Psychological Distress In Cancer Patients Research Articles

Anxiety and Depression in Cancer Patients: The Association with Religiosity and Religious Coping.

There is a lack of studies looking into religiosity and religious coping in cancer patient. In this cross-sectional study, we examined the religiosity using Duke University Religion Index, religious coping using Brief Religious Coping Scale, anxiety and depression based on Hospital Anxiety and Depression Scale among 200 cancer patients. The association between religiosity and religious coping with anxiety and depression was studied. The findings showed that subjects with anxiety or depression used more negative religious coping and had lower non-organization religiosity. Hence, measurements in reducing negative religious coping and encouraging religious activities could help to reduce psychological distress in cancer patients.

Gender Specific Psychological Distress in Cancer Patients with Underage Children

Background: Psychological distress has become an epidemic among cancer patients. Less is known about the pattern of anxiety and depression in cancer patients with minor children. Gender issue is also important in this regard. Psychological distress is an important predictor of quality of life in cancer patients. A majority of these disorders are eminently treatable.Materials and methods: A cross-sectional comparative study was done to compare anxiety and depression status between cancer patients having and not having minor children, attending at National Institute of Cancer Research Hospital, Oncology department in Dhaka Medical College Hospital and in Uttara Adhunik Medical College Hospital. The study was conducted for the time period from September, 2012 to June, 2013. In study group, having underage children, 123 cancer patients were included. Whereas in comparison group without having underage children, 116 patients were selected. Purposive sampling was applied. Cancer patients in both groups were selected randomly, each between the age from 20 to 60 years, corresponding to Karnofsky Performance Scale Score > 79. All The included cancer patients were married and did not have history of substance use or any prior psychiatric illness or co morbidities related to development of secondary psychiatric disorders. Distress among the patients were measured with the Hospital Anxiety and Depression Scale (Two sub scales – A – Anxiety subscale and D – Depression subscale).Result: In the study group, 60.2% respondents was male and 39.8% was female. And in comparison group male and female ratio was 42.2% and 57.8%. Mean age of the participants in study group was 36.97±4.37 and in comparison group was 42.98±11.74 years respectively. The mean duration since diagnosis was 12.85±13.11 months in study group and 11.53±6.72 months in comparison group. Majority of the respondents in study group were suffering from guynaecological cancer (25.2%) and gastro intestinal cancer (25.2%). Whereas majority cancer patients in comparison group were guynaecological cancer (31%) and haematolymphoid cancer (20.7) as well. Metastasis was present in 42.3% patients in study sample and 64.7% patients in comparison group. It was noticed that, both male and female in study group were found significantly more distressed than the comparison group (p < 0.001). In study group mean anxiety score in male (n=74) was 15.72±2.314 and in female (n=49) was 12.06±2.802, i.e. father with minor children were suffering from more anxiety than the mother (t = 7.878, p < 0.001). Mean depression score in male (study group) was 11.91±2.489, whereas in female it was 17.55±2.542, i.e. female cancer patients with minor children were found more depressed than male (t = 12.211; and p < 0.001). In comparison group, mean anxiety score among male (n=49) was 7.27±1.630 and in female (n=67) mean anxiety score was 8.84±1.592. Female were more anxious than male in comparison group (t = 5.196; p < 0.001). In this group, mean depression score in male was 9.671±1.651 and in female it was 8.58±2.161. Male without minor children were found more depressed than female in this group (t = 2.958; p = 0.004).But among all the cancer patients majority of female were found anxious (93.1%) i.e prevalence of anxiety was more in female. And majority of the male respondents (95.1%) were depressed; (odds ratio; depression in male: female = 3.120; CI at 95% level – from 1.176 to 8.276).Conclusion: Cancer father with minor children were more prone to development of higher anxiety. And anxiety was more prevalent in female among all the cancer patients with and without minor children.J. Paediatr. Surg. Bangladesh 6(1): 10-15, 2015 (Jan)

The Effect of Yoga on the Psychological Distress of Cancer Patients: An Analytical Study

The Effect of Yoga on the Psychological Distress of Cancer Patients: An Analytical Study

Spirituality and its association with psychological distress in cancer patients attending a tertiary care hospital in Bangalore, India

