Update on distress management for cancer patients

Many cancer patients experience psychological suffering during their journey from diagnosis, through treatment, to survivorship or the end of life. Their psychological distress can become severe enough to interfere with their ability to cope with cancer. Conditions such as anxiety, depression, insomnia, and delirium often occur among cancer patients. Although distress is prevalent in cancer patients, it is often under-recognized and under-treated in the oncology setting. Psychological distress may have a negative effect on patients' quality of life. The prevention, early detection, and proper management of distress are important for improving patients' quality of life during and after cancer treatment. It is therefore necessary to develop a system for assessing and managing distress. The US National Comprehensive Cancer Network developed guidelines for distress management in 1999. Korean recommendations for distress management were released in 2009. The Korean government recently designated integrated supportive care centers for survivors at the National Cancer Center and regional cancer centers. The supportive care service is provided for cancer survivors who have completed first-line anti-cancer treatment. Psycho-oncology is one of the most important components of supportive care in cancer. Distress management yields many benefits for cancer patients, but the reality is that significantly distressed patients are often not properly referred for psychosocial care. All distressed patients should be properly referred for psychosocial care, and the psychosocial care of cancer patients should be integrated into routine cancer care practice.

Update on distress management for cancer patients

Many cancer patients experience psychological suffering during their journey from diagnosis, through treatment, to survivorship or the end of life. Their psychological distress can become severe enough to interfere with their ability to cope with cancer. Conditions such as anxiety, depression, insomnia, and delirium often occur among cancer patients. Although distress is prevalent in cancer patients, it is often under-recognized and under-treated in the oncology setting. Psychological distress may have a negative effect on patients' quality of life. The prevention, early detection, and proper management of distress are important for improving patients' quality of life during and after cancer treatment. It is therefore necessary to develop a system for assessing and managing distress. The US National Comprehensive Cancer Network developed guidelines for distress management in 1999. Korean recommendations for distress management were released in 2009. The Korean government recently designated integrated supportive care centers for survivors at the National Cancer Center and regional cancer centers. The supportive care service is provided for cancer survivors who have completed first-line anti-cancer treatment. Psycho-oncology is one of the most important components of supportive care in cancer. Distress management yields many benefits for cancer patients, but the reality is that significantly distressed patients are often not properly referred for psychosocial care. All distressed patients should be properly referred for psychosocial care, and the psychosocial care of cancer patients should be integrated into routine cancer care practice.

Neurocognitive and Psychological Functioning of Children with an Intracranial Germ Cell Tumor / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to investigate the neurocognitive functioning of children with intracranial germ cell tumor (IGCT) prior to receiving proton beam therapy (PBT), and to identify differential characteristics of their neurocognitive functioning depending on tumor location. As a secondary object of this study, neurocognitive functions were followed up at 1-2 years after PBT to examine early post-treatment changes. MATERIALS AND METHODS: Between 2008 and 2014, 34 childrenwith IGCT treatedwho received PBT atNational Cancer Center, Korea were enrolled in this study. Standardized neurocognitive tests of intelligence, memory, and executive functioning were performed with baseline psychological assessments using the Child Behavior Checklist (CBCL). Follow-up assessments after PBT were conducted in 20 patients (T2). The results were analyzed based on the locations of tumors, which included the suprasellar, pineal gland, basal ganglia, and bifocal regions. RESULTS: The neurocognitive function of IGCT patients was significantly lower than that of the normal population in performance intelligence quotient (p=0.041), processing speed (p=0.007), memory (p < 0.001), and executive functioning (p=0.010). Patients with basal ganglia tumors had significantly lower scores for most domains of neurocognitive functioning and higher scores for CBCL than both the normal population and patients with IGCT in other locations. There was no significant change in neurocognitive function between T1 and T2 for all types of IGCT patients in first 1-2 years after PBT. CONCLUSION: Tumor location significantly affects the neuropsychological functioning in patients with IGCT. Neuropsychological functioning should be closely monitored from the time of diagnosis in IGCT patients.

Negative Public Attitudes Towards Cancer Survivors Returning to Work: A Nationwide Survey in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Early diagnosis and an improved survival rate have emerged as important issues for cancer survivors returning to work during the prime of their working life. This study investigated the attitudes of the general public towards cancer survivors returning to work in Korea and attempted to identify the factors influencing this negative attitude. MATERIALS AND METHODS: A general public perception survey regarding cancer survivors returning to work, targeting 2,000 individuals between 40-70 years of age, was conducted as face-to-face home visit. RESULTS: The public expressed a negative attitude towards cancer survivors returning to work, in terms of both perception and acceptance. Negative perception was higher among those in metropolitan areas compared with urban/rural areas (odds ratio [OR], 1.71), with monthly incomes $4,000 (OR, 1.54), and with patient care experience compared with those without (OR, 1.41). Negative acceptance was higher among those with monthly incomes $4,000 (OR, 1.71) and those with patient care experience compared with those without (OR, 1.54). The common factors between acceptance and perception that influenced negative attitude included area of residence, patient care experience, and monthly income. CONCLUSION: This study identified negative attitudes towards cancer survivors returning to work in South Korea and the factors influencing the reintegration of cancer survivors into society. It is necessary to promote community awareness and intervention activities to enable access to community, social, and individual units for the social reintegration of cancer survivors.

