Psychological Distress In Cancer Patients Research Articles

The effectiveness of brief reminiscence-based psychosocial interventions for cancer patients: A systematic review and meta-analysis.

To determine the effectiveness of brief reminiscence-based psychosocial interventions in alleviating psychological distress in cancer patients. Cancer patients suffer tremendous psycho-spiritual pain, which affects their quality of life. Brief reminiscence-based psychosocial interventions have demonstrated positive effects on the mental health of cancer patients; however, the efficacy of these interventions has been inconsistent. A systematic review and meta-analysis. This review was conducted and reported in accordance with the PRISMA 2020 checklist provided by the EQUATOR network. The Cochrane Library, Web of Science, PsycINFO, PubMed, Embase, CINAHL and Scopus databases were systematically searched from inception to 27 November 2022 to identify randomised controlled trials (RCTs) published in English. Twenty studies involving 1744 cancer participants were included. The meta-analysis showed statistically significant effects of brief reminiscence-based psychosocial interventions on hope, anxiety and depression at post-intervention. A separate analysis revealed that brief reminiscence-based psychosocial interventions had a sustainable effect on hope, spiritual well-being, anxiety and depression at 1 month after the intervention. However, no statistically significant effect on quality of life was found in our study either immediately after the intervention or at 1 month. Brief reminiscence-based psychosocial interventions can significantly reduce anxiety and depressive symptoms and improve hope and spiritual well-being in cancer patients. This study further supports that brief reminiscence-based psychosocial interventions should be incorporated into the routine care of cancer patients to address their psychosocial distress. All authors of this article contributed to the study conception and design. All authors of the included studies provided original data for this paper.

Prospective study of predictors for anxiety, depression, and somatization in a sample of 1807 cancer patients

In cancer patients, psychological distress, which encompasses anxiety, depression, and somatization, arises from the complex interplay of emotional and behavioral reactions to the diagnosis and treatment, significantly influencing their functionality and quality of life. The aim was to investigate factors associated with psychological distress in cancer patients. This prospective and multicenter study, conducted by the Spanish Society of Medical Oncology (SEOM), included two cohorts of patients with cancer (localized resected or advanced unresectable). They completed surveys assessing psychological distress (BSI-18) before and after cancer treatment and coping (MINI-MAC) and spirituality (FACIT-sp) prior to therapy. A multivariable logistic regression analysis and a Structural Equation Modeling (SEM) were conducted. Between 2019 and 2022, 1807 patients were evaluated, mostly women (54%), average age 64 years. The most frequent cancers were colorectal (30%), breast (25%) and lung (18%). Men had lower levels of anxiety and depression (OR 0.66, 95% CI 0.52–0.84; OR 0.72, 95% CI 0.56–0.93). Colorectal cancer patients experienced less anxiety (OR 0.63, 95% CI 0.43–0.92), depression (OR 0.55, 95% CI 0.37–0.81), and somatization (OR 0.59, 95% CI 0.42–0.83). Patients with localized cancer and spiritual beliefs had reduced psychological distress, whereas those with anxious preoccupation had higher level. SEM revealed a relationship between psychological distress and coping strategies, emphasizing how baseline anxious preoccupation exacerbates post-treatment distress. This study suggests that age, sex, extension and location of cancer, coping and spirituality influence psychological distress in cancer patients.

Assessment of psychological distress and its association with socio-demographic variables among cancer patients in a tertiary care hospital in Bengaluru, Karnataka: a cross sectional study

Background: Cancer diagnosis is known to cause significant mental distress and anxiety. Psychologically distressed patients are less compliant to treatments and endure longer hospitalization. Assessment of distress is critical to develop necessary interventions. Our research aims to assess the severity, contributing factors, and relationships between socio-demographic characteristics and psychological distress in cancer patients. Methods: A cross sectional study with random sample of 188 cancer patients were assessed for distress with NCCN distress thermometer (DT) from a tertiary care facility. Descriptive analysis and Chi-square test performed using SPSS-28. Results: 75% reported "moderate and above" distress levels, with a mean distress of 5.5±2.99. Respondents below 40 years, females, currently unmarried, nuclear families, highly educated, and financially dependent were more likely to experience severe distress (score 8-10). Significant emotional concerns were associated with severe distress, followed by practical problems. Conclusions: Distress can be routinely screened with a simple visual analogue scale like DT. A severely distress patient had 3 or more physical, practical, emotional and 2 or more social and spiritual concerns and a person with mild distress had just one emotional concern and spiritual concern and none of the other three. Early identification, routine screening and psychosocial support can reduce distress with optimal efficacy.