Background: Psychological distress which is under diagnosed most of the times is common in cancer patients.This may have an effect on quality of life and survival time. Spirituality predetermines the individual responses to life experiences. There are also studies which have shown that spirituality can overcome psychological distress. Hence, this study was conducted with an objective to assess the association of spirituality and psychological distress among cancer patients attending a tertiary hospital in Bangalore . Methods: A cross sectional study was conducted between March 2014 and August 2014 in the Surgical Oncology Department of M S Ramaiah Hospital, Bangalore. After obtaining a written informed consent, a pretested semi-structured questionnaire, consisting of Hospital anxiety and depression scale, Spirituality Involvement and belief scale along with socio-demographic details, was administered to 84 newly diagnosed, hospital admitted cancer patients. Statistical analysis was performed using SPSS version 18 . Results: The present study revealed that the mean age of study subjects was 52.7 years (SD 11.54). The median spirituality, depression and anxiety scores were 57 (IQR 49-115.5), 13.5 (IQR 7-16) and 5 (IQR 2.25-7.75) respectively. It was observed that there was a statistically significant negative correlation of spirituality with depression (Correlation coefficient r= - 0.833, P=0.01) and anxiety (correlation coefficient r= -0.631, P=0.01) . Conclusions: An inverse association between spirituality and psychological distress amongst cancer patients revealed a possibility that spirituality may help in the control of psychological distress .

General practitioners' 'lived experience' of assessing psychological distress in cancer patients: an exploratory qualitative study.

While psychological distress in cancer patients is common, little is known about how general practitioners (GPs) assess distress. Using semi-structured interviews, a phenomenological study of seven GPs was conducted to explore GPs' experiences of assessing distress. Findings revealed five themes: (1) Being in the Relay Team - receiving and passing the baton: where the assessment of distress was conceptualised as a relay baton passed between a team of health care professionals, with GPs most involved at diagnosis and in the palliative phase. (2) Being in a Relationship: where the doctor-patient relationship was described as a powerful facilitator to assessment. (3) Being Skilled: where GPs perceive they are skilled at assessment adopting a patient-centred approach. (4) Being Challenged - encountering barriers: challenges with assessment were identified regarding the GPs' own emotions, patient related factors and time; the duality of family as both barrier and facilitator was voiced. (5) The Intruder in the Room: where GPs did not use validated screening tools which were viewed as an intruder in the doctor-patient relationship. Further research to objectively assess GPs' skills in distress assessment and attitudes towards the use of screening tools within the cancer care context are merited.

Mindfulness-Based Stress Reduction for lung cancer patients and their partners: Results of a mixed methods pilot study

Background: Lung cancer patients and partners show high rates of impaired quality of life and heightened distress levels. Mindfulness-Based Stress Reduction has proven to be effective in reducing psychological distress in cancer patients. However, studies barely included lung cancer patients. Aim: We examined whether Mindfulness-Based Stress Reduction might be a feasible and effective intervention for patients with lung cancer and partners. Design: Mindfulness-Based Stress Reduction is a training in which mindfulness practices are combined with psycho-education to help participants cope with distress. In this mixed methods pilot study, questionnaires on psychological distress and quality of life were administered before, directly after and 3 months after the Mindfulness-Based Stress Reduction training, in combination with semi-structured interviews. Setting/participants: Patients with lung cancer and partners were recruited at one tertiary care academic medical centre. A total of 19 lung cancer patients and 16 partners participated in the Mindfulness-Based Stress Reduction training. Results: Most patients were diagnosed with advanced stage lung cancer. Vast majority completed the training. Those receiving anti-cancer treatment did not miss more sessions than patients who were not currently treated. Patients and partners felt positive about participating in a peer group and with their partner. Among participants no significant changes were found in psychological distress. Caregiver burden in partners decreased significantly after following Mindfulness-Based Stress Reduction. The qualitative analysis showed that the training seemed to instigate a process of change in participants. Conclusion: The Mindfulness-Based Stress Reduction training seemed to be feasible for patients with lung cancer and their partners. A randomized controlled trial is needed to examine the effectiveness of Mindfulness-Based Stress Reduction in reducing psychological distress in lung cancer patients and partners.

