Psychological Distress Thermometer Research Articles

Impacts and Pathways of Behavioral Activation on Psychological Distress Among Patients Diagnosed With Esophageal and Gastric Cancer in China: A Randomized Controlled Trial.

The objective of this study is to investigate the efficacy of behavioral activation (BA), a novel psychological intervention, in ameliorating psychological distress and anxiety symptoms among patients diagnosed with esophageal and gastric cancer, as well as the mediating role of self-efficacy between BA and psychological distress. A total of 139 patients diagnosed with esophageal and gastric cancer were recruited in China from March 2023 to October 2023 and randomly assigned to either the BA plus care as usual group (BA+CAU group) or the care as usual group (CAU group). Pre- and post-intervention questionnaires, including the Psychological Distress Thermometer (DT), Generalized anxiety disorder 7-item (GAD-7) Scale, General Self-Efficacy Scale (GSES) and the activation subscale of Behavioral Activation for Depression Scale (BADS-A), were administered. Generalized estimating equation analyses revealed that, compared to usual care alone, combining BA with usual care significantly ameliorated psychological distress, anxiety as well as improved self-efficacy and activation. The mediation analysis revealed that self-efficacy served as a mediator in the relationship between activation and psychological distress. BA primarily based on telephone or WeChat can not only directly ameliorates psychological distress and anxiety symptoms in patients with esophageal cancer and gastric cancer but also indirectly alleviates psychological distress by enhancing self-efficacy. The study also demonstrates the potential of BA in cancer patients, a skill that can be effectively acquired by primary care workers without specialized training and implemented more flexible. NCT06348940.

Postoperative body weight change and its influencing factors in patients with gastric cancer.

The high incidence and mortality of gastric cancer (GC) pose a significant threat to human life and health, and it has become an important public health challenge in China. Body weight loss is a common complication after surgical treatment in patients with GC and is associated with poor prognosis and GC recurrence. However, current attention to postoperative weight change in GC patients remains insufficient, and the descriptions of postoperative weight change and its influencing factors are also different. To investigate body weight changes in patients with GC within 6 mo after gastrectomy and identify factors that influence dynamic body weight changes. We conducted a prospective longitudinal study of 121 patients with GC and collected data before (T0) and 1 (T1), 3 (T2), and 6 (T3) mo after gastrectomy using a general data questionnaire, psychological distress thermometer, and body weight measurements. The general estimation equation (GEE) was used to analyze the dynamic trends of body weight changes and factors that influence body weight changes in patients with GC within 6 mo of gastrectomy. The median weight loss at T1, T2, and T3 was 7.29% (2.84%, 9.40%), 11.11% (7.64%, 14.91%), and 14.75% (8.80%, 19.84%), respectively. The GEE results showed that preoperative body mass index (BMI), significant psychological distress, religious beliefs, and sex were risk factors for weight loss in patients with GC within 6 mo after gastrectomy (P < 0.05). Compared with preoperative low-weight patients, preoperative obese patients were more likely to have weight loss (β = 14.685, P < 0.001). Furthermore, patients with significant psychological distress were more likely to lose weight than those without (β = 2.490, P < 0.001), and religious patients were less likely to lose weight 6 mo after gastrectomy than those without religious beliefs (β = -6.844, P = 0.001). Compared to female patients, male patients were more likely to experience weight loss 6 mo after gastrectomy (β = 4.262, P = 0.038). Male patients with GC with high preoperative BMI, significant psychological distress, and no religious beliefs are more likely to lose weight after gastrectomy.

