Supportive care needs and psychological distress and/or quality of life in ambulatory advanced colorectal cancer patients receiving chemotherapy: a cross-sectional study.

BACKGROUND: Although currently many advanced colorectal cancer patients continuously receive chemotherapy, there are very few findings with regard to the supportive care needs of such patients. METHODS: The purposes of this study were to investigate the patients' perceived needs and the association with psychological distress and/or quality of life, and to clarify the characteristics of patients with a high degree of unmet needs. Ambulatory colorectal cancer patients who were receiving chemotherapy were asked to complete the Short-Form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexuality needs), the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS: Complete data were available for 100 patients. Almost all of the top 10 most common unmet needs belonged to the psychological domain. The patients' total needs were significantly associated with both psychological distress (r = 0.65, P < 0.001) and quality of life (r = -0.38, P < 0.001). A multiple regression analysis revealed that the female gender was significantly associated with higher total needs. CONCLUSIONS: The moderate to strong associations that exist between patients' needs and psychological distress and/or quality of life suggest that interventions that respond to patients' needs may be one possible strategy for ameliorating psychological distress and enhancing quality of life. Female patients' needs should be evaluated more carefully.

Effectiveness of a psycho-oncology training program for oncology nurses: a randomized controlled trial.

OBJECTIVE: Oncology nurses are expected to play an important role in psychosocial care for cancer patients. The aim of this study was to examine whether a novel training program aimed at enhancing oncology nurses' ability to assess and manage common psychological problems in cancer patients would improve participants' self-reported confidence, knowledge, and attitudes regarding care of patients with common psychological problems (trial register: UMIN000008559). METHODS: Oncology nurses were assigned randomly to either the intervention group (N = 50) or the waiting list control group (N = 46). The intervention group received a 16-h program, the content of which focused on four psychological issues: normal reactions, clinically significant distress, suicidal thoughts, and delirium. Each session included a role-play exercise, group work, and didactic lecture regarding assessment and management of each problem. Primary outcomes were changes in self-reported confidence, knowledge, and attitudes toward the common psychological problems between pre-intervention and 3 months post-intervention. Secondary outcomes were job-related stress and burnout. Intervention acceptability to participants was also assessed. RESULTS: In the intervention group, confidence and knowledge but not attitudes were significantly improved relative to the control group. No significant intervention effects were found for job- related stress and burnout. A high percentage (98%) of participants considered the program useful in clinical practice. CONCLUSIONS: This psycho-oncology training program improved oncology nurses' confidence and knowledge regarding care for patients with psychological problems. Copyright © 2015 John Wiley & Sons, Ltd.

Medical Decision-Making Incapacity among Newly Diagnosed Older Patients with Hematological Malignancy Receiving First Line Chemotherapy: A Cross-Sectional Study of Patients and Physicians.

BACKGROUND: Decision-making capacity to provide informed consent regarding treatment is essential among cancer patients. The purpose of this study was to identify the frequency of decision-making incapacity among newly diagnosed older patients with hematological malignancy receiving first-line chemotherapy, to examine factors associated with incapacity and assess physicians' perceptions of patients' decision-making incapacity. METHODS: Consecutive patients aged 65 years or over with a primary diagnosis of malignant lymphoma or multiple myeloma were recruited. Decision-making capacity was assessed using the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory-Revised (SICIATRI-R). Cognitive impairment, depressive condition and other possible associated factors were also evaluated. RESULTS: Among 139 eligible patients registered for this study, 114 completed the survey. Of these, 28 (25%, 95% confidence interval [CI]: 17%-32%) were judged as having some extent of decision-making incompetency according to SICIATRI-R. Higher levels of cognitive impairment and increasing age were significantly associated with decision-making incapacity. Physicians experienced difficulty performing competency assessment (Cohen's kappa -0.54). CONCLUSIONS: Decision-making incapacity was found to be a common and under-recognized problem in older patients with cancer. Age and assessment of cognitive impairment may provide the opportunity to find patients that are at a high risk of showing decision-making incapacity.

Prevalence, course and factors associated with delirium in elderly patients with advanced cancer: a longitudinal observational study.