The impact of COVID-19 and socioeconomic status on psychological distress in cancer patients

ObjectiveWe aimed to investigate the impact of the COVID-19 pandemic on psychological symptom burden against the socioeconomic background of cancer patients using data from routine assessments before and during the pandemic MethodIn this cross-sectional study, standardised assessment instruments were applied in N = 1,329 patients to screen for symptoms of anxiety, depression, post-traumatic stress, and fatigue from 2018 to 2022. Two MANOVAs with post-hoc tests were computed. First, only time was included as predictor to examine the isolated impact of the pandemic. Second, income level and education level were included as further predictors to additionally test the predictive power of socioeconomic factors ResultsIn the final model, only income had a significant impact on all aspects of psychological symptom burden, with patients with low income being highly burdened (partial η² = .01, p = .023). The highest mean difference was found for depressive symptoms (MD = 0.13, CI = [0.07; 0.19], p < .001). The pandemic had no further influence on psychological distress ConclusionsAlthough the pandemic is a major stressor in many respects, poverty may be the more important risk factor for psychological symptom burden in cancer outpatients, outweighing the impact of the pandemic.

Perceived injustice and its impact on psychological distress in cancer patients and survivors.

Perceived injustice is a novel psychosocial construct that reflects negative cognitive appraisals of unfairness, externalized blame and the irreparability and severity of one's loss. Previous research has highlighted the negative impact of perceived injustice on recovery and mental health outcomes, particularly in pain-related samples. This study aimed to (i) explore the role of perceived injustice on psychological outcomes in a general cancer population and (ii) describe demographic and psychosocial characteristics associated with perceptions of injustice. The study employed a cross-sectional, observational design. Using a purposive convenience sampling technique, individuals that have or have had cancer completed an online survey assessing perceived injustice (IEQ), psychological distress (HADS), mental adjustment to cancer (Mini-MAC) and satisfaction with care (PSCC) (N = 121). Levels of perceived injustice were high with 43.2% of the sample scoring in the clinical range. Hierarchical regression analyses showed that perceived injustice contributed unique variance to the prediction of anxiety and depression. Low satisfaction with care, being under the age of 40 and not having children were identified as significant predictors of perceived injustice. Satisfaction with care did not significantly moderate the association between perceived injustice and mental health outcomes but directly impacted anxiety levels. Cancer patients reporting high levels of perceived injustice are at greater risk of feeling psychologically distressed. Prevention and management of injustice perceptions may require interventions targeting specific negative attributions, as well as cancer care in general. Further implications for healthcare practice are discussed.

Allostatic Load and Depression Symptoms in Cancer Survivors: A National Health and Nutrition Examination Survey Study.

Individuals with cancer often experience stress throughout the cancer trajectory and have a high risk of experiencing depression. The aim of this study was to examine the relationship between allostatic load (AL), a measure of cumulative stress-related physiologic dysregulation of different body systems, and symptoms of depression in cancer survivors. Participants were 294 adult cancer survivors from the US National Health and Nutrition Examination Survey (NHANES 2007-2018). Allostatic load was measured using 14 indicators representing cardiometabolic risk, glucose metabolism, cardiopulmonary functioning, parasympathetic functioning, and inflammation. Depressive symptoms were measured with the Patient Health Questionnaire-9. The relationship between AL and depressive symptoms was investigated using multiple regression adjusted for diverse sociodemographic and diagnosis variables. Higher AL was associated with higher depressive symptom scores. The higher risk of depression was concentrated among those survivors in the highest AL quartile, with 21% (95% confidence interval, 11%-32%) of survivors presenting a high risk of depression compared with 8% to 11% of survivors in the lower quartiles. In exploratory analyses, the relationship between AL and depressive symptoms was only significant among survivors with a lower income. In contrast, in survivors in the highest income group, depressive symptoms were lower and unrelated to AL. High AL is associated with more depressive symptoms among cancer survivors. Nurses have an important role in identifying psychological distress in cancer patients and survivors. Further research is needed to investigate the usefulness of AL as a marker in the context of cancer follow-up care and screening for psychological distress.

