Psychological Stress In Patients Research Articles

PSY32 DELAY IN DIAGNOSIS OF PRIMARY LYMPHOEDEMA AND ITS IMPACT ON QUALITY OF LIFE: A SYSTEMATIC REVIEW

Currently in the United Kingdom, there is no standardised education for healthcare professionals on primary lymphoedema. Therefore the condition is often under or misdiagnosed. Early diagnosis and treatment reduces its psychological and social impact and delays disease progression and the onset of complications. A systematic review (SR) was conducted to assess the reported time between the onset of symptoms and diagnosis and the impact of a delayed diagnosis on quality of life (QoL) in patients with primary lymphoedema. Electronic databases (Medline, Embase, Cochrane) were interrogated in May 2019 to identify English-language studies reporting the time between onset of symptoms and final diagnosis in patients (all ages) with primary lymphoedema. Data reporting the impact of delay on QoL outcomes were also captured. Studies reporting syndromes with clinical presenting features unrelated to lymphoedema were excluded. The database search identified 2,869 citations of which 29 publications met the pre-defined inclusion criteria. In paediatric studies, the time from symptom onset to lymphoedema diagnosis ranged from 0-12 years (reported in 15 studies). In adults the time to diagnosis ranged from 3-50 years (14 studies) with the majority of studies (11/14 studies) reporting a delay of >14 years before an initial diagnosis was obtained. QoL data were captured qualitatively in three studies (2 paediatric and 1 adult) with all reporting that delayed diagnosis was associated with psychological stress in patients or relatives. This SR provides a comprehensive review of the current evidence base and although there is a paucity of adequately powered studies, data are suggestive of a substantial time delay between symptom onset and diagnosis which impacts negatively on QoL. Further data are required to address this evidence gap and additional education of healthcare professionals may help avoid clinical, psychological, and cost implications of a delay or misdiagnosis of primary lymphoedema.

Do communication skills of oncologists improve by establishing evidence?

Abstract In addition to verbal communication, non-verbal communication has a significant effect on the impression of a recipient such as trustworthiness. As a way for oncologists to learn communication skills, a communication skills training (CST) program in small groups, including lectures with textbooks and videos, role-plays and peer discussions, has been proposed. CST programs have been shown in randomized controlled trials and systematic reviews to be effective in reducing psychological stress in patients and improving communication skills of oncologists, and is recommended in the American Society of Clinical Oncology Consensus Guideline. In Japan, a CST program and a train-the-trainer program were adopted as a commissioned project of the Ministry of Health, Labor and Welfare after the cancer control basic law was enacted in 2007 and implemented for 10 years. Currently, the Japan Psycho-Oncology Society and the Japanese Society of Palliative Medicine are collaborating to conduct CST continuously. In the last 12 years, about 1,500 oncologists have completed the CST program and about 210 facilitators have completed the train-the-trainer program. Further implementation strategies in order to enhance participants’ motivation are needed in the future.

Communication Difficulties and Psychological Stress in Patients Receiving Mechanical Ventilation

Introduction: Communication is fundamental for an individual to verbalize their feelings. Inability of the patient receiving mechanical ventilation to communicate the needs to the health care provider often leads to psychological stress.
 Objective: The objective of the study is to assess the communication difficulties and psychological stress in patients receiving mechanical ventilation.
 Methodology: A cross-sectional research design was used for the study. A total of 48 patient extubated within the preceding 72 hours, was taken as a sample by using a convenience sampling method. Data were collected by using a interview technique in patients from January–September 2018 from a 41- bedded ICU at Nobel Medical College Teaching Hospital. Data analysis was done by descriptive and inferential statistics.
 Results: Difficulty in communication was found where majority of the respondents (82.29%) rated general communication as extremely hard. The study further revealed that 100% of the respondents used hands for pointing and gesturing followed by shaking heads (65.38%), whisper (19.23%) and writing (11.53%). Sleeping and communication difficulty was the major problem 97.91% and 96.94% respectively. Majority of respondents (66.66%) scored Intensive Care Psychological Assessment Tool more than 7. In addition, there is significant association between the sex, total length of ventilation and prior experience with ICU (p= <0.05).
 Conclusion: Patient with mechanical ventilation experience a moderate to extreme level of psychological stress because they have difficulty in communicating their needs. Alternative communication methods should be developed, and health care provider should be aware about the communication difficulties, thereby reducing the stress caused by ineffective communication.

