[Alcohol consumption during the COVID-19 pandemic among French-speaking Belgian students : uncertainty and psychological distress]. / Face à la COVID-19. Consommation d'alcool pendant la pandémie de COVID-19 chez les étudiants belges francophones : incertitude et détresse psychologique.

The COVID-19 pandemic has had a deleterious impact on students. Studies showed an increase in anxiety-depressive symptoms and changes in certain health behaviours (smoking, drugs, etc.). The aim of the present study is to measure whether students' alcohol consumption changed during the third confinement (frequency and quantity) in relation to the factor of intolerance to uncertainty. The study was conducted on a sample of 273 French-speaking Belgian students (Universities and High Schools). The students answered questionnaires measuring their psycho-emotional state, alcohol consumption and intolerance of uncertainty and its mechanisms. Results showed that 65 % of the students had anxiety symptoms. Alcohol consumption remained moderate, with 85 % having not changed the frequency of consumption and 89 % their quantity of alcohol. Finally, the results indicated that the increase in alcohol consumption was essentially linked to positive expectations about the effects of alcohol, but not to measures of anxiety or intolerance of uncertainty. The study highlights the need for national prevention strategies to detect psychological distress in post-pandemic students.

La pandémie de COVID-19 a eu un impact délétère sur les étudiants. Les études montrent une augmentation de symptômes anxio-dépressifs et la modification de certains comportements de santé (tabac, drogue, etc.). L'objectif de la présente étude est de mesurer si la consommation d'alcool des étudiants a changé durant le troisième confinement (fréquence et quantité) en lien avec le facteur d'intolérance à l'incertitude. L'étude a été menée sur un échantillon de 273 étudiants belges francophones (Universités et Hautes Ecoles). Les étudiants ont répondu à des questionnaires mesurant leur état psycho-émotionnel, la consommation d'alcool et l'intolérance à l'incertitude et ses mécanismes. Les résultats montrent que 65 % des étudiants ont des symptômes anxieux. La consommation d'alcool reste modérée avec 85 % n'ayant pas modifié la fréquence de consommation et 89 % leur quantité d'alcool. Enfin, les résultats indiquent que l'augmentation de la consommation d'alcool était essentiellement liée aux attentes d'effets positifs de l'alcool, mais pas en lien avec les mesures d'anxiété ou d'intolérance à l'incertitude. L'étude met en évidence l'importance de mettre en place des stratégies nationales de prévention pour détecter la détresse psychologique des étudiants post-pandémie.

'We're outside the norm again because of the thing that allowed us to be inside the norm': An interpretative phenomenological analysis of the experience of developing an alcohol use disorder after bariatric surgery.

Studies indicate that bariatric surgery is associated with an increased risk of alcohol use disorder (AUD). It is considered some patients develop the disorder after surgery, without having antecedents of preoperative alcohol problems. This qualitative study aimed to explore the experiences of people who developed AUD postoperatively and understand how they make sense of the onset of this disorder. A semi-directed interview was carried out with eight adults who had undergone bariatric surgery and developed AUD de novo postoperatively. Data were analysed using interpretative phenomenological analysis. Four superordinate themes emerged: (1) 'losing control over drinking and self after surgery'; (2) 'feelings of guilt, shame and loss contrasted with perceptions of still being lucky'; (3) 'trying to make sense of the onset of AUD'; and (4) 'retrospective evaluation of bariatric surgery and preoperative information'. These themes indicated loss of control was a central aspect of participant's experiences of postoperative alcohol consumption. AUD was associated with negative emotions and cognitions, but several participants still considered themselves lucky. All tried to make sense of this disorder's onset; many felt they would not have developed AUD if they had not undergone surgery. The onset of AUD influenced their current perceptions and feelings about surgery and the preoperative information regarding AUD risks. Taken together, these results provide insight into the subjective experience of suffering from new-onset AUD post-surgery. However, more studies are necessary to gain a better understanding of the physical and psychological implications of postoperative AUD.

Patients' perceptions of the mechanisms underlying alcohol use problems after bariatric surgery: A qualitative systematic review.

