Cancer and depression: A comparison of cancer victims with the general population, findings from the European Social Survey 2014.

Aims: An increasing number of people in Europe are living with cancer, either as an active disease or as a past experience. Depressive symptoms may impair quality of life in cancer patients and may constitute increased risks for disability, as well as being a risk factor for increased mortality. Our study compared self-reported symptoms of depression in people who currently or previously have experienced cancer with self-reported symptoms of depression in the general population. Methods: Our study was based on data from the European Social Survey 2014, with representative samples from 19 countries. Depression was measured by an eight-item CES-D Scale, with a cut-point of a mean score of 2 to indicate depression. Multilevel modelling was used to examine the relationship between cancer status and depression. Results: Respondents who at the time of the interview reported to have cancer were more likely to report symptoms above the cut-point on the depression scale than people who never had experienced cancer (unadjusted odds ratio (ORunadjusted)=2.59; 95% confidence interval (CI) 2.20-3.06; and ORadjusted=2.00; 95% CI 1.70-2.36). The difference was smaller comparing people who previously had experienced cancer to people who never had experienced cancer (ORunadjusted=1.46; 95% CI 1.19-1.79; and ORadjusted=1.28; 95% CI 1.05-1.55). The differences in depression by cancer status did not vary among the welfare state regimes. Conclusions: Respondents with a cancer disease showed a substantial elevated risk of depression after adjusting for a range of potential confounders. Respondents who had recovered also showed significantly higher adjusted risk of depression than respondents who had never experienced cancer.

Quality of life in primary school children: The Health Oriented Pedagogical Project (HOPP).

AIMS: The primary aim of the present study was to evaluate the association between parents' level of education, measurements of physical attributes, and quality of life in a general sample of primary school children. METHODS: The children's and the parents' versions of the Inventory of Life Quality in Children and Adolescents (ILC) were used to measure health-related quality of life (QOL) in 2140 school children (response rate 93%) and 1639 parents (response rate 71%) recruited from nine primary schools in Norway. A set of physical characteristics were also measured in the children: body mass index (BMI), waist circumference, average daily minutes of physical activity, aerobic fitness, and handgrip strength. RESULTS: The regression analysis showed stronger relationships between the covariates and QOL for the parents' assessments than for the children's. Parents' level of education was significantly related to children's QOL, with the strongest association for parental QOL assessment. Among the physical variables, aerobic fitness ( B = 0.01, p > .001 in both samples), and handgrip strength in the parents' sample ( B = 0.21, p < .05) were significantly related to the children's QOL. CONCLUSIONS: The present study replicated the well-known finding that parents' sociodemographic status is important for children's QOL. Our new contribution is to show that the physiological variables aerobic fitness and muscular strength also contributed significantly to explain variance in QOL. This opens up interesting perspectives on how to improve QOL among children through more emphasis on physical activity and physical fitness in schools.

Quality of life and living with cancer: findings from the European social survey (2014) special module on the social determinants of health.

Background: This study is a comparison of quality of life (QOL) of current and previous cancer victims with people who never had experienced cancer in samples from the general population from the 19 countries in the European Social Survey (ESS) 2014. Methods: The study was based on the ESS 2014 with representative samples from 19 countries. QOL was measured by combining two questions on happiness and life satisfaction into a QOL scale. Multilevel modelling was used to examine whether the relationship between cancer status and QOL varies between countries in general and by welfare state regimes in particular. Results: People with cancer at the time of the interview, showed lower general QOL than both people who previously have had cancer and people who never have experienced cancer. The unadjusted and the adjusted odds ratios (ORs) for poor QOL were respectively, OR = 2.38, (2.07, 2.74) and OR = 1.98, (1.71, 2.30). The difference between the 'Never' and the 'Previously' groups was minor but statistical significant. The welfare state classification was a strong predictor of country differences in QOL, but there was no significant statistical interaction effect between cancer status and the welfare state classification. The study also replicated well-documented findings on differences in QOL by education and social support. Conclusion: The QOL of people with a cancer disease is significantly impaired. People who previously have had cancer, scored only slightly lower on the QOL scale than people who never had experienced cancer. We found evidence indicating that these differences may vary between the countries, but this variation cannot be explained by the welfare state classification.

War Experiences and General Health Among People in Bosnia-Herzegovina and Kosovo.