Evaluation of Postoperative Psychological Distress and Its Driving Factors in Patients with Oral and Maxillofacial Malignant Tumors

Objective: To explore and analyze the evaluation and driving factors of postoperative psychological pain inpatients with oral and maxillofacial malignant tumors. Methods: Relevant data were collected from 80 patients with oral and maxillofacial malignant tumors who attended the outpatient clinic for follow-up consultations between May 2021 to May 2023. The patients used the psychological distress thermometer (DT) to circle words that best described their experiences in the past week, assigning a numerical value (0–10) to indicate their pain level on each day. The scoring results were employed to assess the psychological pain in these patients. A self-developed patient basic information questionnaire was utilized to record demographic details. Logistic regression analysis was employed to evaluate patients two weeks after surgery, focusing on the assessment of psychological distress and the identification and location of driving factors. Results: Following evaluation, the results revealed that the average postoperative DT score for the 80 patients with oral and maxillofacial malignant tumors was 4.53 ± 1.98 points. Scores &lt; 4 points indicated no psychological pain (Group N) in 48 cases, while scores ≥ 4 points indicated psychological pain (Group Y) in 32 cases. The differences in postoperative DT scores among patients with varying educational levels, fears and worries about disease progression, economic problems, sleep problems, level of hope, and oral pain were statistically significant (P &lt; 0.05). Multiple linear regression analysis results indicated that education level, fear and worry about disease progression, economic problems, sleep problems, level of hope, and oral pain are driving factors of postoperative psychological pain in patients with oral and maxillofacial malignant tumors (P &lt; 0.05). Conclusion: The postoperative psychological pain level in patients with oral and maxillofacial malignant tumors is at a moderate level. Educational level, fear and worry about disease progression, economic problems, sleep problems, level of hope, and oral pain were identified as driving factors for postoperative psychological pain in these patients.

Research on the Intervention of Internet+ Health Education Model on Hemodialysis Patients with Psychological Distress

Objective: To observe the status quo of patients’ psychological distress, and to explore the effect of Internet+ health education model (IHEM) on patients who experienced psychological distress during their first hemodialysis treatment, with the goal of reducing their psychological distress and improving their quality of life. Methods: IHEM was conducted on 120 first-time hemodialysis patients for 3 months while a distress thermometer and a list of questionnaires were used to screen patients and provide corresponding psychological intervention. The incidence rate of psychological distress was analyzed statistically to explore the difference in psychological distress at various periods. Results: The incidence rate (score ≥ 4) of psychological distress in first-time hemodialysis patients was 46.67%, and their distress was mainly rooted in physical, emotional, practical problems (economy, time, and energy), etc. Through IHEM, the psychological distress scores of the patients decreased to 3.29 ± 1.02 at one month after their discharge, and the incidence rate was 32.14%; the psychological distress scores of the patients were 2.29 ± 1.02 at 3 months after their discharge, and the incidence rate was 21.14%. The difference before and after the intervention was statistically significant (P &lt; 0.05). Conclusion: A psychological distress thermometer can timely detect the degree and causes of psychological distress among first-time hemodialysis patients, and the use of IHEM may significantly alleviate the psychological distress among hemodialysis patients.

Psychological distress is involved in CRCI in breast cancer survivors via mediating cytokine levels.

Cancer-related cognitive impairment (CRCI) is a frequent consequence in breast cancer survivors after chemotherapy and lowers their quality of life (QOL). Psychological distress is frequently experienced by breast cancer survivors. There are currently few studies investigating the role of psychological distress in the genesis of CRCI. In total, 122 breast cancer survivors after standard chemotherapy within a year were recruited and assessed using the Psychological Distress Thermometer (DT). Sixty breast cancer survivors had non-psychological distress (NPD group) and sixty-two breast cancer survivors with psychological distress (PD group). The scores of the Mini-Mental State Examination (MMSE), prospective and retrospective memory (PM and RM) Questionnaire (PRMQ), and Functional Assessment of Cancer Therapy-General (FACT-G) and the levels of cytokines including interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-4 (IL-4) were compared between the two groups. Using PROCESS, we investigated whether psychological distress predicted cognitive function based on MMSE through IL-1β, TNF-α, and IL-4. The PD group had higher scores on RM, PM, and FACT-G and lower scores on MMSE than the NPD group (t=-11.357, t=-10.720, t=-15.419, t=10.162, respectively; p < 0.05). Meanwhile, a higher level of IL-1β, TNF-α, and IL-4 was observed in the PD group than in the NPD group (t=-3.961, t=-3.396, t=-3.269, respectively; p < 0.05). The link between psychological distress and cognitive function as measured by the MMSE was also mediated by IL-1β, TNF-α, and IL-4 (effect size: 26%, 25%, and 24%). Breast cancer patients with psychological distress displayed poor cognitive function, poor memory, and inferior quality of life, which was accompanied by higher cytokine levels of IL-1β, TNF-α, and IL-4. This study demonstrated IL-1β, TNF-α, and IL-4 as potential pathways to CRCI in response to ongoing psychological distress, which provided evidence for the involvement of psychological distress in CRCI in breast cancer survivors.