Alcohol-related problems increase after bariatric surgery. The objective of this review was to synthesize findings of qualitative studies on patients' perceptions of the mechanisms leading to problematic alcohol consumption after bariatric surgery. This review followed the Joanna Briggs Institute methodology for systematic review of qualitative evidence. A comprehensive search strategy was performed in MEDLINE, PsycInfo, Scopus and Google Scholar. Study selection, data extraction and critical appraisal of included studies were undertaken by two independent reviewers. Confidence in review findings was assessed using the ConQual approach. Four studies were included in this review and led to the development of four synthesized results: (1) persistence or reappearance of psychological problems after bariatric surgery; (2) using alcohol as a coping strategy, sometimes as a replacement for food; (3) changes in the physiological response to alcohol; and (4) importance of increased information about alcohol-related risks and long-term counselling. Confidence in the synthesized results ranged from moderate to low. The results indicated postoperative problematic alcohol consumption is a complex issue, involving psychological and physiological mechanisms. Several recommendations are formulated based on the results obtained. More qualitative and quantitative studies are needed to better understand this phenomenon given the few existing qualitative studies on this topic and some divergent results found between qualitative and previous quantitative research.

At the Peak of the Second Wave of COVID-19, Did Millennials Show Different Emotional Responses from Older Adults?

The COVID-19 pandemic disturbs mental health. Indeed, higher levels of negative emotions and anxiety, along with lower levels of positive emotions and well-being, have been highlighted. As a result, individuals need to regulate these psychological states in a context of uncertainty and daily restrictions (e.g., access to leisure activities, social contacts) or modifications of livelihood (e.g., working modalities). Overall, psychological reactions to the pandemic have been shown to differ based on one's age. The purpose of this research is to compare psychological reactions to the pandemic between Millennials (born between 1981 and 1996) and Older Adults. The generation's prism seems relevant as members of specific generations are shaped (e.g., views of the world, the future) by their similar experiences. Ninety-four Millennials and 129 Older Adults, recruited in the general population, participated to an online survey assessing emotions, emotion regulation strategies, environmental satisfaction, and intolerance of uncertainty. Results show that Millennials experience higher levels of negative emotions along with higher levels of worry and rumination than Older Adults. Millennials also report a higher level of joy. Nonetheless, more Older Adults engage themselves in novel activities. Overall, findings confirm previous ones and indicate the need to offer effective clinicals tool to prevent mental health worsening.

COVID-19 and Its Lockdown in Belgium: How Limited Access to Environmental Satisfaction Impacts Emotions?

The COVID-19 pandemic has been shown to induce several psychological consequences (e.g., increases in anxiety and stress). Accordingly, it seems relevant to investigate how individuals cope with their emotions. Indeed, when facing negative emotions, individuals need to rely on adaptive emotion regulation strategies to alleviate their negative impacts (e.g., decrease in quality of life, increase in sleep disturbances). Moreover, lockdown's measures led to a restriction of the access to activities which, in turn, might have decreased the "environmental satisfaction". Then, this research investigates the pandemic's psychological impacts on emotions and regulation strategies, intolerance of uncertainty, and environmental satisfaction. Our approach's originality relies on comparing one's actual psychological functioning (i.e., since the pandemic) to one's general psychological functioning (i.e., before the pandemic). This study also assesses the relationships between both negative and positive emotions and (1) emotion regulation strategies, (2) intolerance of uncertainty and, (3) environmental satisfaction since the pandemic and its lockdown. The total sample comprised 948 adults from the general population. Results show that, since the pandemic, individuals experience higher levels of negative emotions, lower levels of positive emotions and environmental satisfaction. They also tend to worry less and to resort to acceptance more often. Also, environmental satisfaction is the most important predictor of both negative emotions and positive ones. Overall, findings confirm previous ones and seem to indicate that environmental satisfaction should be addressed more thoroughly.

The Impact of Virtual Reality Exposure on Stress Level and Sense of Competence in Ambulance Workers.

Virtual reality (VR) exposure is used in clinical psychology to treat anxiety disorders. It is also used to enhance resilience in soldiers by allowing them to confront virtual combat environments to help fortify them against the negative consequences of trauma exposure. Most VR studies have focused on military and emergency medical staff; however, thus far, none have investigated VR in ambulance workers (AWs), who are confronted with traumatic situations daily. The current study aimed to assess the impact of a single VR exposure session on self-perceived competence and stress level in a sample of AWs. Participants (N = 40) were randomly assigned to either a VR immersion (i.e., experimental group, n = 20) or an audio immersion (i.e., control group, n = 20) of a shooting attack situation. We hypothesized that compared to controls, VR participants would report decreased anxiety, as measured using visual analog scales, as well as an increased sense of competence. The results showed a significant reduction in fear in both groups, d = 0.33, and an increased sense of competence in VR participants, d = 0.35. Although our hypotheses were only partially confirmed, the observed beneficial effects of VR and the audio immersion on stress levels in AWs suggest that VR exposure could be a useful way to increase resilience in AWs.