OBJECTIVE: The aim of this study was to investigate the prevalence of delirium on admission, the course of delirium during a 2-week period after admission and factors associated with delirium on admission, among elderly patients with advanced cancer. METHODS: Patients aged ≥ 65 years with incurable lung or gastroenterological cancer and the Eastern Cooperative Oncology Group Performance Status 2 or greater were continuously sampled after admission to a university hospital. Participants were evaluated for DSM-IV-TR delirium by trained psychiatrists and the delirium subtype was assessed using the Delirium Motor Subtype Scale within 4 days after admission and again 2 weeks later. In addition, we assessed associated factors with delirium on admission. RESULTS: Among 73 eligible patients, complete data were available from 61 on admission and 49 after 2 weeks. Twenty-six patients (43%) met delirium criteria on admission (hypoactive: 58%, unspecified: 35%, hyperactive: 4%, mixed: 4%). Of these, 19 (73%) remained delirious 2 weeks later. Of 35 patients without delirium on admission, 21 (60%) remained delirium-free 2 weeks later and 7(20%) became delirious. Overall, 33/61 (54%) developed delirium at some point during the study. Patients receiving steroids at admission were more likely to have delirium (odds ratio = 5.0; 95% confidence interval = 1.5-16). CONCLUSIONS: Given the high prevalence of the delirium, all patients with advanced cancer should be screened for delirium both on admission and regularly thereafter. In addition, medical staff should be aware that steroid use on admission is an additional indicator of elevated risk for delirium.

Good death for children with cancer: a qualitative study.

OBJECTIVE: This study aims to explore the characteristics of a good death for children with cancer. METHODS: A total of 10 pediatric cancer survivors, 10 bereaved family members and 20 medical professionals participated in in-depth interviews. Qualitative content analysis was performed on the transcribed data obtained from semi-structured interviews. RESULTS: Thirteen characteristics including unique and specific for children of a good death were identified: (i) sufficient opportunities to play freely, (ii) peer supporters, (iii) continued access to the patient's usual activities and relationships, (iv) assurance of privacy, (v) respect for the patient's decisions and preferences, (vi) a sense that others acknowledge and respect the patient's childhood, (vii) comfort care to minimize distressing symptoms, (viii) hope, (ix) not aware of the patient's own impending death, (x) constant dignity, (xi) strong family relationships, (xii) no sense of being a burden to family members and (xiii) good relationships with medical staffs. CONCLUSIONS: This study identifies important characteristics of a good death for children with cancer. These findings may help medical staffs provide optimal care for children with cancer and their families, enabling them to achieve a good death.

Difference of patient's perceived need in breast cancer patients after diagnosis.

OBJECTIVE: The purpose of this study was to investigate the difference of patients' perceived needs after cancer diagnosis. Differences in quality of life and psychological distress were also examined. METHODS: Ambulatory breast cancer patients who were randomly selected participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey, which covers five domains of need (health system and information, psychological, physical, care and support and sexuality needs), the European Organization for Research and Treatment of Cancer QLQ-C 30 and the Hospital Anxiety and Depression Scale. RESULTS: A total of 408 patients were enrolled and distributed into four groups [Group 1 (N = 115)], within 1 year of diagnosis; Group 2 [N = 105], 1-3 years since diagnosis; Group 3 [N = 94], >3 years since diagnosis; and Group 4 [N = 94], recurrence). Significant differences were observed in total, psychological, physical and daily living, and patient care and support needs, as well as in quality of life, whereas there were no significant differences in health system and information, sexuality needs and psychological distress. In general, Groups 1 and 4 had a higher need level and lower quality of life. CONCLUSIONS: Patients' perceived needs and quality of life may vary according to time since cancer diagnosis and the presence of cancer recurrence. The findings suggest that different care for supporting breast cancer survivors after diagnosis should be recommended, and that the time since diagnosis and/or the presence of recurrence may be relevant indicators for providing optimal and individualized care.

Oncology nurses' recognition of supportive care needs and symptoms of their patients undergoing chemotherapy.

OBJECTIVE: To assess the accuracy of oncology nurses' recognition of supportive care needs and symptoms of their patients undergoing chemotherapy. METHODS: The participants comprised randomly selected cancer outpatients receiving chemotherapy in an ambulatory setting and 17 oncology nurses working in two chemotherapy units in Japan. For assessment of the patients' supportive care needs and symptoms, the patients were asked to respond to a validated self-administered questionnaire. The oncology nurses completed a survey in which they indicated their perception of the level of the same set of needs or symptoms. The two data sets obtained from the patients and nurses were compared statistically to assess the accuracy of the oncology nurses' recognition of their patients' needs and symptoms. RESULTS: Complete data sets were available for 439 patients. The most common primary cancers were breast cancer (36.0%), followed by colorectal (24.4%) and lung (12.3%) cancers. Nurses' awareness of their patients' supportive care needs and physical and psychological symptoms were less than optimal in routine care. In particular, psychological symptoms and support needs for these symptoms were markedly under-recognized. Physical symptoms associated with chemotherapy, such as hair loss, appetite loss and fatigue, were better recognized than symptoms not specific to chemotherapy, such as constipation, insomnia, dyspnea and pain. CONCLUSIONS: Oncology nurses' recognition may not accurately reflect their patients' supportive care needs and symptoms in routine practice. In clinical practice, it may be beneficial to conduct routine screening of patients' perceived needs and symptoms comprehensively using self-administered questionnaires.