Topically injected adrenocorticotropic hormone induces mechanical hypersensitivity on a full-thickness cutaneous wound model in rats.

Cutaneous wound pain causes physical and psychological stress for patients with wounds. Previous studies reported that stress induces hyperalgesia and deteriorates wound healing. However, the effect of the stress response such as in hypothalamic-pituitary-adrenal (HPA) axis on local wound area is unclear. We aimed to investigate the effects of a stress response on the mechanical withdrawal threshold in the local wound area and describe the identification of a wound pain exacerbation. We topically injected adrenocorticotropic hormone (ACTH) into the granulation tissue of full-thickness cutaneous wound model rats on the fifth day postwounding and measured the mechanical withdrawal thresholds, cytochrome P450 2Bs levels and concentration of 5,6-epoxyeicosatrienoic acid in wound exudate. We found that ACTH induced mechanical hypersensitivity at 4 and 6hours after injection (P=.004 and .021, respectively), and increased gene expression of cytochrome P450 2B12 expression (P=.046). Concentration of 5,6-EET in the wound exudate was moderately correlated with the mechanical withdrawal threshold (r=-.630). Finally, the mechanical withdrawal threshold in the 5,6-EET group was significantly lower than that in the control group at 2hours after the injection (P=.015). We propose that 5,6-EET is one of the most promising contributors to the wound pain exacerbation. These findings could guide clinical wound and pain management.

Association of serum cortisol and dehydroepiandrosterone sulfate (DHEAS) levels with psychological stress in patients with vitiligo

Background/aimVitiligo is a depigmentation disorder that leads to serious psychological burden in patients, who are frequently reported to have depression and anxiety. The aim of this study was to investigate the association between stress-related hormone levels and psychological stress in vitiligo. Materials and methodsIn this study 46 vitiligo patients and 46 controls were enrolled; their cortisol, dehydroepiandrosterone sulfate (DHEAS), and cortisol/DHEAS levels were measured. Psychological burden was assessed by the Beck Depression Inventory and Perceived Stress Scale. ResultsPatients and controls did not differ in terms of cortisol, DHEAS, or cortisol/DHEAS. Patients had higher perceived stress than controls but did not differ in terms of depression scores. Correlation analyses revealed that cortisol/DHEAS correlated positively with perceived stress (P = 0.009, r = 0.272). The correlation between cortisol/DHEAS and perceived stress was stronger in the patient group (P = 0.013, r = 0.363) and close to zero among controls. In regression analyses, lower depression and higher perceived stress were shown to predict cortisol/DHEAS values. ConclusionVitiligo patients significantly differed from the healthy population in terms of hormones and psychological distress. There was also an association between perceived stress and cortisol/DHEAS ratio in vitiligo. Abnormality of hormonal response to distress lowers DHEAS, which is known for its antioxidant properties, a possible mechanism for vitiligo development. Another important finding is the significance of using the composite variable cortisol/DHEAS, which seems to be more sensitive to distress than each of its components. We suggest its use in future studies on psychological distress–hormone relationships.

Intervention of auricular point sticking on perioperative psychological stress in patients with anorectal diseases