[The assessment of somatic symptoms and distress among parents of a childhood cancer survivor]. / Évaluation des symptômes somatiques et de la détresse des parents d'un enfant en rémission de cancer.

INTRODUCTION: Studies on somatic symptoms among parents of a childhood cancer survivor are less developed in the literature. The purpose of the study is to examine the somatic symptoms intensity (i.e. physical symptoms aggravated by emotional or psychological factors) and its associations with anxious and depressive symptoms and worries. METHODS: Sixty-one parents of a childhood cancer survivor (since 4-years until 6-years of survivorship) participated in this transversal and quasi-experimental study. Parents filled in three clinical questionnaires assessing their anxious, depressive and somatic symptoms and their worries related to the child's health evolution. RESULTS: Parents suffered mainly from a loss of energy and insomnia in the middle of the night. Significant correlations between somatic symptoms and anxious and depressive symptoms were observed. Lastly, depressive symptoms seem to be a significant factor to predict the level of somatic symptoms. CONCLUSION: Recommendations for the management of parents of a childhood cancer survivor have been published. However, longitudinal studies focused on parents are still necessary to improve preventive initiatives and the management of these families.

Alcohol Craving in Heavy and Occasional Alcohol Drinkers After Cue Exposure in a Virtual Environment: The Role of the Sense of Presence.

The development of new technologies, and more specifically the opportunity to immerse participants in virtual controlled environments, provides a new ecological framework for researchers to study complex behaviors. This experiment aimed to compare post-immersion craving in occasional and heavy alcohol drinkers. Twenty-two occasional drinkers and eighteen heavy drinkers were recruited and immersed in a virtual bar, including alcoholic beverages. After the exposure, heavy drinkers reported a significantly higher craving than occasional drinkers. Post-immersion alcohol craving was significantly related to the levels of perceived ecological validity of the virtual environment. Finally, a moderation analysis suggested that the levels of craving more strongly increased with perceived ecological validity in heavy drinkers than in occasional drinkers. Therefore, the perceived ecological validity was an important experimental parameter to study craving in a virtual environment. These results further suggested that virtual reality might be a useful tool for both the scientific study of alcohol addiction and the treatment of alcohol dependence and relapse.

[Acceptability of neonatal screening of the sickle cell disease during the pandemic of COVID-19 in Kisangani, Democratic Republic of the Congo]. / Acceptabilité du dépistage néonatal de la drépanocytose au cours de la pandémie au COVID-19 à Kisangani, en République Démocratique du Congo.

INTRODUCTION: the implementation of neonatal screening to identify infants with sickle cell disease during the COVID-19 pandemic is a major challenge in the Democratic Republic of the Congo (DRC). The purpose of this study is to determine whether socio-economic factors are associated with acceptability of newborn screening to identify infants with sickle cell disease during the COVID-19 pandemic in Kisangani, DRC. METHODS: we conducted an observational study of mothers sensitized to neonatal screening to detect sickle cell disease in their newborns with hemotypeSCTM (HT401RUO-USA). The study was carried out at the maternity wards in Kisangani from March 21st to June 30th 2020. Collected data were parity, educational level, age, socio-economic level, occupation, awareness and the reason for the denial of screening. RESULTS: out of 55.5% (273/492) of sensitized mothers, 107 (39.19%) accepted and 166 (60.80%) refused neonatal screening to detect sickle cell disease in their newborn. The reasons for refusal were lack of information (67.5%; 95% CI [59.8-74.5]), lack of money due to confinement (66.3%; 95% CI [58.5-73.4]), blood test to develop a vaccine for protection against COVID-19 (63.2%; 95% CI = [55.4-70.6]). Factors associated with the acceptability of screening were age > 35 years (p = 0.0009; ORa = 3.04; 95% CI = 1.57-5.87) and low socio-economic level (p = 0.0016; ORa = 2.29; 95% CI = 1.37-3.85). CONCLUSION: the acceptability of neonatal screening to detect sickle cell disease during COVID-19 is low in Kisangani. The government should identify effective communication channels to promote health care initiatives.