Clinical indicators of depression among ambulatory cancer patients undergoing chemotherapy.

OBJECTIVE: This study aimed to investigate clinical indicators of depression among randomly selected ambulatory patients with cancer who were receiving chemotherapy. METHODS: The patients were asked to complete the Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer QLQ-C 30 and an ad hoc questionnaire regarding several additional common chemotherapy-related symptoms. RESULTS: Complete data were available for 211 patients. Of the total, 13.7% patients experienced clinical depression. The presence of clinical depression was significantly associated with patient demographic characteristics (education level) as well as several symptoms such as the presence of pain, sleep disturbances, loss of appetite, nausea and fatigue. Multivariate logistic regression analysis indicated that a lower education level and the presence of pain were significantly associated with clinical depression. CONCLUSIONS: These findings suggest that ambulatory cancer patients who are receiving chemotherapy and have pain and/or a lower education level have a higher probability of suffering from clinical depression; these factors may be useful for the early identification of depression in cancer patients.

Perceived needs, psychological distress and quality of life of elderly cancer patients.

OBJECTIVE: Very few findings regarding the perceived needs of elderly cancer patients have been reported. This study investigated needs and psychological distress perceived by and/or quality of life of elderly cancer patients. METHODS: Randomly selected ambulatory patients with cancer participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexual); the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer QLQ-C 30. RESULTS: Complete data were available for 619 cancer patients, including 113 subjects who were over 70 years old. The needs and the psychological distress perceived by the elderly patients were comparable with those perceived by relatively younger patients, although elderly patients perceived fewer sexual needs. Regarding the quality of life global health status, most symptom-related quality of life parameters were not significantly different between the two groups, while significant differences were observed with regard to several functional domains, including physical, emotional and social domains in addition to financial difficulties. CONCLUSIONS: Only a few differences in the needs and the psychological distress perceived by patients existed between the elderly and the younger subjects, although some differences in the quality of life domains were noted, probably as a result of the influence of aging itself. Medical staff should provide elderly cancer patients with good clinical care similar to that provided to younger patients while considering the different impacts of aging on each quality of life dimension.

Oncologists' recognition of supportive care needs and symptoms of their patients in a breast cancer outpatient consultation.

OBJECTIVE: The purpose of this study was to investigate the accuracy of oncologists' recognition of their patients' supportive care needs and symptoms in breast cancer outpatient consultation in Japan. METHODS: The participants included a sample of randomly selected outpatients with breast cancer and two oncologists. The patients responded to validated self-administered questionnaires to assess their supportive care needs and symptoms. The oncologists responded to a questionnaire in which they indicated their perception of level of the same set of needs or symptoms following consultation. The two data sets were compared statistically. RESULTS: Complete data sets were available for 408 patients. Low negative predictive values for the psychological (30%) and information domain (30%) indicated that the patients often have psychological and information needs that the oncologists do not appropriately recognize. The sensitivity and specificity of the physicians' assessment for all physical symptoms except pain were <40 and >85%, respectively, indicating that the physicians could not detect, but could rule out the possibility of a patient experiencing physical symptoms. Borderline/clinical depression and anxiety were the only two symptoms that the oncologists reported more frequently than the patients did. As a result, the specificity of the physicians' assessment for the detection of borderline/clinical depression and anxiety was relatively low (74 and 27%). CONCLUSIONS: Oncologists' recognition may not accurately reflect their patients' supportive care needs and symptoms in usual care. Incorporation of a standard assessment system for supportive care needs and symptoms in clinical practice must heighten the oncologists' awareness of their patients' these problems.

Social anxiety disorder as a hidden psychiatric comorbidity among cancer patients.