Clinical Case Conference / 신경정신의학

No abstract available.

Overview of Psychopharmacotherapy for Cancer Patients / 신경정신의학

Cancer patients experience various physical and psychological symptoms, which can be alleviated by psychotropic medications. In the process of developing the recommendations for distress management in cancer patients, the Korean psycho-oncology research group performed systematic reviews on the oncological psychopharmacotherapy literature. This study describes the general principles and some practical suggestions.

Anxiety and Pharmacological Interventions in Cancer Patients : Systematic Review / 신경정신의학

OBJECTIVES: Cancer patients experience various types of anxiety, from normal fears to pathological anxiety, through the entire process of the illness. This anxiety requires attention, because it may interfere with their cancer treatment and result in a negative impact on quality of life. The present paper aimed to provide an overview of current pharmacotherapy for anxiety in the oncology setting, by systematically reviewing the related literature. METHODS: We searched both international and Korean domestic databases with the search terms "cancer", "anxiety", and "pharmacological treatment", targeting between 1980 and 2008, and graded the evidence levels according to the Scottish Intercollegiate Guideline Network (SIGN). RESULTS: Of 215 studies searched, we selected only 22 pharmacological clinical studies. There was no meta-analysis or systematic review of psychopharmacotherapy for anxiety disorders among cancer patients. Also, we reviewed a few expert opinions and available clinical trials on anxiety in general. CONCLUSION: Based on the limited evidence, the present review provides an understanding and some recommendations for treating anxiety in cancer patients. Further investigation of psychopharmacotherapy for anxiety in cancer patients is warranted, to develop evidence-based guidelines for comprehensive cancer care.

Pharmacological Treatment for Sleep Disturbance in Patients with Cancer : A Systematic Review / 신경정신의학

OBJECTIVES: Sleep disturbance constitutes a significant and relatively common source of suffering for cancer patients. It is a challenge for oncologists to address this troubling symptom with pharmacotherapy's limited evidence base. This paper systematically reviewed the literature for evidence of pharmacological treatment of sleep disturbances in this population. METHODS: We searched international and domestic databases using the search terms "cancer", "sleep disturbance", and "pharmacological intervention", limiting the search to English- and Korean-language articles published between 1980 and 2008. Included studies were intervention studies, systematic reviews, and meta-analyses on pharmacological treatment for the sleep disturbance of adult patients suffering various medical conditions, including cancer. We graded the included studies according to Scottish Intercollegiate Guideline Network (SIGN) methodology checklists. RESULTS: Of the 223 studies searched, we only 7 studies met the criteria : 1 systematic review and 6 (85.7%) intervention studies. Among currently prescribed medications for sleep disturbance, only a few have been studied in patients with cancer, and their long-term follow-up data was not available. CONCLUSION: Based on available literature, the evidence in favor of pharmacological treatment for sleep disturbance (in cancer patients) is weak. Further studies containing long-term follow-up data should be conducted.

Focus Group Study on Psychosocial Distress of Cancer Patients / 성인간호학회지

PURPOSE: The purpose of the study was to describe psychosocial difficulties experienced by cancer patients. METHODS: Three focus group interviews were conducted to collect the data from 19 outpatients with cancer undergoing treatments during 2009. All interviews were audio-recorded and transcribed verbatim. The data were analyzed using constant comparative analysis of grounded theory. RESULTS: As a result of constant comparative analysis, 'psychosocial distress' was identified as a core category, and seven subcategories were identified. 'Plunged into negative emotions' and 'damaged self-identity' were identified as major categories in the individual dimension. 'Difficulty in dealing with diagnosis' and 'hasty expectations and concerns' were identified in the dimension of family. 'Inefficient communication' and 'lack of necessary information' were identified in the dimension of health care setting. 'Lonely journey into a strange territory' was identified in the dimension of society. CONCLUSION: The results of the study indicate that cancer patients experience a wide range of psychosocial problems. Thus, in assessing and relieving psychosocial distress of cancer patients, it is necessary to focus not only on the level of the individual but also on the levels of family, health care setting, and society in general is necessary.

History and Current Status of Psycho-Oncology / 신경정신의학

Cancer statistics shows a high risk and increasing incidence of cancer among Koreans. Considerable burdens related to cancer and its treatment causes significant psychosocial distress among cancer patients and their family. Due to early detection and progress in cancer treatments, cancer is becoming a chronic illness and the quality of life and long-term impact of cancer is receiving increasing attention. Psycho-oncology is a subspecialty of oncology that addresses a psychosocial dimension of cancer throughout 'the continuum of cancer care', viz. from prevention and early detection to palliative and end-of-life care. This paper reviews the development of psycho-oncology and its current status in international and national context so as to promote efforts toward an integrative cancer care in Korea.