Screening of Psychological Distress in Cancer Patients During Chemotherapy: A Cross-sectional Study.

Objective:The objective of this prospective, noninterventional, 8-months, observational study was to analyze and compare depression, anxiety, and stress (DAS) levels and their impacting factors in homogenous surviving cancer patients receiving chemotherapy as compared to normal control.Materials and Methods:A prospective and descriptive study was carried out jointly by Pharmacology and Oncology departments of a tertiary care center in Malwa region of Punjab. The data was collected by administering the validated questionnaire/response (21-item Depression Anxiety and Stress Scale (DASS-21)) after taking ethical approval and informed consent.Results:All eligible 300 subjects participated in the study and they were compared with 300 matched control. The mean age of the cases (cancer patients) and controls was 50.58 ± 13.64 and 46.1 ± 11.78 (mean (M) ± standard deviation (SD)) years. Statistical significant difference was observed in mean ‘scoring of DAS’ in cancer patients when compared with control groups. Anxiety mean scoring showed a statistical significant difference in groups (according to chemotherapy cycles given and duration of disease). Stress was more observed in breast cancer patients.Conclusion:Holistic approach in cancer management including psychological evaluation and its solution at appropriate time/stage signifies the need of time as the present study revealed that the percentage of DAS as per the DASS scale was 90, 56, and 28%, respectively. A judicious diagnosis with an apposite intercession including psychological consultation with social support at appropriate time may alleviate the extra burden of psychological disorder, rather enhance the quality of life of cancer-affected rural population.

サイコオンコロジー研究

サイコオンコロジー研究

El termómetro del distrés como prueba de cribado de ansiedad y depresión en pacientes oncológicos recién diagnosticados

Objective: The Distress Thermometer (DT) is one of the most used and studied screening tests of psychological distress in cancer patients. However, it includes many false positives. Furthermore, it has not been adequately studied with Spanish populations or with recently diagnosed patients. This research examines the diagnostic performance of the DT with a sample of Spanish recently diagnosed cancer patients. Method: The diagnostic performance of DT was assessed in a sample of 135 recently diagnosed cancer patients using the Hospital Anxiety and Depression Scale (HADS) and a semi-structured diagnostic interview as gold standard. Results: The diagnostic performance of DT was acceptable (AUC=0.79) to detect psychological distress using the HADS as gold standard. The optimal cut-off score was 4 (Sensitivity=0.89; Specificity=0.56). The diagnostic performance of DT using the HADS plus the diagnostic interview as gold standard was good (AUC=0.86).The optimal cut-off score was 6 (sensitivity=0.82; Specificity=0.76). Discussion: The DT is an appropriate screening test to detect anxiety and depressive disorders in recently diagnosed cancer patients. Increasing the cut-off score up to 6 points boosts its specificity, proving to be more useful for the detection of clinically significant distress.

Oncologists’ proficiency in identifying psychological distress in cancer patients: Hits and misses.

e20572 Background: The past decade has seen a plethora of evidence defining the magnitude of Psychological distress of cancer patients, its clinical implications and impact on cancer outcomes. In t...

Sexual activity and body image: Examining gender variability and the influence of psychological distress in cancer patients

Psycho-social factors impacting on the overall quality of life for cancer patients may differ between men and women. This study examined the influence that psychological distress and clinical and social variables have on sexual activity and body image in adult oncology patients. Symptom data were collected from the Memorial Symptom Assessment Scale (MSAS). Analysis indicated women and patients with reported functional limitations were more likely to be less satisfied with how they looked. The final model showed that younger adults, Caucasians, those who were married, and patients with some functional limitations were more likely to have problems with sexual interest/activity. Gender was not a significant predictor of having problems with sexual interest/activity. These results can be used by clinicians to identify patients who may be at an increased risk for negative body image and problems in sexual functioning. Further research regarding gender differences in cancer-related psychological symptoms is needed to assist health care professionals in providing comprehensive care while alleviating unresolved and interrelated health and psycho-social symptoms.

