Interconnectivity of fear of progression and generalized anxiety - Network analysis among a sample of hematological cancer survivors.

PURPOSE: Fear of cancer progression and recurrence (FoP) and generalized anxiety disorder (GAD) are syndromes commonly seen in cancer patients. This study applied network analysis to investigate how symptoms of both concepts are interconnected. METHODS: We used cross-sectional data from hematological cancer survivors. A regularized Gaussian graphical model including symptoms of FoP (FoP-Q) and GAD (GAD-7) was estimated. We investigated (i) the overall network structure and (ii) tested on pre-selected items whether both syndromes could be differentiated based on their worry content (cancer related vs. generalized). For this purpose, we applied a metric named bridge expected influence (BEI). Lower values mean that an item is only weakly connected with the items of the other syndrome, which can be an indication of its distinctive characteristic. RESULTS: Out of 2001 eligible hematological cancer survivors, 922 (46%) participated. The mean age was 64 years and 53% were female. The mean partial correlation within each construct (GAD: r = .13; FoP: r = .07) was greater than between both (r = .01). BEI values among items supposed to discriminate between the constructs (e.g., worry about many things within GAD and fear not to endure treatment within FoP) were among the smallest so our assumptions were confirmed. CONCLUSIONS: Our findings based on the network analysis support the hypothesis that FoP and GAD are different concepts within oncology. Our exploratory data needs to be validated in future longitudinal studies.

Physical and psychosocial factors associated with sexual satisfaction in long-term cancer survivors 5 and 10 years after diagnosis.

Our study provides data on sexual satisfaction among long-term cancer survivors 5 and 10 years after diagnosis, and identifies factors detrimental (e.g. psychosocial and physical symptom burden) or beneficial (e.g. social support) to survivors' sexual satisfaction. We measured sexual satisfaction among cancer survivors recruited via the local clinical cancer registry across a wide range of tumor sites 5 years (cohort 1) and 10 years (cohort 2) after diagnosis. We further assessed chronic comorbidity index (CCI) and symptom scales (EORTC QLQ-C30), depression (PHQ-9) and anxiety (GAD-7), satisfaction with partnership (PFB), quality of life (EORTC QLQ-C30), and social support (OSSS). 924 patients (5-year cohort = 608/10-year cohort = 316) participated in the study (53% men, 80% cohabiting, mean age 66 years, range 18-85). We found that nearly half of the respondents perceived their sexual life as less satisfying than before cancer. High sexual satisfaction was associated with a low chronic comorbidities index (r = - 0.27, p < .001),  less fatigue (r = - 0.35, p<.001), less nausea/vomiting (r = - 0.13, p<.001) and less pain (r = - 0.23, p<.001), r ; less depression (r = - 0.24, p < .001), less anxiety(r = - 0.23, p < .001); a high level of social support (r = 0.16, p < .001), a high level of satisfaction with their relationship (r = 0.24, p < .001), and high quality of life (r = 0.33, p < .001). Sexual satisfaction may be affected by both psychosocial and physical symptom burden, with the latter having a greater impact on sexual satisfaction. It is essential for health care providers that sexual health issues are understood, evaluated, and treated, including those of long-term cancer survivors.

Partnership, sexuality, and fertility-related communication: findings from a register-based study among long-term hematological cancer survivors.

PURPOSE: Even though the number of hematological cancer survivors suffering from long-term and late consequences of their disease is growing, knowledge about their situation regarding partnership, sexuality, and fertility-related communication is sparse to date. METHODS: We recruited survivors of hematological malignancies (≥ 3 years after diagnosis) from two cancer registries in Germany. We applied validated instruments and study-specific items on satisfaction with partnership, sexual functioning, and fertility-related communication with physicians. We provided descriptive statistics and conducted multiple regression analyses to identify associations of the outcomes with patient factors and well-being (anxiety, depression, and quality of life). RESULTS: Of 2001 eligible survivors, 922 (46%) participated. Fifty-seven percent were male, and the mean age was 64 years. Ninety percent and 60% reported to be satisfied with their partnership and sexual life, respectively. However, 81% and 86% reported being sexually impaired by physical or mental symptoms, respectively. Seventy-four percent of those with incomplete family planning had a fertility-related conversation with a physician. Female gender (p < .05, Beta = - .09), older age (p < .01, Beta = .10), and chemotherapy (p < .01, Beta = .10) were associated with less sexual pleasure caused by physical impairment. Satisfaction with partnership (p < .001, Beta = .22), satisfaction with sexual life (p < .001, Beta = .28), and conversation about fertility (p < .05, Beta = .26) were associated with better quality of life. CONCLUSION: Even though long-term survivors seem to be generally satisfied with their partnership and sexual life, they may suffer from specific impairments. Our findings need to be verified in longitudinal studies.

The association between sleep problems and general quality of life in cancer patients and in the general population.