Impact of the CALM intervention on breast cancer patients during the COVID-19 pandemic.

The COVID-19 outbreak has adversely affected breast cancer patients both physically and mentally. Managing Cancer and Living Meaningfully (CALM) is a psychological intervention that is easy to implement. It also decreases the possibility of virus transmission because it can be administered online. Therefore, this study investigated the effects of CALM on the sleep quality, memory, psychological distress, and quality of life (QoL) of breast cancer patients during the ongoing COVID-19 pandemic. Sixty breast cancer patients were recruited and randomly assigned to a CALM group and a Care as Usual (CAU) group. They filled in questionnaires before and after the CALM intervention and CAU. These included the Sleep Quality Scale (SQS), Prospective Memory Scale (PM), Retrospective Memory Scale (RM), Psychological Distress Thermometer (DT), and Quality of life (QoL) Scale. The scores of all the aforementioned scales after the CALM intervention (ACM) were significantly lower compared to the said scores before the CALM intervention (BCM) and after Care as Usual (ACU) (t = 12.369/8.013, t = 8.632/4.583, t = 7.500/6.900, t = 12.479/9.780, t = 12.224/6.729 respectively, P < 0.05) There was a linear correlation between the QoL, DT, and SQS scores. CALM is an effective psychotherapy for breast cancer patients, especially during the COVID-19 pandemic, for improving the QoL because it relieves psychological distress and enhances sleep quality.

The correlations between psychological distress, cognitive impairment and quality of life in patients with brain metastases after whole-brain radiotherapy.

Psychological distress and cognitive impairment are highly prevalent among patients with brain metastases after whole-brain radiotherapy (WBRT). Our purpose was to evaluate the correlations between psychological distress, cognitive impairment and quality of life in patients with brain metastases after WBRT. Seventy-one patients with brain metastasis treated with WBRT were enrolled in this study and were investigated with several scales, including the Montreal Cognitive Assessment Scale (MoCA), the Functional Assessment of Cancer Therapy-Cognitive Function version 3 (FACT-Cog, version 3), the Functional Assessment of Cancer Therapy-Brain Module version 4 (FACT-Br, version 4) and the Psychological Distress Thermometer (DT), before and after WBRT. The MoCA, FACT-Cog and FACT-Br scores in patients with brain metastases were significantly decreased after WBRT compared with before WBRT (z = -7.106, -6.933 and -6.250, respectively, P < 0.001), while the DT scores were significantly increased (z = 6.613, P < 0.001). There was an obvious negative correlation between the DT score and the FACT-Cog score (r = -0.660, P < 0.001), a significant negative correlation between the DT score and the FACT-Br score (r = -0.833, P < 0.001), and an obvious positive correlation between the FACT-Cog score and the FACT-Br score (r = 0.603, P < 0.001). These results suggest that WBRT can cause cognitive impairment in patients with brain metastases, increase their psychological distress and reduce their quality of life (QOL). After receiving WBRT, the cognitive function and QOL of patients with brain metastases were decreased, while psychological distress increased. The cognitive impairment and the decline of QOL after WBRT are associated with increased psychological distress, and that the decline of QOL is associated with cognitive impairment of patients.