To explore and quantify the intervention effect of auricular point sticking on perioperative psychological stress in patients with anorectal diseases. Eighty patients who underwent anorectal surgery were randomly divided into an observation group (40 cases) and a control group (40 cases). The routine preoperative guidance, preoperative visits, and informed of the postoperative condition were received in the control group. On the basis of the treatment in the control group, auricular point sticking was immediately applied at Shenmen (TF4), Shen (CO10), Wei (CO4), Gan (CO12), Pi (CO13), Pizhixia (AT4), E (AT1), Nie (AT2) and Zhen (AT3) in the observation group.The patients were pressed by themselves, 3 to 5 min per point each time, 5 times a day, and the contralateral auricular points were replaced every 2 or 3 days until 1 week after surgery. The Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), and Pittsburgh sleep quality index (PSQI) scores were compared between the two groups before and 7 days after surgery. There was no significant difference in the total HAMA scores between after and before surgery in the observation group (P>0.05). The total HAMA score in the control group was higher than that before surgery (P<0.05). The total HAMA score in the observation group after surgery was lower than that in the control group (P<0.05). There was no significant difference in the total HAMD scores between the two groups before and after surgery (P<0.05). There was no significant difference in the total HAMD scores between the two groups after the surgery (P>0.05). The scores of somatic anxiety factor in the two groups were higher than those before surgery (P<0.05). The scores of somatic anxiety factor in the observation group were lower than those in the control group (P<0.05). The scores of psychotic anxiety factors in the two groups were lower than those before surgery (P<0.05). There was no significant difference in the score of psychotic anxiety factors between the two groups (P>0.05). The total score of PSQI in the two groups was lower than that before surgery (P<0.05), and the total score of PSQI in the observation group was lower than that in the control group (P<0.05). Auricular point sticking can effectively improve some psychological stress problems during perioperative period in patients with anorectal diseases.

Validation of Extensive Next-Generation Sequencing Method for Monogenic Disorder Analysis on Cell-Free Fetal DNA: Noninvasive Prenatal Diagnosis

During pregnancy, a percentage of the cell-free DNA circulating in the maternal blood is represented by the cell-free fetal DNA (cffDNA), constituting an accessible source for noninvasive prenatal genetic screening. The coexistence of the maternal DNA, the dominant fraction of cell-free DNA, together with the cffDNA component and the scarcity of the cffDNA itself make applying traditional methods of genetics and molecular biology impossible. Next-generation sequencing methods are widely used to study fetal aneuploidies. However, in monogenic disorders, there have been relatively few studies that analyzed single mutations. We present a method for the analysis of an extended group of gene variants associated with recessive and dominant autosomal disorders using next-generation sequencing. The proposed test should allow a complete analysis of common genetic disorders and pathogen-associated variants for diagnostic use. The analysis of cffDNA for single gene disorders may replace invasive prenatal diagnosis methods, associated with the risk of spontaneous abortion and psychological stress for patients. The proposed test should assess reproductive risk for both genetic family disorders and de novo occurrences of the disease. The application of this method to a case of beta-thalassemia is also discussed.

CME Exam 2: Acceptance and Commitment Therapy Reduces Psychological Stress in Patients With Inflammatory Bowel Diseases

CME Exam 2: Acceptance and Commitment Therapy Reduces Psychological Stress in Patients With Inflammatory Bowel Diseases

Large-scale Retrospective Cohort Study of Psychological Stress in Patients with Alopecia Areata According to the Frequency of Intralesional Steroid Injection.

Large-scale Retrospective Cohort Study of Psychological Stress in Patients with Alopecia Areata According to the Frequency of Intralesional Steroid Injection.

Effects of propofol sedation on psychological stress in surgical patients under epidural

To explore the effects of propofol sedation on psychological stress in patients undergoing surgery under epidural anesthesia. Sixty patients scheduled to undergo elective ileostomy closure under epidural anesthesia were randomized into propofol sedation group and control group (n=30). The patients in the sedation group received a loading dose of propofol of 0.6 mg·kg- 1· h- 1 followed by a maintenance dose with continuous infusion of 3 mg·kg- 1· h- 1 given after the Observer's Assessment of Alertness/Sedation (OAA/S) score reached 2-3. An equivalent volume of normal saline was administered in patients in the control group. The patients' preoperative and intraoperative anxiety scores were assessed with the State Anxiety Inventory (SAI) on the day before and on the first day after the surgery, respectively. The mean blood pressure (MBP), heart rate (HR), SpO2, OAA/S, and the indicators of psychological stress of brain functional state of the patients (including the wavelet index [WLi], anxiety index [ANXi], comfortable index [CFi] and pain index [Pi]) were recorded at 5 min after entering the operating room (T0), at the time of lumbar puncture (T1) and change to supine position after the puncture (T2), at 20 s (T3), 40 s (T4), and 60 s (T5) after intravenous administration, and at 2 min (T6), 4 min (T5), 6 min (T8), 8 min (T9), 10 min (T10) and 40 min (T11) after skin incision. The patient's satisfaction with anesthesia was assessed with the Visual Analog Scale (VAS) score on the first day after the operation. Serum cortisol level was measured before anesthesia and at the end of operation to calculate the changes in cortisol level. The two groups of patients were comparable for preoperative SAI scores (P&gt;0.05); The patients in the sedation group appeared to have lower intraoprative SAI scores, but this difference was not statistically significant (P=0.05). MBP, HR, and SpO2 at the time points from T6 to T10 and OAA/S, WLi, ANXi, CFi, and Pi at the time points from T6 to T11 were significantly lower in the sedation group (all P &lt; 0.05), and these parameters were not significantly different between the two groups at the other time points (all P&gt;0.05). The patient satisfaction scores were significantly higher in the sedation group (Z=2.07, P &lt; 0.05). Compared with the preoperative levels, serum cortisol level at the end of the operation was increased in the sedation group but lowered in the control group, and the variations of serum cortisol level differed significantly between the two groups (t=4.75, P &lt; 0.01). Intraoperative propofol sedation can alleviate the patients' anxiety, improve the comfort level, and lessen physiological stress during surgeries under epidural anesthesia.

