Survivor Guilt Research Articles

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

PurposeTo prospectively assess the incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS.MethodsA systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrated into a diagnostic algorithm. Almost all CCSs visiting the local late effects clinic between May 2020 and April 2022 were included in the study. CCS exposed to neck RT with doses ≥ 19 Gy received standardized clinical and neurological assessment and, in case of abnormal results, an MRI scan to confirm muscle atrophy.ResultsTwo hundred and five CCS were included of whom 41 received RT to the neck with ≥ 19 Gy. In the entire cohort and in the subgroup receiving RT, 2.4% and 12% of CCS were affected by DHS, respectively. Results of clinical and neurological assessment correlated well with MRI results. Neck circumference and neck/thigh ratio were lower after neck RT. Over 50% of CCS experienced neck disability and pain.ConclusionsA relevant proportion of CCS exposed to neck RT is affected by DHS. High concordance of MRI results with the neurological examination supports the clinical value of the diagnostic algorithm. Measurement of neck circumference might be an easy tool for assessment of neck muscle atrophy in survivors at risk.Implications for cancer survivorsIntegration of a diagnostic algorithm for DHS in standard long-term follow-up care facilitates diagnosis as well as initiation of early treatment and obviates the need for invasive examinations.

The Human Toll of Collective Trauma: The Ravages of War and Persecution

This paper explores the concept of historical trauma (HT) as an extension of post-traumatic stress disorder (PTSD), expanding the definition to encompass the accumulated emotional and psychological trauma across generations and lifespans. Coined by Lakota social work professor Maria Yellow Horse Brave Heart, HT refers to the enduring impact of abuse and displacement on marginalized groups, such as enslaved African Blacks, Native Americans, Indigenous people in Canada, and others globally. HT becomes ingrained in cultural memory, impacting individuals with symptoms including depression, survivor guilt, anger, substance abuse, hypervigilance, and more.Examining the distinction between history and collective memory, the paper delves into the effects of persecution and oppression on specific groups, emphasizing chronic and severe stress. The focus extends to genocides worldwide, exploring maternal stress's impact on fetal development, drawing insights from events like the Ice Storm in Quebec, the Leningrad siege, and the Dutch famine. The paper concludes by questioning whether interventions can mitigate the maternal/paternal transmission of stress-induced pathologies, providing avenues for further research and potential solutions to alleviate the enduring effects of historical trauma.

AML-047 Risk Factors Beyond Chemotherapy Exposure for Therapy-Related Myelodysplastic Syndrome (tMDS) and Acute Myeloid Leukemia (tAML) Development in Lymphoma Survivors: A 15-year SEER-Medicare Analysis

AML-047 Risk Factors Beyond Chemotherapy Exposure for Therapy-Related Myelodysplastic Syndrome (tMDS) and Acute Myeloid Leukemia (tAML) Development in Lymphoma Survivors: A 15-year SEER-Medicare Analysis

POSTER: AML-047 Risk Factors Beyond Chemotherapy Exposure for Therapy-Related Myelodysplastic Syndrome (tMDS) and Acute Myeloid Leukemia (tAML) Development in Lymphoma Survivors: A 15-year SEER-Medicare Analysis

POSTER: AML-047 Risk Factors Beyond Chemotherapy Exposure for Therapy-Related Myelodysplastic Syndrome (tMDS) and Acute Myeloid Leukemia (tAML) Development in Lymphoma Survivors: A 15-year SEER-Medicare Analysis

Unveiling the perceptions of Syrian and Turkish citizens afflicted by survivor guilt in the aftermath of the 2023 earthquake: A study based on deep learning

Unveiling the perceptions of Syrian and Turkish citizens afflicted by survivor guilt in the aftermath of the 2023 earthquake: A study based on deep learning

Survivor guilt

Survivor guilt

“She’s still alive”: A wartime meditation on grief and hope

ABSTRACT A Ukrainian therapist who, at the start of the war, flees with her young family, first to Western Ukraine, then to Italy, recounts her complex emotional and professional experiences along the way. The author describes fear, loss, abandonment, survivor guilt, surprising resilience, resourcefulness, tears, and joy.