Development and validation of the Professional Nursing Support Scale for Chinese patients with cancer.

This study aimed to develop and test the psychometric properties of a Professional Nursing Support Scale for patients with cancer in mainland China. The study was conducted in two phases from January 2017 to January 2020. Phase I involved item generation and developing a preliminary version of Professional Nursing Support Scale through literature review, qualitative interviews, content validity evaluation and a pilot study. Phase II involved psychometric properties testing of the Professional Nursing Support Scale in 700 patients with cancer recruited from four public hospitals in Anhui Province, China. A 49-item Professional Nursing Support Scale was finally developed. Exploratory factor analysis showed a four-factor structure of the 49-item Professional Nursing Support Scale, accounting for 56.95% of variance. Cronbach's α ranged from 0.91 to 0.94 for the four subscales. Confirmatory factor analysis further confirmed the best model fit of four-factor structure of the Professional Nursing Support Scale. The Professional Nursing Support Scale also showed an acceptable concurrent validity with Supportive Care Needs Scale short form 34 (r = 0.75, p < 0.001) and Psychological Distress Thermometer (r = 0.39, p < 0.001). The Professional Nursing Support Scale is a reliable and valid instrument to assess perceived needs of professional nursing support and support acquisition in relation to the care in Chinese patients with cancer.

Falls in systolic blood pressure during dialysis which require no nursing intervention are associated with increased patient intra-dialytic symptom self-reporting and prolonged post-dialysis recovery times

BackgroundHaemodialysis (HD) patients may suffer symptoms during dialysis and take time to recover post HD. We wished to determine whether patients with symptomatic intra-dialytic hypotension (IDH), requiring nursing interventions, or an asymptomatic fall in systolic blood pressure (SBP) reported more symptoms during dialysis.MethodsSix hundred three HD patients completed self-reported intra-dialytic symptom questionnaires and recovery using a visual analogue scale, which were compared with their dialysis session records.ResultsTwenty-nine (4.8%) of patients suffered symptomatic IDH, and 187 (31.0%) had a fall in SBP of > 20 mmHg. Symptomatic patients had greater total symptom scores (30 (23–44) vs 23 (10–38), p < 0.05, versus asymptomatic patients, with increased low blood pressure, dizziness, cramps, palpitations and feeling cold reported (all p < 0.05). Patients with a SBP fall of > 20 mmHg had greater total scores compared with those with a SBP increase of > 10 mmHg (26 (13–38) vs 17 (7–34), p < 0.05), with more dizziness, cramps, backache, shortness of breath and headache reported (all p < 0.05). Although ultrafiltration rates were similar, HD weight loss was greater for patients with a SBP fall of > 20 mmHg (2.5 ± 1.1 vs 2.0 ± 1.3%, p < 0.05). Patients with highest symptoms scores (highest vs lowest quartile) had longer recovery times (40.3 vs 7.6% > 4 h), p < 0.001.Multivariable analysis showed that patients reporting more intradialytic symptoms had higher psychological distress thermometer scores (odds ratio (OR) 1.34 (95% confidence limits 1.26–1.44)), systolic blood pressure < 100 mmHg (OR 2.53 (1.04–6.1)), whereas symptom scores were lower for male gender (OR 0.34 (0.22–0.51)), and with increasing age (OR 0.99 (0.97–0.99)).ConclusionPatients with both symptomatic and asymptomatic IDH, self-reported more symptoms during dialysis, and those patients reporting more symptoms had longer recovery times. We found that younger, female patients, those with greater psychological distress, and lower systolic blood pressure self-reported more intra-dialytic symptoms. More attention is required to prevent falls in intra-dialytic blood pressure to improve the patient experience of HD and shorten post-dialysis recovery times.

The effects of supported shared-care and hemodialysis self-care on patient psychological well-being, interdialytic weight gain, and blood pressure control.