Acceptance and Commitment Therapy Reduces Psychological Stress in Patients With Inflammatory Bowel Diseases

Patients with Crohn's disease or ulcerative colitis have relatively high levels of stress and psychological dysfunction. Acceptance and commitment therapy (ACT) is a psychological intervention that comprises acceptance and mindfulness procedures, along with commitment and behavior change strategies, to increase psychological flexibility and reduce stress. We performed a randomized controlled trial to investigate the effect of ACT on stress in patients with inflammatory bowel diseases (IBD). A total of 122 patients with quiescent or stable, mildly active IBD were randomly assigned to an 8-week ACT program or treatment as usual (control group). Clinical, demographic, disease activity, and psychological data and blood and feces were collected at baseline and at 8 weeks and 3 months after the intervention (week 20). Scalp hair was collected at baseline and week 20 for measurement of steroid concentrations. The primary endpoint was change in stress symptoms, assessed with the Depression Anxiety Stress Scale. Secondary endpoints included changes in perceived stress, anxiety, depression, quality-of-life domains, disease activity, and cortisol concentration in hair. Overall, 79participants were included in the complete case intention-to-treat analysis. There were 39% and 45% reductions in stressin the treatment group from baseline to 8 and 20 weeks, respectively, compared with 8% and 11% in the control group (group× time interaction, P= .001). ACT was associated with reduced perceived stress (P= .036) and depression (P= .010), but not anxiety (P=.388), compared with control individuals. In the intention-to-treat analysis, changes in all 4 quality-of-life domains overtime were similar in the ACT and control groups. In the per-protocol analysis, the overall well-being quality-of-life domain improved in the ACT group compared with the control group (P= .009). Subjective and objective disease activity measurements were similar between groups over the study period (all P values >.05). Hair cortisol concentrations correlated with stress (rs= 0.205, P= .050) and anxiety (rs=0.208, P= .046) at baseline but did not change significantly in the ACT group over the study period compared with the control group (P= .831). In a randomized controlled trial of patients with IBD, an 8-week ACTtherapy course improved stress and other indices ofpsychological health.ClinicalTrials.gov Identifier: NCT02350920.

Physiological and Psychological Stress in Patients Living With a Left Ventricular Assist Device.

Patients with a left ventricular assist device (LVAD) commonly experience psychological distress post-implantation, but physiological stress and differences by implant strategy remain unstudied. This study describes indicators of physiological (salivary cortisol, C-reactive protein, sleep quality) and psychological (perceived stress, depression, and fatigue) stress by implant strategy and examines relationships between stress and outcomes (quality of life [QOL] and functional status). Prospective, cross-sectional data were collected from patients ≥3 months post-LVAD implantation (n = 44), and descriptive statistics and logistic regression were used. The study sample was average age 57.7 ± 13 years, mostly male (73%), married (70.5%), and racially diverse. Median LVAD support was 18.2 months. Most had normal cortisol awakening response and fair sleep quality, with moderate psychological stress. There were no differences in stress by implant strategy. Normal cortisol awakening response was correlated with low depressive symptoms. Sleep quality and psychological stress were associated with QOL, whereas cortisol and C-reactive protein levels were associated with functional status. This is the first report of salivary biomarkers and stress in LVAD outpatients. Future research should examine physiological and psychological stress and consider potential clinical implications for stress measurement for tailored approaches to stress management in this population.