Intra-abdominal Surgery and Intestinal Syndromes After Pelvic Radiation Therapy

To determine the effects of intra-abdominal surgery on the intensities of 5 radiation-induced intestinal syndromes in survivors of pelvic cancer. The analysis included 623 women born in 1927 or later who had survived cancer. They all had received external radiation therapy toward the pelvic area to treat gynecologic cancers. Information from 344 women who did not undergo irradiation, matched for age and residency, was also included. Main outcome measures after the surgical procedures were the intensity scores for 5 radiation-induced intestinal syndromes: urgency-tenesmus syndrome, fecal-leakage syndrome, excessive mucus discharge, excessive gas discharge, and blood discharge. The scores were based on symptom frequencies obtained from patient-reported outcomes and on factor loadings obtained from a previously reported factor analysis. Follow-up was 2 to 15 years after radiation therapy. Among survivors of cancer, intra-abdominal surgery increased the intensity of the urgency-tenesmus syndrome, the fecal-leakage syndrome, excessive gas discharge, and blood discharge but had a negligible effect on mucus discharge. Intra-abdominal surgery had an especially negative effect on the urgency-tenesmus syndrome. Although the combination of appendectomy with 1 or more other intra-abdominal surgeries resulted in the highest score for all syndromes, appendectomy alone had weak to no effect. In women who did not undergo irradiation, a similar pattern was seen, albeit with much lower scores. We found intra-abdominal surgery to be a risk factor among survivors of gynecologic cancer, increasing the intensity score of 4 out of 5 radiation-induced intestinal syndromes. During radiation therapy, it may be worthwhile to pay extra attention to the dose of unwanted ionizing radiation to the intestines if the patient previously has undergone intra-abdominal surgery.

IN THE ANGST OF THE INVISIBLE EXISTENCE: MIRRORING THE EXISTENTIAL DILEMMA USING BODILY METAPHORS IN THE SELECTED POEMS OF JAYANTA MAHAPATRA AND KEKI N DARUWALLA

Indian English poetry since the culmination of the colonial phase took a decisive and deliberately marked shift from the slavish imitation of the romantic writers like Keats, Byron, Shelly, and Wordsworth to a more progressive and experimental style with methodical and thematic innovativeness. It was known as post-independence poetry which heralded the arrival of a new way of composing poems with an indigenous ‘Indianness’ essence, sabotaging the strong clutches of its colonizer’s English mother tongue. Some of the greatest contributors include Nissim Ezekiel, Dom Moraes, P. Lal, Adil Jussawalla, A. K. Ramanujan, R. Parthasarathy, Gieve Patel, Arvind Mehrotra, Pritish Nandy, Kamala Das, K. N. Daruwalla, Shiv Kumar, Jayanta Mahapatra, Meena Alexander, Agha Shahid Ali, Vikram Seth, Manohar Shetty, etc. A large section of poetry produced by these avant-garde writers was based on raw human experiences and expressions with overtones of psychoanalysis, existentialism, surrealism, etc. Another major experimentation conducted by the modern Indian poets was the incorporation of symbols and metaphors, which made an allusive reference to the unvoiced pathos of the survival guilt of the modern Indian man. With the emergent uncertainties and disillusionment of the post-independence scenario, themes like an identity crisis, alienation, feminist concerns, Marxism, etc were projected as close allies with the existential concerns of the era. Using Foucault’s discourse of society on ‘subject’ and ‘power’ in the molding of the individual’s self, the present study marks an attempt to demonstrate how the two selected poets Jayanta Mahapatra and Keki N Daruwalla try to reflect their existential concerns and post-colonial ‘angst’ by meticulously employing differently disabled bodily metaphors.

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study

BackgroundPost intensive care syndrome is defined as the presence of any impairment affecting the physical, psychiatric, or cognitive domains as a result of critical illnesses. ObjectivesTo explore functional, cognitive and psychological outcomes at 30 days post hospital discharge among survivors of COVID-19–associated acute respiratory distress syndrome, who required mechanical ventilation. MethodsProspective cohort study. We included adult patients with COVID-19–associated acute respiratory distress syndrome, invasively ventilated in two ICUs in Buenos Aires. We measured functional, cognitive and psychological impairments with Barthel index, Montreal Cognitive Assessment test, Patient Health Questionnaire-9 and General Anxiety Disorder-7. Primary outcome was post-intensive care syndrome. Secondary outcome was mortality at 60 days. ResultsWe admitted 40 patients, median age was 69 (60–75) and mostly male (75%). Mortality at 60 days was 37%. Cox regression analysis identified diabetes and Apache II as independent predictors of mortality. Out of 22 patients studied, 14 (64%) developed PICS after discharge. With a physical, cognitive and psychological impairment in 64%, 41% and 32% of patients, respectively. Obesity, days of mechanical ventilation, Apache II, vasopressors use, delirium duration and cumulative midazolam dose were associated with functional dependence. ConclusionsWe identified a high prevalence of functional, cognitive and mental impairment at 30 days after hospital discharge in COVID-19–associated acute respiratory distress syndrome survivors, invasively ventilated. The physical domain was the most frequently affected. These findings suggest the need for long-term follow-up of this population.