The impact of clinical conditions and social factors on the psychological distress of cancer patients: an explorative study at a consultation and liaison service in a rural general hospital

BackgroundIn recent decades, increasing attention has been paid to the subjective dimension of cancer, especially to psychosocial screening procedures, major psychiatric disorders but also psychological and psychosocial distress, and finally to met needs of oncologic patients. This study aims first to describe cancer patients in a rural hospital attended by a psycho-oncological consultation-liaison team, second to assess predictors for psychological distress in cancer patients, and finally to identify predictors for recommendation of further psychosocial support.MethodsThe sample (n = 290) comprises a full survey of patients at breast and bowel cancer services (n=209) and patients referred by other medical and surgical services because of psychosocial impairment (n = 81). All patients were assessed by means of the PO-Bado (Psycho-Oncological Basic Documentation) expert rating scale. Assessment of predictors for psychological distress was conducted by multivariate regression models and assessment for predictors for need for outpatient psychosocial support by a logistic regression analysis. All analyses were conducted using STATA 12.ResultsMost members of the assessed sample (average age 65, 82% women) were not severely impaired from a functional and psychological point of view. A total of 14% had received psychiatric treatment before. Mood swings, anxiety, grief, and fatigue were the most important distress symptoms. Selectively referred patients vs. full survey patients of cancer centres, as well as bowel vs. breast cancer patients show a higher level of psychological and physical distress. Fatigue, assessed metastases, and functional limitations were the best predictors for psychological burden. Referral mode, gender, age, family problems, fatigue, and previous psychiatric treatment were associated with further need of psychosocial support.ConclusionsPsycho-oncological consultation and liaison services may offer support to patients in an early stage of cancer, especially in cancer centres. Because of selectively referred patients show a higher burden, the use of basic screening instruments could be meaningful. Fatigue, metastases status, and functional limitations may better predict psychological distress than pain, duration of illness, psychosocial conditions or previous psychiatric treatment. More attention has to be paid to outpatient follow-up with older cancer patients, those with family problems, and those suffering from significant fatigue.

Higher emotional distress in female partners of cancer patients: prevalence and patient–partner interdependencies in a 3‐year cohort

Assessment and treatment of psychological distress in cancer patients was recognized as a major challenge. The role of spouses, caregivers, and significant others became of salient importance not only because of their supportive functions but also in respect to their own burden. The purpose of this study was to assess the amount of distress in a mixed sample of cancer patients and their partners and to explore the dyadic interdependence. An initial sample of 154 dyads was recruited, and distress questionnaires (Hospital Anxiety and Depression Scale, Symptom Checklist 9-Item Short Version and 12-Item Short Form Health Survey) were assessed over four time points. Linear mixed models and actor-partner interdependence models were applied. A significant proportion of patients and their partners (up to 40%) reported high levels of anxiety, depression, psychological distress, and low quality of life over the course of the investigation. Mixed model analyses revealed that higher risks for clinical relevant anxiety and depression in couples exist for female patients and especially for female partners. Although psychological strain decreased over time, the risk for elevated distress in female partners remained. Modeling patient-partner interdependence over time stratified by patients' gender revealed specific effects: a moderate correlation between distress in patients and partners, and a transmission of distress from male patients to their female partners. Our findings provide empirical support for gender-specific transmission of distress in dyads coping with cancer. This should be considered as an important starting point for planning systemic psycho-oncological interventions and conceptualizing further research.

Impact of a psycho-oncological rehabilitation intervention on psychological distress: the experience of CeRiOn (Oncological Rehabilitation Centre) Florence 2007–2010

Combining medical and psychological knowledge and accompanying patients in an individualised path, the Oncological Rehabilitation Centre of Florence (CeRiOn) aims at offering effective integrated rehabilitation interventions and at reducing psychological distress in cancer patients. In the present observational study, we measured the psychological distress at baseline and at the end of the completed rehabilitation processes. A total number of 627 cancer patients were treated by the psycho-oncological service at CeRiOn in 2007-2010. Among them, 99 (all women) participated in more than or equal to three sessions, were followed up for clinical and life status for at least 1 year and had a formal conclusion of their psychological rehabilitation process. For 98 cases, both a baseline and a follow-up measure of distress, by the Psychological Distress Inventory (PDI) and the Distress Thermometer (DT), were available. Relevant before-after amelioration in this selected group of psychologically, highly suffering cancer patients has been shown. Almost all the patients (except 20%) received both group and individual psychological support. The average rehabilitation process lasted 1.7 years. Average distress evaluation decreased from a baseline of 34.7 to 26.4 (P < 0.001) according to PDI and from 5.9 to 2.2 according to DT (P < 0.001). On average, quite a long psychological support time was necessary to complete the rehabilitation process. During this period, patients who had a formal conclusion of the psychological support received at CeRiOn showed a significant reduction of their distress.

