of life (hrQoL), which may be compounded by treatments including radiation therapy (RT). We conducted a prospective longitudinal study to examine the association between hrQoL (physical, social/family, emotional, functional, and brain cancer-specific) and domain-specific neurocognitive function in primary brain tumor patients. Primary brain tumor patients (n = 59) receiving fractionated brain RT underwent comprehensive hrQOL (Functional Assessment of Cancer Therapy-Brain [FACT-Br]) and neurocognitive evaluation at baseline and 3, 6, and 12 months post-RT. Neurocognitive assessments measured attention and processing speed (Delis-Kaplan Executive Function System Trail Making Test [DKEFS-TMT] Visual Scanning, Number Sequencing, and Letter Sequencing and Weschler-Adult Intelligence Scale-IV [WAIS-IV] Digit Span and Coding), memory (Hopkins Verbal Learning Test-Revised [HVLT-R] Total and Delayed Recall and Brief Visuospatial Memory Test [BVMT] Total and Delayed Recall), and executive function (DKEFS Verbal Fluency [DKEFS-VF] Letter Fluency and Category Switching and Wisconsin Card Sorting Test [WCST] Perseverative Errors). Cognitive scores were transformed to t-scores controlling for age and sex; higher cognitive t-scores and hrQOL scores reflect better function. Multivariable linear mixed-effects models assessed independent association between hrQOL scores and neurocognitive function over time, controlling for patient, tumor, and treatment characteristics as well as timepoint-specific patient-reported anxiety and depression symptoms. P-values were corrected for multiple comparisons using false discovery rate. Median age of the cohort was 47 years. Most were male (61%) and married (71%). Higher physical hrQoL showed significant independent association with better verbal memory (HVLT Total Recall p = 0.047), while higher functional hrQoL correlated with better executive function (DKEFS-VF Switching Total p = 0.009) and verbal memory (HVLT Delayed Recall p = 0.006). Higher brain cancer-specific hrQoL was associated with better performance on tests of verbal and non-verbal memory (HVLT Total p = 0.004 and Delayed Recall p = 0.030; BVMT Total p = 0.049 and Delayed Recall p = 0.049). There was no significant association between social/family or emotional hrQoL and neurocognitive scores. This is the first prospective study to assess the independent association of hrQOL and neurocognition in primary brain tumor patients. We found that reduced physical, functional, and brain cancer-specific hrQoL were independently associated with worse executive function and memory among primary brain tumor patients receiving RT. Physical and functional impairments may impact cognitive performance in this population after RT.

The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditions

IntroductionPatients with upper extremity conditions may also experience symptoms of depression, anxiety, and pain that limit functional recovery. Purpose of the StudyThis study examined the impact of mental health and pain symptoms on referral rates to therapy and utilization of therapy services to achieve functional recovery among patients with common hand conditions. Study DesignThis is a retrospective cohort study of patients from one orthopedic center. MethodsData extraction provided demographics, the International Classification of Diseases, 10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS depression, anxiety, and pain interference to therapy referral, the number of therapy visits, and goal attainment. ResultsForty-nine percent (172/351) of patients were referred to hand therapy. There was no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average required one more therapy visit to achieve treatment goals (average visits: 3.7 vs 3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores (50%) achieved their long-term goals than patients with low depression scores (69%, P = .20). ConclusionsPatients' baseline level of depressive symptoms and anxiety do not predict referrals to hand therapy by orthopedic hand surgeons. There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. Therapists may address mental health needs in treatment plans. Future studies should examine if nonreferred patients with depressive symptoms achieve maximal functional recovery.

Prospective evaluation of the impact of stress, anxiety, and depression on household income among young women with early breast cancer from the Young and Strong trial