Research progress in circadian rhythms in the application of psychological rehabilitation of cancer patients.

The psychological distress of cancer patients seriously affects their therapeutic effects. Effective psychological rehabilitation of cancer patients significantly improves their survival chance and quality of life. Circadian rhythm results from adaptation to the environment during the organism's evolution. When the endogenous clock system is disrupted or the external environment is changed, the body and the environment are out of synchronization, and the circadian rhythm will be disrupted. Circadian rhythm disorder is a common phenomenon in cancer patients, and the changes of circadian rhythm are closely related to their psychological distress. Many studies believe that the circadian rhythm disorder of cancer patients may directly or indirectly affect their psychology through various mechanisms, and targeted intervention by regulating the circadian rhythm of patients may be an essential means to promote the psychological rehabilitation.

Psychological distress and associated factors among Palestinian advanced cancer patients: A cross-sectional study.

There is limited research exploring the experiences of people living with advanced cancer in the Gaza Strip (GS), Palestine. Thus, this study aimed to determine the level of psychological distress, anxiety, and depression among advanced cancer patients in the GS and identify factors associated with a high level of distress. A secondary analysis was performed using primary data from a larger study focusing on supportive care needs in advanced cancer patients in GS. Three hundred sixty-one patients agreed to participate and filled out the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression was conducted to identify factors associated with high distress levels. Over two-thirds of advanced cancer patients (70.6%) reported a high level of distress. They also reported a significantly higher distress level than patients with early cancer (96.5 vs. 3.5%; p = 0.001). About 92.8% of participants reported depression and anxiety symptoms. Physical, emotional, and practical problems were the primary sources of distress. Breast cancer patients were more likely to have psychological distress than colon and stomach cancer patients. Newly diagnosed patients had a higher level of anxiety, depression, and distress than those who had a cancer diagnosis for an extended period. Patients with advanced cancer in the GS exhibited a significantly higher level of psychological distress, depression and anxiety than patients with advanced cancer elsewhere. Efforts should be made to identify psychological distress as a routine part of oncology practice. Future research should further explore the causes of psychological distress in cancer patients in conflict zones and feasible mitigation strategies.

Pattern of Psychological Distress in Cancer Patients Visiting Out-Patient Department- A Prospective Study in A Tertiary Cancer Care Hospital in Northern India

Context: Psychological distress in cancer patients is a well recognized but under diagnosed problem. Aims: This study aimed to study the prevalence and pattern of distress among cancer patients visiting the out-patient department of oncology. Settings and Design: This was a prospective observational study, carried out at Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India, between January 2018 and April 2018. Material and Methods: We enrolled 390 cancer patients prospectively after written informed consent. Their demographic, disease and treatment details were recorded. Self reporting Hospital Anxiety and Depression Scale was used for anxiety and depression. Statistical analysis used: After checking for normality of data, normal data was analyzed using Parametric, non-normal using Non-parametric methods. Association between baseline and outcome categorical variables was tested with Chi-square test. A p-value of &lt;0.05 was considered significant. Spearman’s Rho was used for linear correlation. Results: The prevalence of anxiety was 34.6% and depression 40.3% Factors significantly associated with anxiety were female gender (p=0.051), advanced stage (p=0.036), primary site (p=0.006); with depression advanced stage (p=0.001) and number of metastatic sites (p=0.025). Linear correlation between anxiety and depression was strong (Spearman’s rho= 0.735). Conclusions: The prevalence of cancer related psychological distress is high in out-patients. Variables like female gender, primary tumor site, advanced stage and number of metastasis were significantly associated with distress.