Acceptabilité du dépistage néonatal de la drépanocytose au cours de la pandémie au COVID-19 à Kisangani, en République Démocratique du Congo

Introduction: l´implémentation du dépistage néonatal de la drépanocytose pendant la pandémie se coronavirus (COVID-19) représente un défi majeur en République Démocratique du Congo (RDC). La présente étude vise à déterminer si des facteurs socio-économiques sont associés à l´acceptabilité du dépistage néonatal de la drépanocytose pendant la COVID-19 à Kisangani, en RDC. Méthodes: étude observationnelle conduite dans les maternités de Kisangani du 21 mars au 30 juin 2020 chez les mères sensibilisées au dépistage néonatal de la drépanocytose de leurs nouveau-nés à l´hemotypeSCTM (HT401RUO-USA). Les données recueillies étaient la parité, le niveau d´étude, l´âge, le niveau socio-économique, la profession, la notion de sensibilisation et le motif du refus du dépistage. Résultats: sur 55,5% (273/492) des mères sensibilisées, 107 (39,19 %) ont accepté et 166 (60,80 %) ont refusé le dépistage néonatal de la drépanocytose chez leur nouveau né. Les motifs du refus étaient l´absence d´information (67,5%;IC 95% [59,8-74,5]), le manque d´argent dû au confinement (66,3%;IC 95% [58,5-73,4]), la prise de sang pour tentative du vaccin anti-COVID-19 (63,2%; IC 95% = [55,4-70,6]). Les Facteurs associés à l´acceptabilité du dépistage étaient l´âge > 35 ans (p = 0,0009; ORa = 3,04; IC 95% = 1,57-5,87) et le bas niveau socio-économique (p = 0,0016; ORa = 2,29; IC à 95% = 1,37-3,85). Conclusion: l´acceptabilité du dépistage néonatal de la drépanocytose pendant la COVID-19 reste faible à Kisangani. Le gouvernement devrait identifier les canaux de communication efficaces afin de promouvoir les initiatives dans le secteur de la Santé

Considering Patients' Empowerment in Chronic Care Management: A Cross-Level Approach.

This paper consists of an analysis of the concept of empowerment-which is often defined as a key issue in health care-at the macro, meso, and micro levels by focusing on health care reform in Belgium. Three research teams collected data and combined them in an inductive secondary analysis. Our preliminary results demonstrate that patient empowerment does not always encompass the same scientific reality. At the macro level, this concept is linked to the authorities' wish to support at-home care for chronic patients. At the meso level, the role of caregivers in maintaining patients' autonomy, but also the social conditions of their lives, is a salient component of empowerment. At the micro level, individual and personal features such as identity can influence patient empowerment and behavior in the health care system. This cross-level research suggests that patient empowerment is not sufficiently clearly defined at each level of the care production chain, which could impede the reform of health care. This paper underlines the polysemy of a concept viewed as a milestone in European health care policy and the necessity of a clear, collective definition to operationalize and implement it.

Intolerance of uncertainty in parents of childhood cancer survivors: A clinical profile analysis.

PURPOSE: This research aimed to investigate the psychological adjustment related to the risk factor of intolerance of uncertainty in parents of childhood cancer survivors. DESIGN: Participants were mothers (N = 45) and fathers (N = 16) of a childhood cancer survivor (from 4 until 6 years of cancer remission). Parents completed measures of intolerance of uncertainty and its associated factors (positive beliefs about worry, cognitive avoidance, rumination, and problem solving), measures of psychological distress (anxiety, depression somatization, and worries), and performed two Stroop tasks. FINDINGS: A substantial subgroup of parents reported clinical levels of psychological distress and 64% reported a significant level of intolerance of uncertainty. Parents presented a high profile for intolerance of uncertainty (generalized anxiety disorder [GAD] profile) were those who had a high level of distress associated with ineffective psychological adjustment. CONCLUSION: The data are supportive of brief intervention to reduce intolerance of uncertainty. Sensitizing health care professionals to the identification of intolerance of uncertainty and its associated factors is essential for efficient intervention strategies.

Intolerance of uncertainty as the vulnerability factor among parents of childhood cancer survivors: A 3-month follow-up study.