Low 25(OH) vitamin D levels are associated with Long COVID syndrome in COVID-19 survivors

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Sounding the Alarm: What Clinicians Need to Know about Physical, Emotional, and Cognitive Recovery After Venoarterial Extracorporeal Membrane Oxygenation.

We summarize the existing data on the occurrence of physical, emotional, and cognitive dysfunction associated with postintensive care syndrome (PICS) in adult survivors of venoarterial extracorporeal membrane oxygenation (VA-ECMO). MEDLINE, Cochrane Library, EMBASE, Web of Science, and CINAHL databases were searched. Peer-reviewed studies of adults receiving VA-ECMO for any reason with at least one measure of health-related quality of life outcomes or PICS at long-term follow-up of at least 6 months were included. The participant demographics and baseline characteristics, in-hospital outcomes, long-term health outcomes, quality of life outcome measures, and prevalence of PICS were extracted. Twenty-seven studies met inclusion criteria encompassing 3,271 patients who were treated with VA-ECMO. The studies were limited to single- or two-center studies. Outcomes variables and follow-up time points evaluated were widely heterogeneous which limits comprehensive analysis of PICS after VA-ECMO. In general, the longer-term PICS-related outcomes of survivors of VA-ECMO were worse than the general population, and approaching that of patients with chronic disease. Available studies identified high rates of abnormal 6-minute walk distance, depression, anxiety, and posttraumatic stress disorder that persisted for years. Half or fewer survivors return to work years after discharge. Only 2 of 27 studies examined cognitive outcomes and no studies evaluated cognitive dysfunction within the first year of recovery. No studies evaluated the impact of targeted interventions on these outcomes. Survivors of VA-ECMO represent a population of critically ill patients at high risk for deficits in physical, emotional, and cognitive function related to PICS. This systematic review highlights the alarming reality that PICS and in particular, neurocognitive outcomes, in survivors of VA-ECMO are understudied, underrecognized, and thus likely undertreated. These results underscore the imperative that we look beyond survival to focus on understanding the burden of survivorship with the goal of optimizing recovery and outcomes after these life-saving interventions. Future prospective, multicenter, longitudinal studies in recovery after VA-ECMO are justified.

Association between metabolic syndrome, insulin resistance, and IGF-1 in breast cancer survivors of DIANA-5 study

PurposeCirculating insulin-like growth factor-1 (IGF-1) is positively associated with the risk of BC recurrence, and is more frequently dysregulated in older people, especially in those with metabolic syndrome (MetS) and obesity. This study aimed to analyze the association between IGF-1 levels and indices of MetS and insulin resistance in BC survivors.MethodsBaseline data of 563 BC survivors enrolled in the DIet and ANdrogen-5 (DIANA-5; NCT05019989) study were analyzed.ResultsLower circulating IGF-1 levels in subjects with MetS than in those without MetS were found. After stratification of the patients according to the diagnosis of MetS, we highlighted that the insulin was the main predictor of elevated IGF-1 levels only in subjects without MetS. Moreover, we found an interaction between high-density lipoprotein cholesterol (HDL-C), glycemia, and IGF-1 levels, showing a positive correlation between HDL-C and IGF-1, especially in subjects with higher values of glycemia and without a diagnosis of MetS.ConclusionsWhile IGF-1 levels appear to be much more impaired in subjects diagnosed with MetS, in non-MetS subjects, IGF-1 levels may respond better to metabolic parameters and lifestyle changes. Further studies are needed to analyze the role of physical activity and/or dietary intervention in modulating IGF-1 concentrations in BC survivors.Implications for cancer survivorsThese results could have important clinical implications for planning customized strategies aimed at modulating IGF-1 levels in BC survivors. In fact, while the IGF-1 system seems to be much more compromised in subjects with a diagnosis of MetS, in noMetS subjects, IGF-1 levels could better respond to lifestyle changes.

The Burden of Survivorship: Survivor Guilt and Its Association with Psychiatric Sequelae in COVID-19 Patients.