The Association of Cancer Patients’ Emotional Suppression and Their Self-Rating of Psychological Distress on Short Screening Tools

Emotional suppression of negative emotions was previously reported to be related to higher psychological distress in cancer patients. The possible effect of elevated levels of emotional suppression on the use of instruments for screening for distress in cancer patients has not been studied. To assess the relation of cancer patients’ emotional suppression to their self-rating on the Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS). Two hundred forty one cancer patients, aged 21–87 years, completed the DT, the HADS and the Courtauld Emotional Control scale (CEC). Participants reported moderated levels of psychological distress but high mean levels of emotional suppression. Older age and higher levels of education and income predicted lower score on the DT and the HADS. Higher emotional suppression predicted lower self-reported psychological distress on the DT, the total HADS score and the HADS depression subscale, but not on the anxiety subscale. Emotion-regulation style may affect cancer patients’ self-rating on the screening instruments, hence, reduce their accurate identification of distressed patients.

La evaluación del malestar emocional percibido: la faceta desatendida de la atención del cáncer

The purpose of this research was to present the latest development of the The Perceived Emotional Distress Inventory (PEDI) as a brief 15-item self-report measure intended to be used for the assessment of psychological distress in cancer patients. Factor Analyses of Principal Components with promax rotations were performed with a combined male and female sample of 481 cancer patients at St. Joseph’s hospital Cancer Institute in Tampa, Florida, to provide further evidence of construct validity. The factor structure, internal consistency, and Pearson correlation coefficients of the PEDI are presented in this report. The factor analysis identified three factors comparable to those found in previous samples in USA: The first factor, anxiety/depression; second factor, hopelessness; and third factor, anger expression. Global alpha coefficient of 0.92 for the inventory indicates strong internal consistency. Pearson correlations between the subscales of the instrument is impressive for such a brief measure. This study emphasizes the need for a brief, self-report instrument to assess anger expression, anxiety, depression and hopelessness as components of perceived emotional distress in cancer patients, while explicitly excluding the potentially confounding effects of somatic symptoms commonly associated with cancer treatments. Further research will be needed to provide information about the PEDI’s use in populations other than cancer patients including attempts to replicate these findings in more heterogeneous populations.

Relationship between Negative Mental Adjustment to Cancer and Distress in Thyroid Cancer Patients

PurposePrevious studies have reported that over a third of cancer patients experience significant psychological distress with diagnosis and treatment of cancer. Mental adjustment to cancer as well as other biologic and demographic factors may be associated with their distress. We investigated the relationship between mental adjustment and distress in patients with thyroid cancer prior to thyroidectomy.Materials and MethodsOne hundred and fifty-two thyroid cancer patients were included in the final analysis. After global distress levels were screened with a distress thermometer, patients were evaluated concerning mental adjustment to cancer, as well as demographic and cancer-related characteristics. A thyroid function test was also performed. Regression analysis was performed to discern significant factors associated with distress in thyroid cancer patients.ResultsOur regression model was significant and explained 38.5% of the total variance in distress of this patient group. Anxious-preoccupation and helpless-hopeless factors on the mental adjustment to cancer scale were significantly associated with distress in thyroid cancer patients.ConclusionNegative emotional response to cancer diagnosis may be associated with distress in thyroid cancer patients awaiting thyroidectomy. Screening of mental coping strategies at the beginning of cancer treatment may predict psychological distress in cancer patients. Further studies on the efficacy of psychiatric intervention during cancer treatment may be needed for patients showing maladaptive psychological responses to cancer.