Traditionally hemodialysis (HD) treatments are undertaken by dialysis staff. Self-care has been reported to improve psychological well-being and treatment compliance for patients with chronic diseases. We evaluated our shared-care HD program to determine whether shared-care benefits patients. We reviewed the electronic health care and HD sessional records and psychological distress thermometer (DT) scores of patients in our HD centers. HD shared care was classified as grade 0-none, grade 1 patients weighing themselves and measuring blood pressure (BP), grade 2 performs HD, and grade 3 additionally troubleshoots problems. We reviewed 675 HD patients; mean age 64.1 ± 16.3 years, 62.3% male, 45.9% diabetic, Stoke-Davies co-morbidity grade 1 (1-1), frailty score 4 (3-5), DT 3 (0-5). 60.3% performed no shared care, 19% grade 1, 14.8% grade 2, and 6% grade 3. Patients performing more shared care were younger, less frail, less co-morbid, and physically stronger. We then propensity matched 113 patients with grade ≥ 2 shared care for age and frailty with 113 no shared-care patients. Fewer shared-care patients were prescribed antihypertensives (50.7 vs. 70.7%, P < 0.01), and had lower serum N terminal probrain natriuretic peptide 3033 (1083-8502) vs. 4814(1514-135821) pg/mL), phosphate (1.62 ± 0.49 vs. 1.78 ± 0.62 mmol/L), and higher albumin (40.7 ± 4.3 vs. 38.0 ± 4.3 g/L), all P < 0.05 but no differences in psychological DT scores. Although there was no significant benefit in psychological well-being, as measured by the self-reported DT, patients performing more shared care demonstrated other benefits in terms of blood pressure and volume control.

The mediating effect of hope between psychological distress and quality of life in radiotherapy patients with cervical cancer

Objective To investigate the relationship between hope, mental suffering and quality of life in radiotherapy patients with cervical cancer, to provide the basis for the cancer patient′s psychological intervention. Methods A cross-sectional study of 120 cases of radiotherapy cervical cancer patients was conducted, using the psychological distress thermometer, Herth Hope Scale, Life Quality Measurement Scale for patients with cervical cancer to evaluate patients′ hope, quality of life and psychological distress. Results Radiotherapy cervical cancer patients′ psychological distress and hope were negatively correlated (r=-0.385, P <0.01), psychological distress and quality of life were negatively correlated (r=-0.602, P <0.01), hope and quality of life were positive correlation (r=0.711, P <0.01). Patients′ hope played partially mediated effect between psychological distress and quality of life, emotional status, functional status, played fully mediated effect between psychological distress and social family status. The Mediated effect sizes were 35.9%, 36.3%, 55.9% and 100.0%. Conclusions Psychological distress has not only a direct negative effect on the quality of life of cancer patients, but also an indirect negative effect through hope. During the Medical care, we should accurately assess of patient's psychological distress and hope, and take measures to help improve patients' hope and alleviate psychological distress, so as to improve patients′ quality of life. Key words: Cervical cancer; Psychological distress; Hope; Quality of life; Mediating effect

Influential factors and evaluation of psychological distress in cancer patients treated with radiotherapy

Objective To evaluate the degree of psychological distress and analyze the influential factors of cancer patients receiving radiotherapy, aiming to provide theoretical basis for individualized psychological interventions. Methods A cross-sectional survey of 157 cancer patients treated with radiotherapy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University in the previous year was conducted in terms of data collection and mean score of NCCN distress thermometer by using the convenience sampling method. Tumor types included nasopharyngeal cancer, breast cancer and cervical cancer, etc. The influential factors were analyzed by using logistic regression method. Results The mean score of NCCN distress thermometer in 157 cancer patients was 4.07±0.19. Among them, 87 cases (55.41%) experienced significant psychological distress (NCCN distress thermometer score≥4). The main influential factors of psychological distress consisted of depression, loneliness, fear, appearance changes, urination changes, nausea, poor appetite, eating trouble, diarrhoea, constipation, pain and radiodermatitis. Logistic regression analysis demonstrated that nausea and urination changes were the independent influential factors of psychological distress. Conclusions Over half of cancer patients undergoing radiotherapy present with evident psychological distress. Somatic problems and emotional situations are the main factors of psychological pain. Consequently, it is highly necessary to emphasize the psychological health and actively resolve the somatic and emotional symptoms of cancer patients receiving radiotherapy. Key words: Neoplasm/radiotherapy; Psychological distress thermometer; Influential factor

