A longitudinal analysis of symptom clusters in cancer patients and their sociodemographic predictors.

CONTEXT: Exploring the relationships between concurrent symptoms or "symptom clusters" (SCs) longitudinally may complement the knowledge gained from the traditional approach of examining individual symptoms or SCs crosssectionally. OBJECTIVES: To identify consistent SCs over the course of one year and determine the possible associations between SCs and demographic and medical characteristics, and between SCs and emotional distress. METHODS: This study was an exploratory longitudinal analysis of SCs in a large sample of newly diagnosed cancer patients. Patients provided symptom assessment data at baseline, three, six, and 12 months. A factor analysis was conducted (controlling for the patient over time) on pain, fatigue, anxiety, depression, sleep, weight change, and food intake items to identify clusters. A panel regression on each cluster explored associations with demographic and medical characteristics and distress. RESULTS: In total, 877 patients provided baseline data, with 505 retained at 12 months. Three SCs explained 71% of the variance. The somatic cluster included pain, fatigue, and sleep; the psychological cluster included anxiety and depression; and the nutrition cluster consisted of weight and food intake. Low income and treatment with radiation or chemotherapy predicted higher somatic symptom burden. Younger age, being female, low income, and treatment with surgery predicted more psychological symptomatology. Older age and treatment with surgery predicted higher nutritional burden. Patients with higher somatic, psychological, and nutritional symptom burden reported higher distress. CONCLUSION: The presence of SCs across the first year of diagnosis supports the need for routine and ongoing screening for the range of symptoms that may be experienced by patients. Further work is needed to develop interventions that better target individual symptoms that cluster, as well as the entire cluster itself.

Androgen Deprivation Therapy and maintenance of intimacy: a randomized controlled pilot study of an educational intervention for patients and their partners.

PURPOSE: Androgen Deprivation Therapy (ADT) for prostate cancer is associated with many treatment side effects that tend to erode couples' intimacy. We piloted a randomized controlled trial to investigate the effect of an educational intervention designed to preserve couples' intimacy in the face of ADT. METHODS: Couples were recruited at the time the patient was first prescribed ADT and were randomized to a treatment or control group. Those in the treatment group were asked to read an educational guide and participate in an educational session designed to inform couples about possible ADT side effects and management strategies. To assess changes in the couples' relationships, they were administered the Dyadic Adjustment Scale and the Personal Assessment of Intimacy in Relationships questionnaire prior to randomization and again at 6 months. RESULTS: While results were not statistically significant, trends and effect sizes suggest that the educational intervention helped attenuate declines in intimacy for patients, but not for their partners. Couples who participated in the intervention were more successful at maintaining sexual activity than were couples in the control group. CONCLUSIONS: ADT places considerable strain on intimate relationships, particularly for the partners. It appears that patients who receive help in anticipating and managing ADT related changes report better dyadic adjustment and closer intimacy. More efforts are needed to develop interventions to benefit patients' partners. We conclude that the intervention holds promise and that a full-scale evaluation of the intervention is both feasible and warranted.

Gender, age and surgery as a treatment modality leads to higher distress in patients with cancer.

INTRODUCTION: Distress has been defined as a multidimensional construct that extends along a continuum, ranging from common normal feelings of vulnerability, sadness and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation and existential and spiritual crisis. Several studies have pointed out the need to screen for distress in the cancer. Emotional distress has been found as a core indicator of a patient's health and well-being and has installed it as the sixth vital sign. The aim of the present study was to identify the predictors of distress in cancer patients. PATIENTS AND METHODS: For the present study, a total of 760 patients with cancer in a tertiary cancer centre were assessed using the Distress Inventory for Cancer Version 2 (DIC V2). A multivariate logistic regression was carried out to identify the predictors of distress and six subscales. RESULTS: Female patients under the age of 44 years scheduled to undergo surgery or those who had undergone surgery predicted significantly higher levels of overall distress. Composite disease stage other than stage IV metastatic disease and being a daily wage employee predicted significantly lower levels of overall distress. DISCUSSION: Higher distress among women undergoing surgery could imply distress associated with significant cosmetic disfigurement and feeling of loss of womanhood especially in those with breast or cervix cancer. CONCLUSION: The study once again demonstrate gender and age differences in distress and also highlights the importance of knowing that cancer is confined to one organ and has not spread.

Screening for distress (the sixth vital sign) in a global recession: sustainable approach to maintain patient-centered care.

A substantial volume of research on the psychosocial impact of cancer clearly indicates that patients are likely to experience emotional distress. There is also evidence that psychosocial interventions aimed at decreasing distress provide tangible cost offsets to cancer patients, caregivers and treating institutions. One seemingly major drawback in the setup and delivery of a fully fledged screening program for distress is the extensive pecuniary requirements. Given that the categorical need for distress screening may be confounded by financial limitations, especially in a time of global recession, a cost-effective alternative seems appropriate. The model proposed herein is not a substitute screening program, nor does it eliminate the need to allocate resources to address the identified risks. It does, however, offer a cost-effective alternative to implement a high-risk distress patient identifying process, quite similar to algorithms used in screening for prostate cancer.

Patient ethnicity: a key predictor of cancer care satisfaction.