Internet-Based Cognitive Behavioral Therapy for Depression and Anxiety Symptoms in Cancer: A Meta-Analysis

Background: Depression and anxiety affect up to 20% of patients with cancer. Physical treatment and side effects are usually the only factors given attention to during treatment and recovery. Psychological distress can have deleterious effects in their quality of life, and may even affect healing. Treatment options for depression and anxiety are limited. One well-studied treatment is cognitive behavioral therapy (CBT). However, face-to-face treatment has been a challenge for the oncology team during this pandemic. Internet-based cognitive behavioral therapy (iCBT) can be a new means of dealing with cancer patients’ psychological health. Objective: To evaluate iCBT in alleviating depression and anxiety symptoms in patients with cancer. Methods: A systematic search of Pubmed, Embase, Cochrane, Clinical trials databases and hand search were utilized to identify randomized controlled trials (RCTs) investigating the role of iCBT in addressing psychological distress in cancer patients. Meta-analysis was conducted on 4 randomized controlled trials (N=548). All 4 studies were included for analysis. Psychological distress was measured as depression and anxiety based on the Hospital Anxiety and Depression Scale (HADS) total scores. Results: There was a trend in improvement of anxiety and depression in the iCBT treatment group, however, it was not significant (p = 0.06). Due to substantial heterogeneity, subgroup analyses was done and showed improvement of anxiety and depression in patients with different cancer types and baseline psychological distress (p &lt; 0.00001). Conclusion: The results indicate that iCBT can be a potential treatment option in cancer patients who exhibit baseline depression and anxiety, especially during this pandemic. More studies are needed to determine the efficacy of iCBT in cancer patients who are not clinically diagnosed with psychological disorders.

Impact of Demographic Characteristics on Self-Reported Psychological Distress of Cancer Patients during the COVID-19 Pandemic

Purpose/Objective(s)To investigate how at-risk demographic features correlate with the perceived level of psychological distress in cancer patients actively receiving care during the COVID-19 pandemic.Materials/MethodsPatients treated with radiotherapy at a single academic cancer center were reviewed 3 months before (11/01/2019-03/16/2020) and during (03/17/2020- 2/01/2021) the COVID-19 pandemic. Patients who reported an NCCN distress score (range 0=no distress to 10=extreme distress) as a part of their radiation care were reviewed for inclusion. Variables of interest were extracted from the medical record including age, gender, ethnicity, and Karnofsky Performance Scale (KPS) score. Distress scores were recorded around the time of simulation or treatment start. The relationship between these variables and NCCN distress scores were assessed using univariate and multivariate linear regression.ResultsOf all the patients receiving active treatment during the study interval (n=3,129), a total of 2,012 patients reported distress scores and thus were included. Median pre-pandemic distress was 3 (Interquartile Range 0-5) compared to median score of 2 (IQR 0-4) during the pandemic. There was no change in pre- and during pandemic distress on subgroup analysis by age, gender, ethnicity, or KPS score. The following variables were significantly correlated with increased distress on univariate analysis: older age (beta-age = -0.0163 [95% CI: -0.0262 to -0.0063], female gender (OR = 2.43 [95% CI 1.88 to 3.03], race (“black” race OR = 2.77 [95% CI: 1.68 to 4.57] and “other” race OR 1.96 [95% CI: 1.34-2.83]) and lower KPS score (beta-KPS = -0.403 [95% CI: -0.509 to -0.298]. Multivariate analysis was used to test if these demographic features were correlated with psychological distress among all patients. The overall regression was statistically significant albeit with a small effect size (R2=0.0605, p < .0001). On multivariate analysis, the following variables remained significant: age (beta-age = -0.0145 [95% CI: -0.0266 to -0.00241]), KPS score (beta-KPS = -0.429 [95% CI: -0.561 to -0.297]), and female gender (OR = 1.88 [95% CI: 1.28-2.75]).ConclusionThe ongoing COVID-19 pandemic did not significantly affect patient-reported distress levels at the time of receiving cancer-directed therapy. Older age, female gender, and low KPS score were associated with higher psychological distress in cancer patients receiving radiotherapy. Current analysis reveals vulnerable populations of cancer patients may have higher risk of distress during radiotherapy. These populations would warrant additional surveillance during treatment and may benefit from additional psychosocial support.