Status and influencing factors of psychological distress among permanent colostomy patients

Objective To investigate the psychological distress among permanent colostomy patients and to analyze its influencing factors. Methods From January 2017 to January 2018, we selected 112 patients with permanent colostomy at the Second Affiliated Hospital of Zhengzhou University by convenience sampling to collect the general information, and investigate the psychological distress of patients with the Distress Thermometer (DT) and the Problem List (PL) . Multiple linear regression was used to analyze the influencing factors of psychological distress among permanent colostomy patients. Results Among permanent colostomy patients, the total score of psychological distress ranged from 1 to 10 with (6.03±2.20) for the mean value. The highest score of PL was (1.56±0.45) in interaction problem and the lowest score was (1.04±0.26) in religious belief problem. There were statistical differences in the scores of psychological distress among patients with different ages, education levels, family monthly income, whether living alone or not, reimbursement rate of medical insurance, whether being with stoma complications or not and sleep status (P<0.05) . Multiple linear regression analysis showed that the influencing factors of psychological distress of permanent colostomy patients included ages, education levels, family monthly income, whether being with complications or not and sleep disorders (P<0.05) . Conclusions Psychological distress of permanent colostomy patients is severe which may be affected by many factors including ages, education levels, family monthly income, whether being with complications or not and sleep status. Nurses should pay more attention to psychological distress. Key words: Colostomy; Permanent colostomy; Psychological distress; Influencing factors; Psychological distress thermometer

Study on the effect of treatment on psychological distress of hospitalized patients with malignant tumor

Objective To explore the effect of treatment on psychological distress of hospitalized patients with malignant tumor. Methods A total of 268 cases of malignant tumors hospitalized from March 2015 to December 2016 was investigated before and after treatment using patients basic information form and psychological distress thermometer (DT). Results The score of psychological pain of patients with malignant tumor before treatment were (3.74±2.19)points, of which 122 cases (45.52%) (DT score≥4 points)with significant psychological pain.The score after treatment was(3.09±2.05)points.Among which 87 patients with significant psychological pain (32.46%) (DT score≥4points, and the difference between the two groups was statistically significant(P<0.05). After hospitalization, the patients' educational background and the number of treatment were the factors that affected their significant psychological distress (P<0.05). And the economic, emotional and physical problems in the specific problems were the factors affecting the patient's significant psychological distress (P<0.05). After hospitalization, the patients were the protective factors affecting the significant psychological pain of the secondary school (high school) and the intellectuals, and the risk factors of the patients were depression, sadness and eating in the specific problems. Conclusions Hospital treatment can obviously reduce the psychological distress of patients with malignant tumor, psychological distress thermometer (DT) is a simple and convenient psychological pain screening tool.It is widely applied in the clinical work. Key words: Malignant tumor patients; Psychological distress; Psychological distress thermometer; Hospitalization

Correlation between Psychosocial Distress and Quality of Life in Patients with Nasopharyngeal Carcinoma following Radiotherapy.