COVID-19 survivors struggle with intense depressive and post-traumatic symptoms in sub-acute stages. Survivor guilt may affect post-acute psychopathology. Herein, we aim to unveil the potential affective mechanism underpinning post-COVID psychiatric implications by focusing on the association of survivor guilt with psychopathology and maladaptive attributional style. At one month after discharge, we evaluated symptoms of depression on The Zung Severity Rating Scale (ZSDS), post-traumatic distress on Impact of Event Scale-Revised (IES-R), and sleep disturbances on the Women's Health Initiative Insomnia Rating Scale (WHIIRS) in 195 COVID-19 survivors. Interpersonal Guilt Rating Scale (IGRS-15) rated survivor guilt. A discrepancy score between the burden of depression and post-traumatic distress symptoms was computed individually. Dysfunctional depressive attributions were assessed through the Cognition Questionnaire (CQ). Survivor guilt significantly predicts all evaluated psychopathological dimensions. Moreover, higher rates of survivor guilt were associated with an overlap between post-traumatic and depressive symptomatology, thus suggesting that survivor guilt equally sustains both psychiatric manifestations. Finally, survivor guilt fully mediated the relationship between dysfunctional depressive attributions and the discrepancy index. Our results confirm survivor guilt as a clinically relevant form of suffering related to psychopathological dimensions of post COVID-19 infection, gaining the status of a specific phenomenon and a promising treatment target.

Risk of Metabolic Syndrome and Fatty Liver Diseases in Gastric Cancer Survivors: A Propensity Score-Matched Analysis

To investigate the risk of metabolic syndrome and fatty liver diseases in gastric cancer survivors compared to non-cancer subjects. The data from the health screening registry of the Gangnam Severance Hospital from 2014-2019 was used. Ninety-one gastric cancer survivors and a propensity-score-matching 445 non-cancer subjects were analyzed. Gastric cancer survivors were divided into those with surgical treatment (OpGC, n=66) and non-surgical treatment (non-OpGC, n=25). Metabolic syndrome, fatty liver by ultrasonography, and metabolic dysfunction-associated fatty liver disease (MAFLD) were assessed. Metabolic syndrome was in 15.4% of gastric cancer survivors (OpGC; 13.6%, non-OpGC; 20.0%). Fatty liver by ultrasonography was in 35.2% in gastric cancer survivors (OpGC; 30.3%, non-OpGC: 48.0%). MAFLD was in 27.5% of gastric cancer survivor (OpGC; 21.2%, non-OpGC; 44.0%). After adjusting for age, sex, smoking, and alcohol, the risk of metabolic syndrome was lower in OpGC than in non-cancer subjects (OR, 0.372; 95% CI, 0.176-0.786, p=0.010). After adjusting, OpGC showed lower risks of fatty liver by ultrasonography (OR, 0.545; 95% CI, 0.306-0.970, p=0.039) and MAFLD (OR, 0.375; 95% CI, 0.197-0.711, p=0.003) than did non-cancer subjects. There were no significant differences in the risks of metabolic syndrome and fatty liver diseases between non-OpGC and non-cancer subjects. OpGC showed lower risks of metabolic syndrome, fatty liver by ultrasonography, and MAFLD than non-cancer subjects, but there were no significant differences in the risks between non-OpGC and non-cancer subjects. Further studies on metabolic syndrome and fatty liver diseases in gastric cancer survivors are warranted.

Low Vitamin D Levels Are Associated With Long COVID Syndrome in COVID-19 Survivors.

Long COVID is an emerging syndrome affecting 50% to 70% of COVID-19 survivors that still lacks predicting factors. Due to the extraskeletal effects of vitamin D, we retrospectively assessed the association between 25(OH) vitamin D levels and long COVID in COVID-19 survivors 6 months after hospitalization. Long COVID was defined according to NICE guidelines. Fifty long COVID and 50 non-long-COVID subjects matched on a 1:1 basis were enrolled from an outpatient clinic post-COVID cohort seen from August to November 2020. Therapies/comorbidities affecting calcium/vitamin D/bone metabolism, and/or admission to the intensive care unit during hospitalization were exclusion criteria. 25(OH) Vitamin D was measured at hospital admission and 6 months after discharge. We observed lower 25(OH) vitamin D levels, evaluated at follow-up, in subjects with long COVID than those without (20.1 vs 23.2 ng/mL, P = .03). Regarding the affected health areas evaluated in the entire cohort, we observed lower 25(OH) vitamin D levels in those with neurocognitive symptoms at follow-up (n = 7) than those without (n = 93) (14.6 vs 20.6 ng/mL, P = .042). In patients presenting vitamin D deficiency (<20 ng/mL), both at admission and at follow-up (n = 42), those affected by long COVID (n = 22) presented lower 25(OH) vitamin D levels at follow-up than those not affected (n = 20) (12.7 vs 15.2 ng/mL, P = .041). In multiple regression analyses, lower 25(OH) vitamin D levels at follow-up were the only variable significantly associated with long COVID in our cohort (P = .008, OR 1.09, CI 1.01-1.16). COVID-19 survivors with long COVID have lower 25(OH) vitamin D levels than matched patients without long COVID. Our data suggest that vitamin D levels should be evaluated in COVID-19 patients after hospital discharge. The role of vitamin D supplementation as a preventive strategy of COVID-19 sequelae should be tested in randomized controlled trials.