Psychological distress in cancer patients undergoing radiation therapy treatment

The objective of this study was to examine the likely presence of, and factors associated with, anxiety, depression and overall psychological distress in cancer outpatients undergoing radiation therapy treatment in Sydney, Australia. A touchscreen computer survey was conducted in four radiation therapy treatment centre waiting rooms. Patients waiting to receive treatment completed the survey which included questions about demographic and disease characteristics, survey acceptability and the Hospital Anxiety and Depression Scale (HADS). A total of 454 patients (70 %) completed the touchscreen computer survey. The likely presence of anxiety (HADS-A ≥11), depression (HADS-D ≥11) and overall psychological distress (HADS-T ≥15) was 15, 5.7 and 22 %, respectively. Cancer type was found to be associated with each HADS screening category. The majority of patients reported high survey acceptability and willingness to complete similar touchscreen computer surveys in the treatment centre waiting room on additional occasions. As radiotherapy patients frequently attend the radiation oncology department, routine screening and intervention for elevated levels of psychological distress in this setting appears to be feasible. High survey completion rates and high patient-rated acceptability support this approach to screening. The likely presence of psychological distress is reported for this sample; however, the selection of HADS threshold scores is likely to have influenced the reported rates. Further research is needed to identify how cancer type impacts on likely caseness across the different HADS classifications examined.

First Anxiety, Afterwards Depression: Psychological Distress in Cancer Patients at Diagnosis and after Medical Treatment

The purpose of this study was to assess psychosocial changes at two particular moments: at cancer diagnosis and 2-4 weeks after having finished treatment. A total of 67 cancer outpatients were assessed in this study. The inclusion/exclusion criteria were as follows: ambulatory cancer patients aged 18 years or older and receiving medical treatment. Patients with a performance status <50 or with cognitive impairment (≥3 errors in the Pfeiffer Questionnaire) were excluded. The inclusion period ranged from 1 April 2005 to 30 April 2007. The scales used were the 14-item Hospital Anxiety and Depression Scale (HADS), which has two subscales for anxiety (seven items) and for depression (seven items), the Quality of Life Short Form 36 Questionnaire, the Mental Adjustment Scale and the Medical Outcomes Study Questionnaire for measuring social support. All data were compared with sociodemographic and medical characteristics. Patients had higher levels of pre-treatment versus post-treatment anxiety (HADS-Anxiety mean, 7.41 versus 6.69), whereas depression scores were higher post-treatment versus pre-treatment (HADS-Depression mean, 3.14 versus 3.89). After medical treatment, patients were more fatigued, with lower performance status (Karnofsky Index), less social support and less quality of life, but no differences in coping styles were found. Women had higher levels of anxiety than men. Patients with psychiatric antecedents had higher levels of distress, but these differences were only observed after diagnosis and not after the treatment. In general, head and neck cancer patients had higher levels of distress, worse coping and worse social functioning. Cancer patients require special consideration before and after treatment. Anxiety is the symptom that characterizes diagnosis, whereas depression is more common after medical treatment. The head and neck cancer patients were the group with the highest complexity.

Prevalence of mental disorders, psychosocial distress and need for psychosocial support in cancer patients – study protocol of an epidemiological multi-center study

BackgroundEmpirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and psychosocial support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany.Methods/DesignIn this multicenter, epidemiological cross-sectional study, cancer patients across all major tumor entities will be enrolled from acute care hospitals, outpatient cancer care facilities, and rehabilitation centers in five major study centers in Germany: Freiburg, Hamburg, Heidelberg, Leipzig and Würzburg. A proportional stratified random sample based on the nationwide incidence of all cancer diagnoses in Germany is used. Patients are consecutively recruited in all centers. On the basis of a depression screener (PHQ-9) 50% of the participants that score below the cutoff point of 9 and all patients scoring above are assessed using the Composite International Diagnostic Interview for Oncology (CIDI-O). In addition, all patients complete validated questionnaires measuring emotional distress, information and psychosocial support needs as well as quality of life.DiscussionEpidemiological data on the prevalence of mental disorders and distress provide detailed and valid information for the estimation of the demands for the type and extent of psychosocial support interventions. The data will provide information about specific demographic, functional, cancer- and treatment-related risk factors for mental comorbidity and psychosocial distress, specific supportive care needs and use of psychosocial support offers.