OBJECTIVE: Social anxiety disorder is one of the most popular psychiatric disorders in the general population and is also well known as a very common comorbid psychiatric disorder among patients with major depression. On the other hand, social anxiety disorder has been termed "the neglected anxiety disorder" because its diagnosis is often missed. Furthermore, the potential impact of social anxiety disorder on the psychological distress of cancer patients has not been reported. METHOD: We encountered two cancer patients with refractory depression after cancer diagnosis, in whom comorbid social anxiety disorder was unexpectedly detected during a subsequent follow-up. RESULTS: To the best of our knowledge, this is the first report to discuss the potential impact of social anxiety disorder on cancer patients' distress. These two cases may help to improve our understanding of the complicated mental health problems of cancer patients and the potential influence of social anxiety disorder on patients' follow-up medical treatment. SIGNIFICANCE OF RESULTS: Comorbid social anxiety disorder should be considered when a cancer patient's depression is resistant to treatment and the existence of communication problems between the patient and the medical staff is suspected.

Patient's perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan.

OBJECTIVE: A needs assessment can be used as a direct index of what patients perceive they need help with. The purposes of this study were to investigate the association between patients' perceived needs and psychological distress and/or quality of life (QOL) and to clarify the characteristics of patients with a high degree of unmet needs. METHODS: Randomly selected ambulatory female patients with breast cancer participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexuality needs); the Hospital Anxiety and Depression Scale; and the European Organization for Research and Treatment of Cancer QLQ-C 30. RESULTS: Complete data were available for 408 patients. The patients' needs were significantly associated with both psychological distress (r=0.63, p<0.001) and QOL (r=-0.52, p<0.001). A multiple regression analysis revealed that employment status (without full-time /part-time job), duration since diagnosis (less than 6 months), advanced stage, and a lower performance status were significantly associated with higher total needs. Only sexuality needs were significantly associated with a younger age, while the other domains were significantly associated with duration since diagnosis, advanced stage, and a lower performance status. CONCLUSIONS: Moderate to strong associations exist between patients' needs and psychological distress and/or QOL. The characteristics associated with patients' needs are multi-factorial, and interventions to respond to patients' needs may be one possible strategy for ameliorating psychological distress and enhancing QOL.

Patients' supportive care needs and psychological distress in advanced breast cancer patients in Japan.

OBJECTIVE: Few studies have investigated the prevalence of the unmet needs among advanced or recurrent breast cancer patients in Asian countries and little is known about the relation between their unmet needs and psychological distress/quality of life. METHODS: The participants (n = 87) comprised randomly selected ambulatory female patients with advanced or recurrent breast cancer attending the Outpatient Department of Oncology, Immunology and Surgery of Nagoya City University Hospital. The patients were asked to complete self-administered questionnaires assessing the level of their physical and psychological symptoms, supportive care needs and socio-demographic and biomedical factors. The association between the patients' perceived needs and psychological distress/quality of life was then analyzed statistically. RESULTS: The patients had a mean ± standard deviation of 11 ± 7.7 and a median of 10 unmet needs. The prevalence of the 17 most frequent unmet needs was over 50%, and almost all of these unmet need items belonged to the Psychological or the Health system and information domain. The total Short-form Supportive Care Needs Survey Questionnaire with cancer score was significantly associated with the indices of psychological distress and quality of life. Most of the Short-form Supportive Care Needs Survey Questionnaire with cancer domains except Sexuality domain were also significantly associated with all the indices of psychological distress. CONCLUSIONS: Psychosocial needs were strongly associated with psychological distress and quality of life. Quality of life and psychological distress may be improved if interventions for unmet needs, especially psychological and information needs, are made.

Anticipatory nausea among ambulatory cancer patients undergoing chemotherapy: prevalence, associated factors, and impact on quality of life.

The purposes of this study were to investigate the prevalence of anticipatory nausea (AN), its associated factors, and its impact on quality of life (QOL) among ambulatory cancer patients receiving chemotherapy. Patients were randomly selected to participate in this study, and were asked to complete the Morrow Assessment of Nausea and Emesis scale, the Hospital Anxiety and Depression Scale, the Short-form Supportive Care Needs Survey questionnaire, and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Complete data were available for 214 patients. A total of 10.3% of the patients experienced very mild to severe AN. The presence of AN was significantly associated with most domains of the investigated patients' outcome, including psychological distress and perceived needs, with the exception of the health system and information domain of patients' needs, and the physical functioning domain of QOL. Anticipatory nausea was also associated with QOL even after adjustments for age, sex, performance status, and psychological distress. The prevalence of AN in ambulatory cancer patients who receive chemotherapy may not be as high as previously reported. However, given its potentially significant impact on relevant outcome, including QOL, AN should not be neglected in current clinical oncology practice. (Cancer Sci 2010; 101: 2596-2660).