Fournier’s Gangrene in Upper Egypt, Case Series of 14 Patients

Objectives: Fournier's gangrene is a rare but serious necrotizing infection of the skin and subcutaneous tissues affecting mainly the genital, perineal and perianal regions with poor outcome. Multidisciplinary approach ensures the best management with the mainstay of treatment is the repeated adequate surgical debridement. Broad spectrum antibiotics and hemodynamic support, if needed, are also crucial. Plastic surgery is concerned with reconstruction of the residual defect after control of the infection and stabilization of the patient's condition. Methods: we present 14 patients with Fournier's gangrene in the period between July 2009 and August 2015. Those patients were evaluated and managed based on onset, severity of the problem, presence of predisposing factors, site and size of residual defects. Results: Mean age of patients was 47.8 years, male to female ratio was 2.5:1, diabetes mellitus was the commonest predisposing factor, and the scrotum was most frequently involved site. No mortality has been recorded. Conclusion: Fournier's gangrene is no longer a life threatening condition. It is best treated by early and repeated debridement under broad-spectrum antibiotic cover. Reconstruction markedly reduces financial and psychological stress of patients as well as hospital stay and accelerates early return to normal life.

The impact of unplanned reoperations in head and neck cancer surgery on survival

ObjectivesUnplanned reoperation causes physical and psychological stress in patients and it costs more in terms of medical, economic and social resource. The purpose of the study was to evaluate the incidence, risk factors and clinical significance of unplanned reoperation (any unscheduled surgery within 30 days from the initial surgery) in patients who had undergone head and neck cancer (HNC) surgery. Materials and methodsA total of 574 consecutive patients who had received surgery for HNC with or without flap reconstruction from 2010 to 2015 were analyzed. Clinical and biochemical characteristics, cause of unplanned reoperation, cancer subsites, and previous treatment history were compared between unplanned reoperation group (n = 60) and control group (n = 514). Multivariable analyses were performed to identify risk factors for unplanned reoperation. Clinical significance was evaluated by multivariable survival analyses using Cox proportional hazard model. ResultsOverall rate of unplanned reoperation was 10.5%. Flap complication (40.0%) was the most common cause, followed by infection (16.7%), necrosis (11.7%), and bleeding (8.3%). Higher N (N2) classification, long operation time and previous treatment before surgery were identified as risk factors for unplanned reoperation. Based on multivariable survival analyses, recurrence-free survival was significantly decreased in unplanned reoperation group (Hazard ratio = 1.85, 95% confidence interval [1.23–2.80]), but not overall survival. ConclusionUnplanned reoperation significantly decreased recurrence-free survival in patients with HNC surgery. Thus, careful surgical/ perioperative management is needed to reduce unplanned reoperation in HNC patients with advanced nodal disease, long operation time or previous treatment history.

What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals' concerns, perceived patient characteristics and perceived structural factors.

Despite a large body of evidence showing that physical activity (PA) is beneficial to patients with cancer, healthcare professionals (HCPs) are promoting it too scarcely. Factors that hinder HCPs from promoting PA have remained understudied so far. Using a qualitative approach, this study aimed at a comprehensive description of influencing factors for HCPs' PA promotion behaviour and at identifying the reasons and mechanisms behind them. Semi-structured interviews with 30 HCPs were undertaken with a focus on concerns, patient characteristics and structural factors. Answers were analysed using thematic analysis. Results revealed that HCPs had concerns regarding a physical overexertion and psychological stress for patients with cancer. A patient's physical condition and the assumed interest in PA, often derived from former PA, turned out to be the most crucial patient characteristics influencing if PA is addressed. Structural factors relevant for PA promotion pertained to in-house structures, HCPs' workload, timing and coordination, information material for HCPs and patients and availability of exercise programs. In conclusion, this study revealed undetected concerns of HCPs and underlined the relevance of patient characteristics and structural conditions for HCPs' PA promotion towards patients with cancer. A broader perspective is needed to assess these factors in their influence on HCPs' PA promotion.