War experiences may have an extensive impact on the health status of the exposed populations. This population-based study aimed to examine the relationship between war experiences and self-reported general health in representative sample surveys from Bosnia-Herzegovina (n = 3,313) and Kosovo (n = 1,000). Data were collected with face-to-face interviews fielded in the winter of 2003-2004. Logistic regression analysis was used to compute unadjusted and adjusted odds ratios (ORs). The adjusted effects of the extensiveness of war experiences on poor health were positive in both countries, but they were statistically significant only for Bosnia-Herzegovina: OR = 1.04, 95% CI [1.00, 1.08] for Bosnia-Herzegovina and OR = 1.03, 95% CI [0.98, 1.09] for Kosovo. The strongest observed effect was found for Kosovo only: The extensiveness of war experiences was relatively strongly related to longstanding health problems, OR = 1.09, 95% CI [1.03, 1.15]. We found that war experiences may contribute to increased poorer health in the exposed populations; however, the effects 4-9 years after the war ended were modest. Hence, war experiences seemed to be more strongly related to war-related distress and posttraumatic stress disorder than to self-reported general health.

A first step in the development of an international self-report instrument for physical functioning in palliative cancer care: a systematic literature review and an expert opinion evaluation study.

Decline in physical functioning (PF) in progressive cancer increases risk of psychological problems, dependence, and distress, and it considerably affects quality of life. Despite this, assessment of PF has received little attention. Standardized, internationally endorsed assessment tools are needed that assess activities of relevance to palliative cancer patients from very low to high levels of PF. This study was done in cooperation with the European Association for Palliative Care Research Network. It was initiated to develop a computer-based symptom-assessment tool and aimed to 1) identify relevant existing PF-assessment instruments, 2) extract relevant items and classify them into meaningful subdimensions, and 3) construct unidimensional scales of selected PF domains. A systematic literature review was performed to detect relevant PF items from existing instruments. The International Classification of Functioning and Health was used to decide relevant subdimensions of PF, and expert panels within palliative cancer care were consulted to make decisions on activities to be included. One hundred and thirty-five instruments containing 743 items were included from the literature review. Two relevant PF subdimensions were revealed: Mobility (386 items representing 65 different activities) and Self-Care (143 items representing 30 different activities). The final PF tool consisted of two unidimensional scales: 24 hierarchically ranked Mobility items ranging from turning in bed to running, and 16 non-hierarchically ranked Self-Care items. Further testing of the instrument in a palliative cancer population is needed to develop the final PF instrument.

The importance of key personnel and active management for successful implementation of computer-based technology in palliative care: results from a qualitative study.

Symptom assessment is an important issue in palliative care. Computer technology is now available for use in such assessments. The aims of the present study were to investigate the factors that can promote implementation of computer technology in a palliative care unit. Symptom assessment by use of handheld computers combined with a database for storing the assessments and other clinical data were introduced in 2001 at the Palliative Medicine Unit of Trondheim University Hospital. Seventeen respondents (nurses, physicians, and physiotherapists) participated in an in-depth interview. The themes presented in this article are perceived aims, training, information, and communication. A qualitative approach was used in analyzing the data. All the respondents expressed a wish for a resource person, and the expectations regarding this person differed, because this person had to be present at the unit, should provide quick help, should be a driving force, and should be responsible for training and teaching. There is a need for skilled and motivated key personnel in the unit if implementation is to be successful.

War experiences and war-related distress in Bosnia and Herzegovina eight years after war.

AIM: To examine the relationship between war experiences and war-related distress in Bosnia and Herzegovina. METHODS: The survey was performed in the late 2003 on a representative sample of 3313 respondents. The face-to-face interviews included 15 items on war-related distress and 24 items on war experiences. From these items we developed the War-related Distress Scale, the Direct War Experiences Scale, and the Indirect War Experiences Scale. Regression analysis was used to examine the relationship between war-related distress symptoms and war experiences variables, controlling for a range of other variables. RESULTS: Almost half of the respondents did not report any war-related distress symptoms, while about 13% reported 7 or more symptoms. Direct war experiences had a significant effect on war-related distress even eight years after the war, while indirect war experiences showed no significant effect on war-related distress. We found that marital status weakly decreased war-related distress, while household size increased it. CONCLUSION: Direct war experiences seem to have a long-lasting traumatic effect on a substantial number of residents of Bosnia and Herzegovina.

Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer?

OBJECTIVE: To examine the relationship between social support and emotional functioning and stress reactions. Our hypothesis is that patients who reported a high degree of social support will experience better emotional functioning and less serious stress reactions than patients with a low degree of social support. METHOD: The sample was comprised of 434 patients at the Palliative Medicine Unit (PMU), University Hospital of Trondheim in Norway. The patients completed a questionnaire monthly including questions about social support from the MacAdam's Scale, subjective stress measured by the Impact of Event Scale (IES), and emotional functioning measured by the subscale in the EORTC QLQ-30. RESULTS: Although our hypothesis was not supported at the baseline assessment, it was supported at the second assessment, 2 months later. Patients with high social support reported better emotional functioning and less serious stress reactions, in terms of lower scores on the IES avoidance subscale, than patients with a low degree of social support. SIGNIFICANCE OF THE RESULTS: The mixed findings may indicate that social support has only small effects on emotional functioning and stress reactions. Our results on the second assessment indicate, however, that social support might work as a buffer against reactions toward external stressful events such as terminal cancer.