Developmental Changes in the Activation of Signal Transduction Pathway via JNK in Rat Hippocampus after Kainic Acid-Induced Seizure / 신경정신의학

OBJECTIVE: We observed the developmental pattern of activation of MAPK signal transduction pathways known to be activated by electroconvulsive shock(ECS) in young rat hippocampus after kainic acid(KA)-induced seizure. METHODS: We used the method of immunoblotting for examining the basal protein amount and basal level of phosphorylation of MAPK kinase(SAPK/ERK kinase -1, SEK-1), MAPK(c-Jun N terminal protein kinase, JNK), transcription factor(c-Jun) and immediate early gene proteins(Fos) in rat hippocampus at postnatal day 7, 14, and 21, respectively. We also examined the changes of phosphorylation of those proteins after kainic acid-induced seizure in the same way. RESULTS: The basal protein amounts of SEK-1, JNK, and c-Jun did not show age-dependent changes and basal level of phosphorylation of JNK and c-Jun remains unchanged throughout the early developmental period. The basal level of phosphorylation of SEK-1 was peaked at postnatal 7 days and then decreased with aging. After kainic acid-induced seizure, the change of phosphorylation of JNK was not observed but those of SEK-1 and c-Jun increased after postnatal day 14. The expression of Fos was observed at postnatal day 7 and also increased with aging. CONCLUSION: These results show that the MAPK signal transduction system in rat hippocampus matures in accordance with aging, but the process of maturation differs depending specific proteins. This study suggests the signal transduction cascade(SEK-1 - JNK - c-Jun - Fos) which is well established in cell line studies may not be applied to rat hipposcampus because we could not observe the activation of JNK after KA-induced seizure in young rat hippocampus.

The Induction of Immediate Early Genes and Phosphorylation of p42, p44 MAPK and Elk-1 by Kainic Acid in Developing Rat Hippocampus / 신경정신의학

OBJECTIVES: In order to investigate the maturational process of intracellular signal transduction system in rat brain, we studied the induction of the immediate early genes(IEGs)c-fos, junB, and TIS1 in each developmental stage after kainic acid(KA)induced seizure in young rat hippocampus and then compared these with the results after electroconvulsive shock(ECS) And to elucidate the induction mechanism of c-fos via mitogen-activated protein kinase(MAPK)by KA in each developmental stage, we investigated the phosphorylation of p42, p44 MAPK and Elk-1 after KA treatment in young rat hippocampus. METHODS: We examined the induction patterns of IEGs by northern blot analysis, and the phosphorylation of p42, p44 MAPK and Elk-1 by immunoblotting in rat hippocampus at post-natal day 7, 14, and 21(P7, P14 & P21) respectively after intraperitoneal injection of KA. RESULTS: Unlike ECS, KA did not induce c-fos, junB, and TIS1 in P7 hippocampus. But these genes were apparently induced at P14 and to an adult level at P21. These three IEGs showed similar temporal patterns of induction in each developmental stage. Although the basal level of phosphorylated 42p, 44p MAPK was considerable in P7 rat hippocampus, the increase of phosphorylation after KA treatment was observed at P14 . While the phosphorylation of Elk-1 was detected with high basal level in P7 rat, the amount of phosphorylated Elk-1 was not changed after KA treatment. CONCLUSION: Our results suggest that the differences in IEGs induction patterns between KA and ECS may be due to the differences in the activated signal transduction pathways. And our results also implicate that the signal transduction system involved in MAPK phosphorylation after KA treatment mature with aging and c-fos induction via MAPK activation may be regulated through some pathways other than Elk-1 in rat hippocampus.

Chromosomal abnormalities in child psychiatric patients

To determine the frequency of chromosomal abnormalities in a child psychiatric population, and to evaluate possible associations between types of abnormalities and patient's clinical characteristics, cytogenetic examination was performed on 604 patients. Demographic data, reasons for karyotyping, clinical signs, and other patient characteristics were assessed and correlated with the results from karyotyping. Chromosomal abnormalities were found in 69 patients (11.3%); these were structural in 49 cases and numerical in 20. Inversion of chromosome nine was found in 15 subjects, trisomy of chromosome 21 in 11, and fragile X in five patients. When karyotyping was performed because of intellectual impairment or multiple developmental delay, significantly more abnormalities were found than average; when performed because autistic disorder was suspected, the number of abnormalities was significantly fewer. There were no differences in clinical variables between structural and numerical abnormalities, nor among nine types of chromosomal abnormalities, except that numerical abnormalities and polymorphism were found at a later age, and that walking was more delayed and IQ was lower in patients with Down syndrome. Clinicians should be aware of the possible presence of chromosomal abnormalities in child psychiatric populations; the close collaboration with geneticists and the use of more defined guidelines for cytogenetic investigation are important.

Development of the Korean form of toddler temperament scale / 신경정신의학

No abstract available.