Objective: It is well-known that patients with cancer frequently experience sleep problems, and that sleep quality is associated with general quality of life (QoL). The aims of this study were to analyze the relationship between sleep problems and other components of QoL in more detail and to investigate sex and age differences in sleep quality in cancer patients in comparison with the general population. Method: This study comprised one general population sample (n = 4,476) and eight samples with cancer patients (n between 323 and 4,020). Sleep Quality was measured using the QoL questionnaire EORTC QLQ-C30. Results: All of the cancer patient groups reported more sleep problems than the general population. Sleep problems were associated with all facets of QoL both in cancer patients and in the general population. The highest associations were found in cancer patients for fatigue (r = 0.52) and emotional functioning (r = -0.47). The association between sleep quality and general QoL was lower in the cancer samples (r = -0.37) than in the general population (r = -0.46). Female cancer patients reported markedly more sleep problems than male patients did (d = 0.45), while this sex difference was lower in the general population (d = 0.15). In contrast to the general population, younger cancer patients had greater trouble sleeping than older patients did (d = -0.17). Conclusion: The results underline the significance of the role mental factors play in sleep problems. Health care providers should pay special attention to female patients and younger patients concerning this issue.

COMSKIL: a communication skills training program for medical students.

Objectives: Training communication skills has come to be recognized as a vital aspect of medical school education. A medical communication course based on the COMSKIL Communication Skills Training (CST) Program was developed, integrated into the core curriculum, and evaluated at the Leipzig University Medical School. Methods: Between October 2016 and July 2017, 312 medical students (mean age 21.80 years; 62% male) participated in the medical communication course. Each course unit was evaluated via questionnaires specifically designed to address the theoretical and practical content of the curriculum. The items correspond to the material covered in each course unit. Students responded using a 5-point-Likert scale (1="not at all helpful", 5="extremely helpful") to rate the degree to which the course helped them learn about the subject matter and train the skills covered in the curriculum. Results: The average score for the first part of the course (theoretical foundations) was M=3.69 (SD=0.35). The second part received a similar rating (M=3.84; SD=0.73). The role play exercises with actor-patients received a score of M=4.27 (SD=0.62). In an overall evaluation at the end of the course, students rated the administration of the course (setting, etc), knowledge gained, and skills trained with a score of M=4.11 (SD=0.66). The role play exercises received an overall score of M=4.36 (SD=0.61). Conclusion: A new curriculum for teaching medical students patient-physician communication skills based on the COMSKIL CST program was established at the University of Leipzig. The goal of this course is to teach students about the kinds of communication scenarios they will encounter in their future working lives as care providers and equip them with the fundamental communication techniques and skills they need to successfully handle those situations. A formal evaluation of the program resulted in satisfactory findings, indicating that it is well suited for use in medical universities.

The Longitudinal Communication Curriculum at Leipzig University, Medical Faculty - implementation and first experiences.

Purpose: Communication skills are an essential instrument for building a sustainable patient-doctor-relationship for future doctors. They are learnable and teachable. The learning should be facilitated with the help of a longitudinal curriculum, which is planned at Leipzig University. Project: At the Medical Faculty of Leipzig University, the Longitudinal Communication Curriculum is established since 2016/17. Up to now, the curriculum consists of four parts in which students repeatedly practise their communication skills in curricular and extracurricular courses. Several formats help to teach an integrated learning of communication and physical examination skills. Assessment of communication skills is also performed. Curricular implementation is accompanied by concomitant evaluation. Results: Three parts of the curriculum already have taken place. Students report an increase in communication skills. Students rate the units as instructive and helpful. The assessment of communication skills occurs in two clinical practical examinations (OSCEs). Together with summative assessment a formative feedback was implemented. Students judge this practice as highly positive. Discussion: The curriculum is part of undergraduate medical education in Leipzig. It would be beneficial to add another simulated patient encounter, as well as interprofessional units. Student questionnaires will be evaluated and results will help to develop the curriculum. Conclusion: Consolidation of the curriculum accompanied by evaluation and adaption of content can help to assure the quality of the curriculum. Additional professions and study units shall be integrated in the Longitudinal Communication Curriculum in the future.

Rapid screener for the assessment of fear of progression in cancer survivors: The Fear of progression-Questionnaire Rapid Screener.

OBJECTIVES: Fear of progression (FoP) among cancer survivors can adversely affect all areas of life. Existing instruments are too long for implementation in routine care. Therefore, we developed and tested a rapid screener for FoP (FoP-Q-RS). METHODS: Data were derived from a register-based study among cancer survivors. The 12-item short form of the Fear-of-Progression Questionnaire (FoP-Q-SF) served as item-pool. Confirmatory factor analysis (CFA) was applied to determine (a) fit indices including comparative fit index (CFI) and standardised root mean square residual (SRMR) and (b) measures of reliability including composite reliability (CR). Fit indices were compared to the FoP-Q-SF. Sensitivity and specificity were calculated to recommend a cut-off (criterion: GAD-7 score ≥10). RESULTS: One thousand two cancer survivors participated (response rate: 53%). We selected five items for the FoP-Q-RS. CFA indicated acceptable fit (CFI = 0.936; SRMR = 0.048) and reliability (CR = 0.793). Fit indices were better than for the FoP-Q-SF. The cut-off ≥12 showed optimal balance between sensitivity (72%) and specificity (70%), the cut-off ≥10 revealed higher sensitivity (86%) with still tolerable specificity (52%). CONCLUSION: The FoP-Q-RS shows good psychometric properties and may be applied in routine care. Further studies on preferable cut-offs and other populations are needed.