Does psychological stress in patients with clinically suspect arthralgia associate with subclinical inflammation and progression to inflammatory arthritis?

BackgroundWithin established rheumatoid arthritis (RA), stress can have pro-inflammatory effects by activating the immune system via the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. It is unknown if stress levels also promote inflammation during RA development. We studied whether the psychological stress response was increased in clinically suspect arthralgia (CSA) and if this associated with inflammation at presentation with arthralgia and with progression to clinical arthritis.MethodsIn 241 CSA patients, psychological stress was measured by the Mental Health Inventory (MHI-5) and the Perceived Stress Scale (PSS-10) at first presentation and during follow-up. Systemic inflammation was measured by C-reactive protein (CRP) and joint inflammation by 1.5 T-MRI of wrist, MCP, and MTP joints.ResultsAt baseline, 12% (24/197) of CSA patients had a high psychological stress response according to the MHI-5. This was not different for patients presenting with or without an elevated CRP, with or without subclinical MRI-detected inflammation and for patients who did or did not develop arthritis. Similar findings were obtained with the PSS-10. When developing clinical arthritis, the percentage of patients with ‘high psychological stress’ increased to 31% (p = 0.025); during the first year of treatment this decreased to 8% (p = 0.020). ‘High psychological stress’ in non-progressors remained infrequent over time (range 7–13%). Stress was associated with fatigue (p = 0.003) and wellbeing (p < 0.001).ConclusionsPsychological stress was not increased in the phase of arthralgia, raised at the time of diagnoses and decreased thereafter. The lack of an association with inflammation in arthralgia and this temporal relationship, argue against psychological stress having a significant contribution to progression from CSA to inflammatory arthritis.

Application of language intervention in the regulation of psychological stress during endoscopic retrograde cholangiopancreatography examination

Objective To investigate the application effect of language intervention in the regulation of psychological stress of patients during endoscopic retrograde cholangiopancreatography (ERCP) examination. Methods A total of 70 ERCP patients in Yiwu Central Hospital from April 2013 to May 2017 were included in the study using simple stratified sampling method. A number of 35 cases from April 2013 to April 2015 were recruited as the control group and received routine health education. Another 35 cases from May 2015 to May 2017 were included in the observation group who received additional language intervention. The heart rate, blood pressure, Self-Rating Anxiety Scale (SAS) score, Self-Rating Depression Scale (SDS) score, blood glucose and cortisol levels of patients at different time points were compared between two groups. Results The time factor and between group factor of heart rate, blood pressure, blood glucose and cortisol levels of patients had interaction effect (P<0.05) . The scores of SAS and SDS in the observation group were lower than the scores before the examination, and the differences were statistically significant (P<0.05) . After the examination, there were statistically significant differences in the SAS and SDS scores between two groups (P<0.05) . Conclusions The application of language intervention during the ERCP examination can significantly improve the psychological stress state of patients and the safety of ERCP. Key words: Anxiety; Depression; Blood pressure; Blood glucose; Cortisol; Language intervention; Endoscopic retrograde cholangiopancreatography

Analysis of psychosocial stress factors in patients with renal cancer.

The experience of stress in patients with cancer through helplessness and the suppression of emotions correlates with unfavorable disease prognosis. Significant distress can reduce survival probability as well as subjectively perceived poor quality of life. Currently, there are few data on psychological stress in patients with renal cancer and most studies focus on survival time. The aim of the study was to evaluate the psychosocial stress of patients with renal cancer with screening questionnaires for an inpatient psychosocial treatment program. Patients undergoing inpatient surgical or medical treatment for renal cancer were prospectively assessed for psychosocial stress with two standardized stress screening questionnaires used for the identification of the need for psychosocial care [NCCN Distress Thermometer (NCCN-DT), Hornheider Screening Instrument (HSI)]. Seventy-four patients with a mean age of 65 years were assessed. The average NCCN-DT score was 4.8 (scale of 0-10) and did not correlate with tumor stage, sex or prognosis. According to the DT results, 27% of patients were in need of psychosocial care which was significantly higher than the self-reported need. The main stressors were anxiety (32%), pain (27%), nervousness (26%), sadness, worry and sleeping difficulties (20%). There is a significant number of patients with renal cancer with increased psychological distress and a consecutive need for psychosocial care. This is underreported and largely unrecognized by patients as well as physicians and nurses. Easy-to-use assessment tools can be very helpful in identifying patients in need and this information can be used to implement psychological support and thus improve patient care.