BackgroundYoung women with breast cancer tend to report lower quality of life and higher levels of stress than older women with breast cancer, and this may have implications for other psychosocial factors including finances. We sought to determine if stress, anxiety, and depression at diagnosis were associated with changes in household income over 12-months in young women with breast cancer in the United States.MethodsThis study was a prospective, longitudinal cohort study comprised of women enrolled in the Young and Strong trial. Of the 467 women aged 18–45 newly diagnosed with early-stage breast cancer enrolled in the Young and Strong trial from 2012 to 2013, 356 (76%) answered income questions. Change in household income from baseline to 12 months was assessed and women were categorized as having lost, gained, maintained the same household income <$100,000, or maintained household income ≥$100,000. Patient-reported stress, anxiety, and depression were assessed close to diagnosis at trial enrollment. Adjusted multinomial logistic regression models were used to compare women who lost, gained, or maintained household income ≥$100,000 to women who maintained the same household income <$100,000.ResultsAlthough most women maintained household income ≥$100,000 (37.1%) or the same household income <$100,000 (32.3%), 15.4% lost household income and 15.2% gained household income. Stress, anxiety, and depression were not associated with gaining or losing household income compared to women maintaining household incomes <$100,000. Women with household incomes <$50,000 had a higher risk of losing household income compared to women with household incomes ≥$50,000. Women who maintained household incomes ≥$100,000 were less likely to report financial or insurance problems. Among women who lost household income, 56% reported financial problems and 20% reported insurance problems at 12 months.ConclusionsBaseline stress, anxiety, and depression were not associated with household income changes for young women with breast cancer. However, lower baseline household income was associated with losing household income. Some young survivors encounter financial and insurance problems in the first year after diagnosis, and further support for these women should be considered.Trial registrationClinicaltrials.gov, NCT01647607; date registered: July 23, 2012.

Serial Assessment of Depression and Anxiety by Patients and Providers in Women Receiving Chemotherapy for Early Breast Cancer.

Depression and anxiety are common in patients with breast cancer and associated with worse quality of life and treatment outcomes. Yet, these symptoms are often underrecognized and undermanaged in oncology practice. The objective of this study was to describe depression and anxiety severity and associated patient factors during adjuvant or neoadjuvant chemotherapy in women with early breast cancer using repeated single-item reports. Depression and anxiety were measured from consecutive patients and their clinicians during chemotherapy infusion visits. Associations between psychiatric symptoms and patient characteristics were assessed using Fisher's exact tests for categorical variables and t tests for continuous variables. The joint relationship of covariates significant in unadjusted analyses was evaluated using log-binomial regression. Cohen's kappa was used to assess agreement between patient- and clinician-reported symptoms. In a sample of 256 patients, 26% reported at least moderately severe depression, and 41% reported at least moderately severe anxiety during chemotherapy, representing a near doubling in the prevalence of these symptoms compared with before chemotherapy. Patient-provider agreement was fair (depression: κ = 0.31; anxiety: κ = 0.28). More severe psychiatric symptoms were associated with being unmarried, having worse function, endorsing social activity limitations, using psychotropic medications, and having a mental health provider. In multivariable analysis, social activity limitations were associated with more severe depression (relative risk [RR], 2.17; 95% confidence interval [CI], 1.36-3.45) and anxiety (RR, 1.48; 95% CI, 1.05-2.09). Oncologists frequently underestimate patients' depression and anxiety and should consider incorporating patient-reported outcomes to enhance monitoring of mental health symptoms. In this sample of 256 patients with breast cancer, depression and anxiety, measured using single-item toxicity reports completed by patients and providers, were very common during adjuvant or neoadjuvant chemotherapy. Patient-reported depression and anxiety of at least moderate severity were associated with multiple objective indicators of psychiatric need. Unfortunately, providers underrecognized the severity of their patients' mental health symptoms. The use of patient-reported, single-item toxicity reports can be incorporated into routine oncology practice and provide clinically meaningful information regarding patients' psychological health.

Measures of Juvenile Fibromyalgia.

Juvenile fibromyalgia (JFM) is a chronic and debilitating noninflammatory musculoskeletal pain syndrome that is typically diagnosed in adolescence. There are no specific medical tests or disease markers to diagnose the condition, and classification is based on patient report of pain and other associated symptoms after ruling out other underlying medical causes. JFM can be disabling in multiple life domains and therefore, a multidimensional assessment of JFM is recommended to gain a full picture of the extent of JFM symptoms along with their impact on physical and emotional functioning and quality of life. The following updated review outlines evidence-based measures useful in the assessment of school-age children and adolescents with JFM. New measures include 1) the Pain and Symptom Assessment Tool (PSAT) that offers a standardized tool for the classification of fibromyalgia in pediatric patients and 2) the Patient-Reported Outcomes Measurement Information System (PROMIS®) Pediatric Pain Interference, Anxiety, and Depression Scales. Updated information is presented on previously established measures that assess the impact of JFM on functioning and quality of life - the Functional Disability Inventory (FDI) and the Pediatric Quality of Life Inventory (PedsQL) 3.0 Rheumatology Module Pain and Hurt Scale, are also discussed. In general, there are increasing options for validated patient-reported outcome measures available to measure the spectrum of symptoms in JFM and assess impact on daily life. Greater consistency in identification of JFM and use of standardized assessment tools will undoubtedly lead to higher quality research much needed in this relatively understudied musculoskeletal pain condition.