Symptom burden, psychological distress, and symptom management status in hospitalized patients with advanced cancer: a multicenter study in China

The management of physical symptoms and psychological distress of cancer patients is an important component of cancer care. The purpose of this study was to evaluate the symptom burden, psychological distress, and management status of hospitalized patients with advanced cancer in China and explore the potential influencing factors of undertreatment and non-treatment of symptoms. A total of 2930 hospitalized patients with advanced cancer (top six types of cancer in China) were recruited from 10 centers all over China. Patient-reported MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9) scales and symptom management-related information were collected and linked with the patient's clinical data. The proportion of patients reporting moderate-to-severe (MS) symptoms and whether they were currently well managed were examined. Multivariable logisticregression models were applied to explore the factors correlated to undertreatment and non-treatment of symptoms. About 27% of patients reported over three MS symptoms, 16% reported over five, and 9% reported over seven. Regarding psychological distress, the prevalence of HADS-anxiety was 29% and that of PHQ-9 depression was 11%. Sixty-one percent of patients have at least one MS symptom without any treatment. Sex [odds ratio (OR)= 2.238, 95% confidence interval (95% CI) 1.502-3.336], Eastern Cooperative Oncology Group (ECOG; OR= 0.404, 95% CI 0.241-0.676), and whether currently undergoing anticancer treatment (OR= 0.667, 95% CI 0.503-0.886) are the main factors correlated with the undertreatment of symptoms. Age (OR= 1.972, 95% CI 1.263-3.336), sex (OR= 0.626, 95% CI 0.414-0.948), ECOG (OR= 0.266, 95% CI 0.175-0.403), whether currently undergoing anticancer treatment (OR= 0.356, 95% CI 0.249-0.509), and comorbidity (OR= 0.713, 95% CI 0.526-0.966) are the main factors correlated with the non-treatment of symptoms. This study shows that hospitalized patients with advanced cancer had a variety of physical and psychological symptoms but lacked adequate management and suggests that a complete symptom screening and management system is needed to deal with this complex problem.

Study protocol: the OptiScreen-Study: optimized psycho-oncological care—from screening to intervention

PurposeAdequate, needs-oriented psycho-oncological care contributes to reducing psychological distress in cancer patients and their relatives and improving quality of life. Regarding the precise determination of objective and subjective needs, there are often discrepancies in practice between the screening instrument completed by patients, the clinical impression of the treatment team, and the judgment of the psycho-oncology team.MethodsThe present multicenter study “OptiScreen”, involving three German Comprehensive Cancer Centers (Hannover, Leipzig, Dresden), aims to professionalize psychosocial screening to enable targeted and needs-based allocation to psycho-oncological support. Optimization and professionalization of the screening process will be achieved by training of oncological nursing staff to improve the targeted identification of distressed patients and provide them with needs-based psycho-oncological care. The non-randomized pre-post study will include inpatients with gastrointestinal cancers from the visceral oncology centers at the three sites. First, the comparison group (CG) will be assessed of N = 300. After completion of nursing training, the intervention group (IG) with N = 600 patients will be evaluated by validated questionnaires.ResultsThe aim is to reduce barriers on both the patient and treatment side by promoting interdisciplinary dialogue and linking the screening with a personal consultation offer provided by the nurses, which should help to increase utilization and reduce patients' fears, shame and information deficits.ConclusionIt is not sufficient to establish a well-validated screening procedure, it also has to be feasible and useful in clinical practice. “OptiScreen” aims to improve the psycho-oncological care situation. In parallel, the study enables the professionalization of psycho-oncological care with the involvement of important professional groups (e.g. nursing) and thus aims to develop a “best practice model”.

Psychological distress of cancer patients caused by treatment delay during the COVID-19 pandemic in China: Across-sectional study.