INTRODUCTION: Research in cancer care satisfaction itself is scarce; investigation of the role of ethnicity in care satisfaction is even rarer. OBJECTIVE: The present study examined relationships between ethnicity and satisfaction with care in a sample of 759 patients diagnosed with three different types of cancer (lung, head and neck, or gynecologic) from a large tertiary cancer hospital. METHOD: Respondents filled out an assessment package that consisted of demographics, the Ware Patient Satisfaction Questionnaire-III (PSQ-III), 17 additional items constructed by the research team to examine other specific areas of satisfaction, and the Psychological Screen for Cancer (PSSCAN) Part C, to measure anxiety and depression. RESULTS: In a multivariate analysis, being non-White emerged as the primary predictor variable (beyond patient age, gender, marital status, education, cancer site, duration of illness, and presence or absence of metastases) of several of the PSQ-III satisfaction subscales. Conclusion. Health care systems must consider how to become more responsive to the needs of all individuals, regardless of their ethnic background and levels of acculturation.

Cancer patient ethnicity and associations with emotional distress--the 6th vital sign: a new look at defining patient ethnicity in a multicultural context.

Variations in access to care, utilization of available resources and treatment outcomes in the context of ethnicity have been recognized, but very little research of this nature exists in the oncology context. The present paper is an in-depth analysis of data on a large representative sample of Canadian cancer patients with a focus on the role of 'ethnicity', its association to psychological distress, and its impact on the cancer experience. Because of a heterogeneous representation of ethnic self-identifications which were not easily grouped or classified, English as a second language was considered as a surrogate marker to ethnicity. People who self-reported to be from an English-speaking country were grouped together and compared to those hailing from countries which do not have English as a primary language. In a hierarchical logistic regression model (n = 2,402) the demographic and cancer-related variables associated with significant clinical distress in the first block were gender (male, except those with prostate cancer), age less that 68 years, less than a year since diagnosis, diagnosis of lung cancer, and recurrent disease. In the second block, after controlling for the influence of these factors, patient-reported ethnicity (being originally from a non-English speaking country) added significantly to the prediction of patient distress. Though compelling, there is a need to understand the relationship between the ethnic features and language (English versus non-English language). A hypothesis is presented as an attempt to understand an individual's 'ethnicity' within the framework of a multicultural society.

The future in psychosocial oncology: screening for emotional distress--the sixth vital sign.

This article explores the possible future of psychosocial oncology. Advancements in treatment and the concomitant increase in survivorship, combined with a highly educated patient population, will result in huge demands on an already strained healthcare system. Role changes and paradigm shifts will be required in order to cope with these challenges. Issues with current treatment silos and fragmented care systems are presented, and the role of a biopsychosocial approach is discussed.

Distress overlaps with anxiety and depression in patients with head and neck cancer.

Psychological problems in cancer patients often go unrecognized until they are specifically sought. This is more in patients with depression as they are reluctant to complain about their symptoms. The present study was carried out to evaluate the relation of distress with anxiety and depression in 123 patients with head and neck cancers using Distress Inventory for Cancer version 2 (DIC2) and the Hospital Anxiety and Depression scale (HADS). The mean DIC 2 scores were 24.6 while that of subscales ranged from 2.6 to 11.0. Fifteen patients were found to have clinical caseness for anxiety while 12 (10%) were caseness for depression. Total distress, emotional and social distress subscales were found to have positive correlation with anxiety and depression suggesting a possible overlap of two constructs. In multivariate analysis only belief in god was found to significantly affect the distress. Results of present study suggest significant psychological morbidity in head neck cancer patients undergoing curative treatment. This is the first study reporting on the psychometric properties of distress inventory on cancer version 2 since its validation, the results suggest a possible overlap of two constructs similar to that seen with other tools on distress and this may have major implications for clinical practice.

Distress, anxiety, and depression in cancer patients undergoing chemotherapy.

BACKGROUND: Chemotherapy for cancer is an intense and cyclic treatment associated with number of side-effects. The present study evaluated the effect of chemotherapy on distress, anxiety and depression. PATIENTS AND METHODS: A total of 117 patients were evaluated by using distress inventory for cancer (DIC2) and hospital anxiety and depression scale (HADS). Majority of the patients were taking chemotherapy for solid tumors (52; 44.4%). RESULTS: The mean distress score was 24, 18 (15.38%) were found to have anxiety while 19 (16.23%) had depression. High social status was the only factor found to influence distress while female gender was the only factor found to influence depression in the present study. CONCLUSION: The study highlights high psychological morbidity of cancer patients and influence of gender on depression. Construct of distress as evaluated by DIC 2 may have a possible overlap with anxiety.

Early effect of surgery on quality of life in women with operable breast cancer.

BACKGROUND: Quality of life (QOL) after a diagnosis of breast cancer varies considerably across individuals. The treatment modality of the patients significantly contributes to their QOL. The present study reports the initial findings on the early effects of surgery in patients with breast cancer. METHODS: Two hundred and fifty-one women with breast cancer undergoing surgery were interviewed prior to and after the surgery using the Functional Assessment of Cancer Therapy for Breast (FACT-B). Trial Outcome Index (TOI) was calculated besides total and subscale scores. The results were analyzed using paired t-test and two-sample paired Wilcoxon signed rank test. Multivariate analysis was carried out using repeated measures general liner model with 2-way interactions. RESULTS: Significant reduction in physical well-being (P = 0.001), functional well-being (P = 0.00) and the breast-specific subscale (P = 0.000) was observed after surgery. No significant change was observed in social or emotional well-being. Total FACT scores and TOI too showed significant declines (P = 0.000; and P = 0.000 respectively) on univariate analysis. Multivariate analysis, however, showed no difference in QOL after surgery, but QOL was significantly poor among women undergoing mastectomy. CONCLUSIONS: Results of the present study indicate no significant change in overall QOL immediately after the surgery, probably reflecting strong family and social support for these women. QOL was significantly better among women undergoing breast conservation compared with mastectomy.