The aim of this study was to investigate the relationship between psychosocial distress and quality of life (QOL) in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Fifty-three patients with an initial diagnosis of NPC were enrolled in this study. The psychological Distress Thermometer (DT) and Functional Assessment of Cancer Therapy-Head & Neck (FACT-H&N) were conducted before and after radiotherapy in NPC patients. We compared the differences in psychological distress and QOL before and after radiotherapy and analyzed the correlation between psychological distress and QOL after radiotherapy. The performance on the DT was 6.60 ± 1.42 and 2.81 ± 1.43 before and after chemotherapy, respectively, with a significant difference between the time points (t = -13.73, P < 0.01). The performance on the FACT-H&N was 68.30 ± 6.14 and 39.84 ± 6.14 before and after chemotherapy, respectively, with a significant difference between the time points (t = -19.9, P< 0.01). There was a significant negative correlation between the DT score and the FACT-H&N score (r = -3.64, P< 0.01). Patients with NPC experience different degrees of psychological distress, an important factor that affects quality of life, after radiotherapy.

Analysis of psychological distress in patients with lower extremity arteriosclerosis obliterans

Objective To investigate the degree of psychological distress in patients with lower extremity arteriosclerosis obliterans, and to understand the causes and to analyze the influencing factors. Methods The general information questionnaire, psychological distress thermometer, family APGAR index and family burden scale questionnaire were used to conduct a cross-sectional survey in 145 patients with obliterans in hospital during the period from July 2015 to July 2017. Results The average score of psychological pain of all patients was (4.7±2.2) points, the patients with significant psychological distress was 102 cases, accounting for 70.3% (DT score≥4 points). The main reason caused by lower extremity arterial occlusive disease in patients with psychological distress among the top 10 were: pain, anxiety, sleep problems, physical activity, work/school, restricted travel, numbness, fatigue, constipation, economic problems. Multiple linear regression analysis showed that the hospitalization, duration of illness, family care and family burden of the disease affected the scores of psychological pain in different seasons (P<0.05). Conclusions The patients with lower extremity arteriosclerosis obliterans have severe psychological pain, so the targeted measures should be taken to prevent and treat the risk factors. Key words: Arteriosclerosis obliterans of lower extremity; Psychological pain; Influencing factor; Distress thermometer

Predictors of Psychological Distress Trajectories in the First Year After a Breast Cancer Diagnosis

PurposePsychological distress is a significant and ongoing problem for breast cancer. These mental health problems are often neglected as they are not always properly understood. This study was performed to explore the trajectory of psychological distress over 1 year since breast cancer surgery and to identify the associated factors for the trajectory. MethodsOne hundred seventeen women who underwent surgery for breast cancer completed the psychological distress thermometer and problem lists from after surgery to 12 months after surgery. Information on their sociodemographic and clinical characteristics was also obtained. Group-based trajectory modeling was performed to identify the distinct trajectories of psychological distress. Chi-square test and logistic regression analysis were performed to determine predictors of psychological distress trajectories. ResultsA two-group linear trajectory model was optimal for modeling psychological distress (Bayesian information criterion = −777.41). Group-based trajectory modeling identified consistently high-distress (19.4%) and low-decreasing distress (80.6%) trajectories. Old age, depression, nervousness, and pain were significant predictors of consistently high-distress trajectory. ConclusionOur results indicate that distinct trajectory groups can be used as a screening tool to identify patients who may be at an increased risk of psychological distress over time. Screening for psychological distress during disease diagnosis is important and necessary to identify patients who are at an increased risk of elevated distress or at risk of experiencing psychological distress over time.

Correlation analysis of alexithymia and psychological distress in breast cancer patients with chemotherapy