ObjectiveThe currents study sought to explore the impact of treatment delay on the mental health for patients with cancer during the 2019 coronavirus disease (COVID‐19) pandemic.MethodsTravel restrictions were imposed in most areas of the country between 23 January 2020 and 25 February 2020 owing to the COVID‐19 epidemic. Travel restrictions were lifted from 26 February 2020 to 12 March 2020. The number of new confirmed cases significantly reduced after 12 March 2020. Study participants, comprised of individuals from three distinct groups: (1) 835 cancer patients who attended Zhejiang Cancer Hospital between 26 February 2020 and 12 March 2020; (2) 185 healthy volunteers recruited between 26 February 2020 and 12 March 2020; (3) 168 cancer patients who attended the hospital during the non‐epidemic period (after 12 March 2020). Two outcome measures including patients' posttraumatic stress responses and general psychological distress (GPD) were assessed using the Chinese versions of the Impact of Events Scale‐Revised and the Kessler Psychological Distress Scale (K10). Treatment delay was assessed via counting the time interval from diagnosis to treatment initiation, or from planned treatment date to actual date of therapy. Communication satisfaction was evaluated via a self‐report questionnaire. An independent sample t‐test or Wilcoxon rank sum test was used for comparison. Statistical analysis included Chi‐square test, Mann‐Whitney test and multivariate logistic regression.ResultsAll 1188 participants (835 patients with cancer and 185 controls during the outbreak, and 168 patients with cancer during the non‐epidemic period) completed and submitted the questionnaires. A positive association was observed between treatment delays and increased GPD levels (OR 1.716; 95% confidence interval ,CI 1.254–2.348; p = 0.001) as well as posttraumatic stress disorder (PTSD) symptoms (OR: 1.545, 95% CI: (1.166–2.047), p = 0.002). Patients who reported good communication with their doctors showed a significantly lower risk of GPD (OR: 0.526, 95% CI (0.348–0.794), p = 0.002) and PTSD (OR: 0.683, 95% CI (0.490–0.951), p = 0.024) compared with patients who reported unsatisfactory communication or had no contact with their doctors. Multivariate logistic regression analysis showed that treatment at a local hospital, treatment delays and unsatisfactory or no communication with cancer‐care professionals were significantly correlated with severe GPD and PTSD symptoms of patients (all p ≤ 0.05).ConclusionThe findings indicate that cancer patients who underwent treatment delays during the COVID‐19 pandemic may become vulnerable to psychological distress. The results showed that effective communication with doctors and cancer‐care professionals during outbreak significantly reduces GPD levels and PTSD symptoms.

Cancer and Covid-19: A preliminary study on the trauma aspects of coronavirus in cancer patients.

ObjectiveBecause of Covid 19, it has become necessary to revise the treatment of cancer patients (“how” and “when”). That has had important psychological repercussions. The purpose of this study is the evaluation of the impact of Covid19 in terms of Post‐Traumatic Stress Disorder and Depression and the potential association with coping strategies.MethodsWe conducted an exploratory study with 106 patients undergoing treatment, using following questionnaires: Screening Questionnaire for Disaster Mental Health and Mini‐Mental Adjustment to Cancer.ResultsOnly 25.5% of our sample showed symptoms of posttraumatic stress disorder (PTSD) and 6.6% revealed a probable presence of depression. In addition, it came up a significant correlation between SQD_P and the coping styles “Hopelessness” (r = 0.41 p < 0.001) and “Anxious Preoccupation” (r = 0.45, p < 0.001).A strong correlation also emerged between non‐Covid 19 patients and PTSD (r = 0.29, p = 0.002).ConclusionsOur preliminary data did not reveal a prevalence of PTSD, but the persistence of the health emergency requires to focus future research on protective and risk factors related to PTSD and psychological distress in cancer patients, in order to reduce the mental health burden of Covid19.

The Psychological Distress of Cancer Patients following the COVID-19 Pandemic First Lockdown: Results from a Large French Survey.

Simple SummaryCancer patients commonly experience anxiety which could increase with the COVID-19 pandemic situation. The aim of this study was to measure post-traumatic stress disorder (PTSD) and anxiety in cancer patients in France following the first COVID-19-related lockdown and associated factors. We found that the factors associated with PTSD and anxiety were different in nature. Factors associated with PTSD were not related to cancer but to the COVID-19 crisis, while factors associated with anxiety were mainly cancer related. More specifically, the fear of coming to hospital because of the risk of contracting COVID-19 was the strongest predictor of PTSD, and a better lockdown experience was protective against PTSD. Fear of cancer recurrence appear to be the main predictor of anxiety. Our study highlights the need to better integrate psychosocial support in pandemic response measures. Healthcare providers should not prioritize COVID-19 over cancer as the latter remains a central concern for cancer patients.Cancer patients commonly experience psychological distress that may increase with the current COVID-19 pandemic. This prospective study aimed to measure post-traumatic stress disorder (PTSD) and anxiety in cancer patients following France’s first COVID-19-related lockdown, together with associated factors. Cancer patients receiving outpatient treatment or post-treatment follow-up completed a questionnaire which measured, among other things, PTSD (IES-R), anxiety (State-Trait Anxiety Inventory), and fear of cancer recurrence (FCR). Of the 1097 patients included in the study, 14.7% and 30.5% suffered from PTSD and anxiety, respectively. Patients afraid to come to hospital due to the risk of COVID-19 transmission (OR = 3.49, p < 0.001), those with a negative lockdown experience (OR = 0.98, p < 0.001), women (OR = 1.97; p = 0.009), and patients living alone (OR = 1.63, p = 0.045) were all more likely to have PTSD. Older patients (OR = 1.65, p = 0.020), women (OR = 1.62, p = 0.018), those with a higher FCR score (OR = 5.02, p < 0.001), patients unsatisfied with their cancer management (OR = 2.36, p < 0.001), and those afraid to come to hospital due to COVID-19 (OR = 2.43, p < 0.001) all had a higher risk of anxiety. These results provide a greater understanding of the psychological consequences of the COVID-19 pandemic in cancer patients and highlight the need to better integrate psychosocial support in pandemic response measures in order to guide health systems.