Meta-analysis of the effects of psychosocial interventions on survival time in cancer patients.

OBJECTIVE: To provide a quantitative summary of effects of psychosocial interventions on cancer survival, and to present an overview of methodological and reporting aspects of the studies. METHOD: Electronic searches and manual searches of reference lists from review articles and retrieved papers. Two coders independently coded study, participant, treatment, and outcome characteristics of the studies meeting selection criteria. RESULTS: Thirteen journal articles published between 1989 and 2003 reporting results from 14 controlled intervention studies were included. Results are based on data obtained from 2626 subjects. Effect sizes [hazard ratios (HR)] were heterogeneous and random effects models were used in the analyses. The total mean inverse-variance-weighted HR was 0.85 (95% CI: 0.65-1.11). Randomized studies (n=8) showed no overall treatment effect (HR: 0.77, 95% CI: 0.56-1.06), neither did the nonrandomized studies (HR: 1.00, 95% CI: 0.61-1.62). Interventions using individual treatment (n=3) were, however, found to be effective (HR: 0.55, 95% CI: 0.43-0.70) but interventions using group treatment (n=9) were ineffective (HR: 0.97, 95% CI: 0.73-1.27). Group treatments of breast cancer (n=6) were ineffective (HR: 0.95, 95% CI: 0.69-1.31). CONCLUSION: A definite conclusion about whether psychosocial interventions prolong cancer survival seems premature. Future studies should use randomization to avoid self-selection of patients with poor prognosis. Interventions should focus on a single diagnosis, take into account known risk factors, and describe their interventions thoroughly.

Health-related quality of life (HRQOL) in family members of cancer victims: results from a longitudinal intervention study in Norway and Sweden.

This study compared the health-related quality of life (HRQOL) of family members of patients who participated in a program of palliative care (intervention family members) with those in conventional care (control family members). The HRQOL was measured by the short-form (SF-36) health survey questionnaire, including eight subscales. The longitudinal intervention study includes two sites: Trondheim, Norway and Malmø, Sweden. Our first hypothesis was that the HRQOL of the family members would deteriorate over time in the terminal phase and reach a low point a few months after the death of the patients, and thereafter gradually increase. This hypothesis was fully supported by the trajectories for the five scales, role limitation due to physical problems, vitality, social functioning, role limitation due to emotional problems, and mental health; but only partially so for the remaining three scales, physical functioning, bodily pain, and general health perception. From a second hypothesis, we expected the trajectories of the HRQOL scale scores for the two groups to show an increasing difference over time in quality of life in favor of the intervention group. This was the case for two of the scales: role limitation due to emotional problems and mental health. Before we may reach a definitive conclusion on the effects of palliative care programs for the HRQOL of family members, we need further longitudinal intervention studies with large samples.

Measuring quality of palliative care: psychometric properties of the FAMCARE Scale.

This study measures quality of palliative care in 181 family members (i.e. spouse, child) to cancer victims with terminal disease 1 month after the time of death. The specific aim was to explore the underlying factor structure and dimensionality of the 20 items of the FAMCARE Scale, measuring family satisfaction with health care given to the patient and to them. The results from a factor analysis, a Mokken Scaling Program analysis, and a reliability analysis, showed that 19 out of the 20 items form a strong one-dimensional scale. Since the scale is one-dimensional, the possibility of reducing the number of items should be explored in future research. Our recommendation is to measure satisfaction with care 1-2 months after the death of the patient. One should also explore the possibilities of measuring satisfaction with care prospectively as an integral part of the palliative care program.

Family satisfaction with end-of-life care for cancer patients in a cluster randomized trial.

The main aim of this study was to examine similarities and differences in satisfaction with care between 112 family members who were close to patients who had participated in an intervention with a comprehensive palliative care program and the 68 family members in a conventional care program (controls). The FAMCARE Scale measured satisfaction with care at one month after the time of death. The majority of respondents reported high satisfaction with care. The respondents related to the patients in the intervention group reported significantly higher satisfaction with care than the respondents related to the patients in the control group. This difference remained unchanged after controlling for a range of other relevant factors: relationship to the deceased, sex and age of the respondent, sex and age of the patient, time since inclusion in the study, and place of death.