Objective To investigate the current status of alexithymia and psychological suffering in breast cancer patients with chemotherapy, and analyze the correlation between them. Methods Totally 128 breast cancer patients underwent chemotherapy were investigated by using the general information questionnaire, Toronto alexithymia scale (TAS-20) and psychological distress thermometer (DT). Results The total score of alexithymia in patients was (57.87±14.78) points, among which the score of disorder in describing affection was (14.94±4.41) points; the score of disorder in identify affection was (15.43±4.63) points; and the score of externally oriented thinking was (13.78±3.77) points. The total score of psychological distress in patients was (5.13±1.62) points, and 67.74% of patients suffered from moderate-severe mental pain. Spearman correlation analysis showed that: patients′ disorder in describing affection and externally oriented thinking were positively correlated with the score of mental sufferings, practical problems, communication problems and emotional problems (r=0.343-0.421; P<0.05). The score of disorder in identify affection was positively related with the score of psychological distress, practical problems, communication problems, emotional problems and mental religion problems (r=0.224-0.502; P<0.05). Conclusions The alexithymia and psychological distress are at a high level in breast cancer patients with chemotherapy, and the alexithymia is closely related to the psychological suffering of patients. Nursing workers should improve the level of alexithymia in patients, thus reducing the psychological suffering of patients. Key words: Breast neoplasms; Chemotherapy; Alexithymia; Psychological distress

Integration of palliative care for patients with solid tumors on phase I clinical trials.

138 Background: Cancer patients receiving Phase I clinical trials are a population with advanced disease, high symptom burden, and with multiple QOL concerns including use of advance directives. Methods: An NCI funded R01 is currently in progress (2014-2019) as a randomized clinical trial to test a palliative care intervention (PCI) in this population. The PCI includes comprehensive patient assessment, goals of care communication, interdisciplinary care planning and patient teaching. Aims and hypotheses test the impact of the PCI on symptoms, QOL, resource use, spirituality and distress. Outcomes for the study (N = 400) will be conducted at the conclusion of the RCT. This paper reports preliminary baseline data of the first 100 subjects accrued. Results: Subjects mean age was 59 years and 59% were female, similar to prior trials. Forty eight percent (48%) were ethnic minorities, higher than prior trials (3% non-white, Finlay E, 2014; 9%, Parsons JA, et al. PLoS One 2012) with colon (22%) and lung (21%) cancers as dominant. Patients had a mean of 2 comorbidities (range 0-8) and 40% of the patients are &gt; 65 years of age. The most common symptoms reported by PRO-CTCAE (1 = least to 5 = most concern) were sexuality (4.2), fatigue (2.9), pain (2.6) and anxiety (2.5). Psychological Distress Thermometer, (0 - least to 10 = most distress) mean score was 4. FACIT spiritual concerns (1 = least to 5 = most concerning) identified greatest concerns of illness strengthening faith (2.0), strength from faith (2.0) and sense of harmony (2.6). There was limited use of supportive care services, PC consultation, or advanced directives. Conclusions: The population of Phase I trial patients is an important group for palliative care integration with major unmet needs in symptom management and advance care planning.

Screening for distress and supportive care needs during the initial phase of the care process: a qualitative description of a clinical pilot experiment in a French cancer center

To provide a qualitative description of a clinical pilot experiment in a French cancer center, conducted by a nurse after the treatment decision consultation attended by new cancer patients during the initial phase of the care process. The Psychological Distress Thermometer (PDS) and a problem checklist were administered to 255 patients before nurse consultation, helping her to manage the clinical interview, explore patient's distress and supportive care needs, and finally refer the patients in need to the required Supportive Care units. Patients were primarily referred to the social service unit (35% patients), followed by the physiotherapy unit (23.9%) and the psycho-oncology unit (19.6% of patients). In cases of significant distress (43% patients with PDS>3), the percentage of patients referred to the psychosocial units increased (44% referred to the Social Unit, 35% to the Psycho-Oncology Unit). However, the main interest of our screening procedure resides in its qualitative and didactic dimension, based on clinical training and cooperation with healthcare professionals during the process of investigating patients' distress and their supportive care needs. Difficulties and limitations are also described. This first clinical experiment conducted among dedicated nurses involved in a Therapeutic Decision Consultation in a French cancer center has provided evidence in support of the idea that non-specialist professionals are able to identify patients' distress and their Supportive Care needs (particularly in the psychosocial field) provided that they have received appropriate training.