Predictors of Opioid Consumption in Immediate, Implant-Based Breast Reconstruction.

Current rates of opioid prescribing have deleterious consequences on both patient and societal levels. This study aims to evaluate responsible opioid prescribing and predictors of opioid consumption in immediate implant-based breast reconstruction. Patients undergoing consultation for immediate, implant-based breast reconstruction were enrolled in a prospective, cohort survey study. A survey was administered at the preoperative and postoperative appointment to collect data on pain expectations and opioid use. A medical record review was performed. Of 100 enrolled patients, 97 (97.0 percent) underwent surgery and 85 (85.0 percent) completed the postoperative survey. Preoperatively, 27 patients (27.0 percent) had a history of a chronic pain syndrome, 34 (34.0 percent) had a history of a mental health comorbidity, and nine (9.0 percent) had a history of active preoperative opioid use. A total of 85 tissue expander (87.6 percent) and 12 direct-to-implant (12.4 percent) reconstructions were completed. Patients were prescribed an average of 36.0 5-mg oxycodone tablets postoperatively. Patients reported consuming an average of 20.6 tablets, or 57.0 percent of the average prescription amount. The majority of patients (75.3 percent) reported taking an opioid less than once per day at the time of survey completion, and 24 patients (28.2 percent) reported that they did not use any opioids postoperatively. Preoperative opioid use (p = 0.004), inpatient opioid consumption (p < 0.0001), and patient-reported anxiety related to pain control (p < 0.05) were predictors of opioid consumption. Patients undergoing mastectomy and implant-based breast reconstruction are prescribed nearly twice as many opioid tablets as consumed, and one in three patients report not using any opioids postoperatively. Clinical factors may help guide prescribing practices. Risk, III.

Self-reported Symptoms of Anxiety Predict Positive Suicide Risk Screening in Adolescents Presenting to the Emergency Department.

The objective of this study was to assess whether patient-reported anxiety symptoms are associated with suicide risk in pediatric emergency department (ED) patients. An additional objective was to examine differences between patients presenting for medical/surgical or psychiatric complaints. Pediatric patients aged 10 to 21 years were recruited from 3 pediatric EDs. Participants completed self-report questionnaires assessing for suicidal ideation and behavior, in addition to questions of interest about recent feelings of unbearable anxiety and depression. Adjusted odds ratios were calculated to assess the relationship between endorsement of recent anxiety and screening positive for suicide risk. Data were analyzed from 522 participants, including 344 presenting with medical/surgical chief complaints and 178 presenting with psychiatric complaints. Overall, 28.9% of participants screened positive for suicide risk, 29.9% endorsed recent feelings of anxiety, and 24.3% endorsed recent feelings of depression. Patients who self-reported recent anxiety symptoms were 5 times more likely to screen positive for suicide risk (adjusted odds ratios = 5.18, 95% confidence interval = 3.06-8.76). Analysis of the 344 medical/surgical patients revealed that this subsample was also 5 times more likely to screen positive for suicide risk if they endorsed recent anxiety (adjusted odds ratios = 4.87, 95% confidence interval = 2.09-11.36). Self-reported suicidal ideation and feelings of unbearable anxiety are prevalent among patients presenting to pediatric EDs. Patients who self-report recent feelings of unbearable anxiety are significantly more likely to screen positive for suicide risk, regardless of whether their presenting complaint is medical/surgical or psychiatric in nature.

A Comparison of Three Music Therapy Introduction Dialogues on Acceptance of Music Therapy Services by Patients in an Outpatient Cancer Center

Abstract Music therapy is not often well understood by patients with cancer; therefore, patients may be initially hesitant to accept music therapy services. The purpose of this study was to compare the effectiveness of three different scripts (described from here on as “introduction dialogues”) used to offer music therapy services to patients in an outpatient cancer center. Relationships between patient-reported anxiety levels, gender, and age with the acceptance rate of music therapy services were also examined. Patients (n = 59) were offered music therapy using one of three different introduction dialogues, asked to complete an anxiety Visual Analogue Scale (VAS), and provided with music therapy services if accepted. Results showed that introduction dialogue #2 (benefits of music therapy explained, including research) had the greatest acceptance rate. Moderate anxiety levels, males, and individuals 61+ years of age also showed greatest acceptance rates. A breakdown of different variables influencing patient response, limitations of the study, and future recommendations are also discussed.