Quality-of-life and toxicity in cancer patients treated with multiple courses of radiation therapy

BackgroundTreatment of metastatic cancer patients with multiple repeat courses of radiotherapy has become more frequent due to their improved overall survival. However, very little is known about their long-term outcome. This analysis reports on the quality-of-life, hematologic toxicity, patient-reported experiences and satisfaction, and psychological distress of cancer patients treated with multiple repeat radiotherapy. MethodsAll patients treated with ≥5 courses of radiotherapy between 2011 and 2019 at the Department of Radiation Oncology, University Hospital Zurich (USZ) were screened for this study. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. All patients completed two questionnaires: EORTC QLQ-C30 questionnaire for quality-of-life and a questionnaire evaluating psychological distress and patient-reported experiences. Hematologic toxicities were assessed via a recent blood sample. ResultsOf n = 33 patients treated with ≥5 radiotherapy courses and being alive, 20 (60.6%) participated in this study. The most common primary tumor was non-small cell lung cancer (n = 14, 42.4%). The most common sites of irradiation were brain (n = 78, 37.1%) and bone metastases (n = 59, 28.1%). All participating patients reported that they had experienced a subjective benefit from multiple repeat radiotherapy and denied increased side effects in later radiotherapy courses. Yet, 45% (n = 9) of the patients reported an increase of psychological distress with increasing numbers of radiotherapy treatments. While global health status was stable, patients having received multiple repeat radiotherapy reported increased fatigue (p = <0.006). Blood analysis showed significantly reduced hemoglobin and lymphocyte levels compared to the healthy population (p = <0.03). Discussion and conclusionPatient-reported experiences and satisfaction of long-term cancer patients treated with multiple repeat radiotherapy are positive. However, increased levels of fatigue and significantly reduced hemoglobin and lymphocyte levels were observed. These data indicate the need to further investigate the effects of multiple courses of radiotherapy in chronic cancer patients.

What if… I Asked Cancer Patients About Psychological Distress? Barriers in Psycho-Oncological Screening From the Perspective of Nurses-A Qualitative Analysis.

IntroductionScreening questionnaires to assess psychological distress in cancer patients are well-established, but in practice there are difficulties in implementation screening up to referral to psycho-oncology. Interdisciplinary collaboration between psycho-oncology, physicians, and nursing is very important to this process. However, there are barriers and obstacles on all sides.ObjectiveThe aim of this study is to capture in particular the barriers from the perspective of oncology nursing.Materials and MethodsSemi-structured interviews with nursing experts (n = 15; n = 10 female; 24–62 years) from different oncology departments of three university hospitals in Germanys were conducted and qualitative content analysis was carried out by two raters.ResultsThe Screening routine is variably well-integrated into daily clinical practice. Structural barriers such as time pressure and a lack of focus on mental distress in nursing are present. Barriers on the side of nurses are primarily a lack of knowledge and communication insecurities when dealing with patients.ConclusionsThere is a need for training and implementation of a disciplinary screening approach. The structural and organizational barriers, which are a challenge for the successful screening process due to unfavorable interdisciplinary team communication and clinical daily structure, should be addressed in further studies. Implications for Practice: In order to establish an interdisciplinary screening process and to overcome the barriers, trainings to deal with knowledge deficits and insecurities seem to be useful.