PURPOSE: In a 3-month follow-up study, we assessed the intolerance of uncertainty in 61 parents of a childhood cancer survivor. The objective was to compare its prevalence over time. We tested these parents twice i.e., at treatment completion (time 1) and 3 months later (time 2). We hypothesized that this personality factor stayed stable and had aversive effects on cognitive processes. FINDINGS: Noticeable intolerance of uncertainty rates were found. At both assessments, results showed that this factor was central in the development of excessive worries, poor problem orientation, rumination, cognitive avoidance and positive beliefs about worry. Repeated measures revealed a decrease for anxiety and cognitive avoidance, and an increased level for somatic symptoms. CONCLUSIONS: Parents who are intolerant of uncertainty are at risk to display dysfunctional behaviors over time. Sensitizing health care professionals to the identification of this factor and its associated difficulties is essential for the implementation of efficient intervention strategies.

Implementation of a 2-Day Simulation-Based Course to Prepare Medical Graduates on Their First Year of Residency.

OBJECTIVES: Residents beginning their specialization in pediatrics and emergency medicine (EM) are rapidly involved in oncall duties. Early acquisition of crisis resource management by novice residents is essential for patient safety, but traditional training may be insufficient. Our aim was to investigate the impact of a 2-day simulation-based course on residents to manage pediatric and neonatal patients. METHODS: First year residents participated in the course. They completed two questionnaires concerning perceived stress and self-efficacy in technical skills (TSs) and non-TSs (NTSs) at 3 times: before (T0), after (T1), and 6 weeks after the course (T2). RESULTS: Eleven pediatric and 5 EM residents participated. At T0, stress about "communicating with parents" (P = 0.022) and "coordinating the team" (P = .037) was significantly higher among pediatric compared with EM residents; self-efficacy was not different between the specialities. After training, perceived stress about "managing a critical ill child" and perceived stress total significantly decreased among EM residents, whereas it remained the same among pediatricians (respectively, P = 0.001 and P = 0.016). Regarding self-efficacy, it had significantly increased in both groups (P < 0.001). Specifically, the increase in TSs self-efficacy was significant after the training (p = .008) and after 6 weeks (p < .001), and the increase in NTs self-efficacy was only significant after 6 weeks (P = 0.014). CONCLUSIONS: Our course improved perceived stress, TSs, and NTSs self-efficacy of residents. This encourages us to formalize this as a prerequisite for admission to the pediatric and EM residency.

Group interventions to reduce emotional distress and fatigue in breast cancer patients: a 9-month follow-up pragmatic trial.

BACKGROUND: Long-term effects of psychosocial interventions to reduce emotional distress, sleep difficulties, and fatigue of breast cancer patients are rarely examined. We aim to assess the effectiveness of three group interventions, based on cognitive behavioural therapy (CBT), yoga, and self-hypnosis, in comparison to a control group at a 9-month follow-up. METHODS: A total of 123 patients chose to participate in one of the interventions. A control group was set up for those who agreed not to participate. Emotional distress, fatigue, and sleep quality were assessed before (T0) and after interventions (T1), and at 3-month (T2) and 9-month follow-ups (T3). RESULTS: Nine months after interventions, there was a decrease of anxiety (P=0.000), depression (P=0.000), and fatigue (P=0.002) in the hypnosis group, and a decrease of anxiety (P=0.024) in the yoga group. There were no significant improvements for all the investigated variables in the CBT and control groups. CONCLUSIONS: Our results showed that mind-body interventions seem to be an interesting psychological approach to improve the well-being of breast cancer patients. Further research is needed to improve the understanding of the mechanisms of action of such interventions and their long-term effects on quality of life.

Cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy: A longitudinal cohort study.

OBJECTIVE: Despite the well-known negative impacts of cancer and anticancer therapies on cognitive performance, little is known about the cognitive compensatory processes of older patients with cancer. This study was designed to investigate the cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy. METHODS: We assessed 89 consecutive patients (age ≥ 65 y) without severe cognitive impairment and 89 age-, sex-, and education level-matched healthy controls. Cognitive compensatory processes were investigated by (1) comparing cognitive performance of patients and healthy controls in novel (first exposure to cognitive tasks) and non-novel (second exposure to the same cognitive tasks) contexts, and (2) assessing psychological factors that may facilitate or inhibit cognitive performance, such as motivation, psychological distress, and perceived cognitive performance. We assessed cognitive performance with the Trail-Making, Digit Span and FCSR-IR tests, psychological distress with the Hospital Anxiety and Depression Scale, and perceived cognitive performance with the FACT-Cog questionnaire. RESULTS: In novel and non-novel contexts, average cognitive performances of healthy controls were higher than those of patients and were associated with motivation. Cognitive performance of patients was not associated with investigated psychological factors in the novel context but was associated with motivation and psychological distress in the non-novel context. CONCLUSIONS: Older, clinically fit patients with hematologic malignancies undergoing chemotherapy demonstrated lower cognitive compensatory processes compared to healthy controls. Reducing distress and increasing motivation may improve cognitive compensatory processes of patients in non-novel contexts.