Positive Optimism and Palliative Chemotherapy: Does It Really Effect Symptom Burden? (S757)

•Better communication•Analysis on multiple occasions Optimism, a positive trait of human personality, has been linked to lower pain level and psychological stress in patients with chronic illness. The purpose of this study is to determine correlation between dispositional optimism and symptom burden in palliative care (PC) patients. We hypothesize that higher dispositional optimism equates to lower symptom burden. Dispositional Optimism scores were measured using the revised “Life Orientation Test” (LOT-R) in a set of PC male patients (ages 30-89) in VA PC clinics. LOTR scores were correlated against “Edmonton Symptom Assessment Score” (ESAS). Age, gender, ethnicity, diagnosis, and presence of depression data was collected. Differences in LOTR and ESAS scores were measured among variables. Cronbach alpha of >0.85 for survey was used. Participants (N= 34) were 82% >60 years old, 76% Caucasian, and 67% Non-Hispanic/Latino. Seventeen participants had cancer, 3 COPD, 1 CHF, 3 ESRD, and 8 other terminal diseases. Optimism scores were higher in non-white (18 vs.14, P=0.04) and cancer (16 vs.13, P= 0.04). Optimism was higher in cancer with chemotherapy vs. without (19 vs. 13, P=0.004) but no significant difference in ESAS (32 vs. 38). There was a nonsignificant negative correlation between LOTR vs. ESAS and PHQ2 vs. optimism scores. A strong positive correlation was found between PHQ2 and ESAS (P=0.001). In PC patients, symptom burden did not correlate with optimism. Results support a model in which optimism is a variable trait affected by external factors. Specifically, higher optimism in non-white patients may be attributed to spiritual/cultural differences. Higher optimism in cancer patients versus chronic diseases may be attributed to perceived curative potential and availability of therapeutic options. This suggests the need for improved communication with patients throughout the course of their disease. Higher symptom burden is correlated with increased depression as expected.

Tofacitinib (Selective Janus Kinase Inhibitor 1 and 3): A Promising Therapy for the Treatment of Alopecia Areata: A Case Report of Six Patients.

Background:Alopecia areata (AA) is a chronic autoimmune disorder characterized by patchy loss of hair from scalp, beard, eyebrows, or rarely even body hair. Rarely, the disease can be widespread and severe leading to loss of entire scalp and body hair causing apprehension and psychological stress in patients. Management of such cases is equally difficult with the available options of topical and systemic immunosuppressant. Tofacitinib, JAK3 inhibitor, is emerging as a promising drug for the management of severe and resistant cases of AA/totalis/universalis.Objective:Our study aims to show the effectiveness of oral tofacitinib in the treatment of alopecia universalis (AU).Methods:Six patients diagnosed with AU/alopecia totalis duration of disease 6 months–15 years refractory to other treatments were selected and were started on oral tofacitinib 5 mg twice daily up to 10 mg BID and were followed up every 4 weeks. The efficacy was measured by hair regrowth using photographic assessment, Severity of Alopecia Tool score, and physical examination. Patients will be followed up for 6 months after stopping treatment for assessing disease relapse.Results:All our six patients showed dramatic response to oral tofacitinib. Patients were followed up every 4 weeks, and results were assessed. Significant hair regrowth was evident in all the patients by the end of 12 weeks. Currently, four of our patients are on oral tofacitinib 10 mg BID and are under follow-up. There was no relapse in one patient after stopping drug for 4 months. Another patient started developed AA patches in the eyebrows within 2 months of stopping tofacitinib. Acneiform eruptions were seen in two patients which were managed with topicals.Conclusion:In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side effects. We recommend that further controlled studies be required to establish safety and confirm efficacy.