User evaluation of a mobile education application for the management of metabolic syndrome among cancer survivors.

This study aimed to develop a smartphone education application for managing metabolic syndrome among cancer survivors and obtain user evaluation based on quantitative and qualitative data. Ten cancer survivors and 10 oncology nurse specialists responded to a structured usability evaluation tool (Mobile Application Rating Scale: MARS). Quantitative data analysis was performed through descriptive statistics using SPSS version 25.0. We conducted semi-structured interviews of the cancer survivors and oncology nurse specialists. Qualitative data of interview responses were coded as the app's strengths and weaknesses, information, motivation, and behavioral change. The overall usability evaluation score of the app was 3.66±0.39 for cancer survivors and 3.79±0.20 for oncology nurse specialists. Both cancer survivors and oncology nurse specialists scored the area of functionality as the highest and engagement as the lowest. Additionally, the qualitative usability evaluation suggested that the app should be visually improved by including figures and tables to enhance readability and providing videos and more specific guidelines to directly elicit behavioral change. Metabolic syndrome in cancer survivors can be effectively managed by using the educational application developed in this study by improving the shortcomings of the app for cancer survivors.

Medical traumatic stress in cystic fibrosis: A qualitative analysis

BackgroundPeople living with cystic fibrosis (PwCF) face a lifetime of potentially traumatic illness-related experiences that can lead to posttraumatic stress symptoms. Existing criteria for this type of posttraumatic stress, called medical traumatic stress (MTS), may not fully capture the CF experience. In this study we aimed to explore: 1) illness-related experiences perceived as traumatic in the setting of CF, 2) perceived MTS symptoms in PwCF, and 3) perceived health-related functional impairments from MTS. MethodsInformed by our aims, we developed and piloted guides for semi-structured interviews and focus groups with PwCF, family members of PwCF, and CF medical providers. We then conducted a series of interviews and focus groups. The qualitative analytical process followed Deterding and Waters’ three stages of flexible coding for in-depth interviews, generating key themes and sub-themes in each domain of study inquiry. ResultsWe recruited 51 participants, including 24 PwCF, 7 family members of PwCF, and 20 CF care team members. Illness-related experiences perceived as traumatic were often characterized by themes of loss of agency, threats of bodily harm, and shifts in identity. Prominent MTS symptoms included shame, survivor guilt, burden guilt, germaphobia, and symptom panic. Health-related themes of functional impairments perceived to result from MTS included poor adherence and strained relationships between providers and patients/families. ConclusionsThis is the first study to explore the specific experiences of MTS in PwCF. It highlights the need for screening that includes these specific exposure types and symptoms, which may be mitigatable with medical trauma-focused interventions.

Mortality and burden of post-COVID-19 syndrome have reduced with time across SARS-CoV-2 variants in haematology patients.

Haematology patients contracting SARS-CoV-2 were identified at the start of the pandemic to be at higher risk of death or of persistent symptoms (post-COVID-19 syndrome). As variants with altered pathogenicity have emerged, uncertainty remains around how that risk has changed. We prospectively set up a dedicated post-COVID-19 clinic to monitor haematology patients infected with COVID-19 from the start of the pandemic. In total, 128 patients were identified and telephone interviews were conducted with 94 of 95 survivors. Ninety-day mortality attributed to COVID-19 has fallen sequentially from 42% for the Original and Alpha strains to 9% and to 2% for the Delta and Omicron variants respectively. Furthermore, the risk of post-COVID-19 syndrome in survivors has fallen from 46% for the Original or Alpha strains to 35% for Delta and 14% for the Omicron strain. Since vaccine uptake has been nearly universal in haematology patients, it is not possible to determine whether improved outcomes reflect the reduced pathogenicity of the virus, or widespread vaccine deployment. Whilst mortality and morbidity remain higher in haematology patients than in the general population, our data suggest that the absolute risks are now significantly lower. Given this trend, we believe clinicians should initiate conversations about risk with their patients on whether to maintain any self-imposed social isolation.

'I just wanna' help in any way': mental health awareness and psychiatric themes in Santan Dave's 'Survivor's Guilt' - Psychiatry in music.

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