A Nonrandomized Comparison Study of Self-Hypnosis, Yoga, and Cognitive-Behavioral Therapy to Reduce Emotional Distress in Breast Cancer Patients.

The authors asked breast cancer (BC) patients to participate in 1 of 3 mind-body interventions (cognitive-behavioral therapy (CBT), yoga, or self-hypnosis) to explore their feasibility, ease of compliance, and impact on the participants' distress, quality of life (QoL), sleep, and mental adjustment. Ninety-nine patients completed an intervention (CBT: n = 10; yoga: n = 21; and self-hypnosis: n = 68). Results showed high feasibility and high compliance. After the interventions, there was no significant effect in the CBT group but significant positive effects on distress in the yoga and self-hypnosis groups, and, also, on QoL, sleep, and mental adjustment in the self-hypnosis group. In conclusion, mind-body interventions can decrease distress in BC patients, but RCTs are needed to confirm these findings.

The role of parental anxiety sensitivity and learning experiences in children's anxiety sensitivity.

This study evaluated the impact of the mother's and father's anxiety sensitivity (AS) and learning experiences on children's AS, and the influence of two moderators: the children's femininity orientation and the children's emotional intelligence (EI). The sample comprised 200 non-clinical children, aged 9-13 years, and their parents (mothers and fathers). Results revealed that the effect of parental AS on children's AS is moderated by the children's EI for maternal AS and by their femininity traits for paternal AS. Learning experiences following somatic sensations influenced the children's level of AS. More specifically, special attention by parents following a child's somatic sensations (reinforcement and transmission of information) was associated with high AS in children. Parental reactions of fear following a parent's somatic sensations (modelling) seem to predict higher scores for AS when the link is moderated by the child's femininity orientation. The implications of these findings are discussed. Statement of contribution What is already known on this subject The influence of parental factors in child's AS has been demonstrate, but these studies are limited. Specific mechanisms might condition the relationship between child's AS and parental factors. What does this study add? Learning experiences and parental AS influence the child's level of AS. It is important to consider the influence of mothers and fathers in child's AS. Child's emotional intelligence and expressive traits may moderate the effect of parental factors.

Factors associated with self-perceived burden to the primary caregiver in older patients with hematologic malignancies: an exploratory study.

OBJECTIVE: Although cancer patients frequently experience self-perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of self-perceived burden to the primary caregiver (SPB-PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation. METHODS: In total, 166 consecutive patients with hematologic malignancies aged ≥65 years were recruited at the time of chemotherapy initiation. Patients' SPB-PC was assessed using a 100-mm visual analogue scale (VAS). Characteristics potentially associated with SPB-PC, including sociodemographic and medical characteristics, physical functioning status (Karnofsky performance score, activities of daily living (ADL)/instrumental ADL), symptoms (fatigue, pain, nausea, quality of life), psychological distress (Hospital Anxiety and Depression Scale (HADS)), perceived cognitive function (Functional Assessment of Cancer Therapy Cognitive (FACT-Cog) Scale), and patients'/primary caregivers' personal relationship characteristics (family tie, support), were assessed. RESULTS: Thirty-five percent of patients reported moderate to severe SPB-PC (VAS ≥ 50 mm). Patients' SPB-PC was associated with lower Karnofsky performance (ß = -0.135, p = 0.058) and ADL (ß = -0.148, p = 0.037) scores, and higher HADS (ß = 0.283, p < 0.001) and FACT-Cog perceived cognitive impairments subscale (ß = 0.211, p = 0.004) scores. The proportion of explained variance was 23.5%. CONCLUSIONS: Health care professionals should be aware that about one third of older cancer patients experience moderate to severe SPB-PC at the time of chemotherapy initiation. They should adapt their support of patients who report such a feeling. Copyright © 2016 John Wiley & Sons, Ltd.

Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?

INTRODUCTION: Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. PURPOSE: To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. METHODS: Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. RESULTS: A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07-18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31-7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47-14.44; p <0.001). CONCLUSIONS: During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying in older cancer patients.