The Impact of Socioeconomic Status on the Psychological Distress of Breast Cancer Patients in Kolkata"

Background: Breast cancer patients experience a variety of psychological symptoms such as anxiety, depression that affect their quality of life. The present study probed whether the socioeconomic status had any significance on psychological distress and quality of life of breast cancer patients in India.Method: This was a cross-sectional and observational study, conducted over 111 breast cancer patients in a tertiary cancer hospital, Kolkata. Subjects were eligible to participate and they were of over 23rd years of age and had a histologically confirmed diagnosis of breast cancer had no history of recurrence or metastasis, and had no previous psychological problems. Age, marital status, residence, education, occupation and family income were assesses for patients’ socio economic status. Psychological symptoms and quality of life were assessed by using validated tools. Means and standard deviations of each outcome were compared by socioeconomic status and multivariate linear regression models for evaluating the association between socioeconomic status, psychological distress and quality of lifeResults: The patient group was categorized into three groups based on their income level as follows: ≤500=27.9%), 500-1000=51.4% and high income = ≥1000=20.7%. A total of 111 breast cancer patients participated in the study; the mean age of participants was 49.7 (SE=1.31).After using multivariate logistic regression with fully adjusted models, the patients who were living alone had significantly higher level of depression and poor quality of life compared to those who are employed. Higher education and family income both positively associated with quality of life after adjusting for age, marital status and occupation.Conclusion: The findings revealed that the family income have a significant impact on the psychological distress of the cancer patients.

Evaluation of psychological distress in breast cancer patients during the COVID- 19 pandemic

Cancer patients are the vulnerable group of population and have more chances of contracting Corona virus disease 2019 (COVID-19). They are at great risk of passing through very stressful events during this COVID-19 pandemic that may lead to different psychological problems. Different psychological symptoms of breast cancer patients are evaluated in this study during the COVID- 19 pandemic. Consecutive fifty women selected with a non-metastatic breast cancer, scheduled to receive cancer treatment in the upcoming days/weeks not. Received treatment in the past, completed the Impact of Event Scale-Revised(IES-R), the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), the Fear of Cancer Recurrence Inventory (FCRI). and the Insomnia Severity Index (ISI) and questionnaires. The study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from the 1st July 2020 to the 30th June 2021.. Patients were investigated about their worries regarding the impact of COVID-19 on their lives as carcinoma breast patients. Since the 1st July 2020 to the 30th June 2021, Consecutive 50 patients were prospectively evaluated. They were diagnosed with non-metastatic breast cancer. The mean age was 42.3 (range 30–70). Most of the patients (90%, n. 45) are married, 8% (n.4) patients are single and 2% (n. 1) patients are widowed. Among the patients 24 (48%) patients have high school or less education level, 19 (38%) have college experience and 7 (14%) have university degrees. Ten patients (20%) lived alone, 8 (16%) with one or two family members, and 32 (64%) with three or more family members. Concerning their working life, 36 (72%) were not working (namely housewives, retired, unemployed, or students) and 14 (28%) was occupied. In consideration of economic status 52% (n. 26) patients have annual family income in BDT 250001- 350000. On the other hand 22% (n. 11) within BDT 350001- 450000, 14% (n. 7) within BDT 150000- 250000, 6% (n. 3) within BDT 450001-550000 and 6% (n. 3) within BDT &gt;550000 respectively. We found that 62% of patients had anxiety (HADS-A), 66% depression (HADS-D), and 68% fulfilled the diagnostic criteria for mild post-traumatic stress disorder (PTSD), 2% patients for moderate and 2% patients for severe PTSD. Results revealed that 50% (n.25) patients were suffering from subthreshold insomnia. On the other hand 46% (n.23) patients had no clinically significant Insomnia but 2% (n.1) patients had moderate and severe insomnia in each category. The Fear of Cancer Recurrence Inventory (FCRI) score was 14.7(SD±6.2) which was more than the cut-off value..Breast cancer patients pass through many stressful events that may develop significant psychological symptoms during this COVID-19 pandemic. The outcome of this study definitely contributes to understand the psychological distress of cancer patients and a to formulate a better plan for their management and psychological support.&#x0D; BSMMU J 2021; 14 (COVID -19 Supplement): 36-41