Initial validation of the German version of the Attentional Function Index in a sample of haematological cancer survivors.

OBJECTIVE: To date, no German instrument exists to assess subjective levels of cancer-related cognitive impairments (CRCI) in cancer survivors. We translated the validated Attentional Function Index (AFI) into German and explored its psychometric properties. METHODS: The validation sample consisted of 1,111 haematological cancer survivors mainly recruited from two cancer registries. Factorial structure was explored using principal component analysis, internal consistency via Cronbach's α, construct validity through correlational analyses (Pearson's r) and associations of patient characteristics with the AFI score via regression analyses. RESULTS: In line with the original version, we revealed three factors, that is "effective action" (seven items), "attentional lapses" (three items) and "interpersonal effectiveness" (three items). The overall reliability α was .91. Verifying construct validity, the AFI score correlated positively with cognitive functioning (r = .64, p ≤ .01) and global QoL (r = .44, p ≤ .01), but negatively with fatigue (r = -.60, p ≤ .01) and depressive symptomatology (r = -.6, p ≤ .01). Older age (ß = .12, p < .001), higher comorbidity (ß = -.07, p = .02) and being male patient (ß = .07, p = .01) were significantly associated with the AFI scores, but effect sizes were small. CONCLUSION: The German translation of the AFI shows good psychometric properties and thus may be reasonably applied to measure the subjective level of CRCI in German-speaking oncological populations.

[Resilience in Long-Term Cancer Survivors - Associations with Psychological Distress and Sociodemographic Characteristics]. / Resilienz bei langzeitüberlebenden Patienten mit einer Krebserkrankung ­ Zusammenhänge mit psychischer Belastung und soziodemografischen Merkmalen.

INTRODUCTION: Resilience is considered as a resource in coping with psychological distress and traumatic experiences and plays an increasing role in psycho-oncology research. The aim of the study is to analyse the resilience in long-term cancer survivors depending on depression, anxiety, sociodemographic and disease-related factors and to compare with the general population. MATERIAL AND METHODS: Our study includes data from 972 patients (53% male, mean age=67 years, 25% prostate cancer, 22% breast cancer) 5 or 10 years after cancer diagnosis via the local cancer registry (RKKL). We analysed resilience (RS-11), depression (PHQ-9) and anxiety (GAD-7). RESULTS: The resilience did not differ significantly between 5 and 10 years after diagnosis (5 years after diagnosis: M=58.5 / 10 years after diagnosis: 59.0; p=0.631). Significant connections between higher levels of resilience and lower levels of depression (beta=0.307; p<0.001), marital status (married, beta=0.080; p=0.016), higher levels of education (beta=0.101; p=0.002) and employment status (employed, beta=0.087; 0.008) could be shown. 20% of variance in resilience could be explained by the independent variables. DISCUSSION: The results indicate that resilience is a stable trait, which is connected with particular values or combinations of values. Lower levels of resilience are associated with unsupported single patients, unemployed patients and patients with lower socioeconomic status. Patients with lower levels of resilience and higher risk for psychological distress can be detected earlier. CONCLUSION: Especially patients with lower levels of resilience need long- range support to cope with the cancer disease and should be included in Cancer- Survivorship-Care-Plans.

Depression and anxiety in long-term survivors 5 and 10 years after cancer diagnosis.

PURPOSE: Our study provides data on depression and anxiety in long-term cancer survivors, in men, women and various age groups, as well as identifies associated factors and coping-related resources. METHODS: We present data obtained from 1002 cancer survivors across a large variety of tumour entities 5 years (cohort 1) and 10 years (cohort 2) after diagnosis, in a cross-sectional study. We analysed depression (PHQ-9) and anxiety (GAD-7) symptomatology in comparison with two large age- and sex-matched samples randomly selected from the general population. RESULTS: Moderate to severe depression and anxiety were reported in 17% and 9% of cancer survivors, respectively. There were no significant differences between the 5 years and 10 years after diagnosis cohorts (p = 0.232). In both cohorts, we found higher depression and anxiety in women than in men (p < 0.001), and lower depression and anxiety in elderly patients (p < 0.001). Cancer survivors younger than 60 years of age were more depressed and anxious than the general population (p < 0.001). The variables, financial problems (Beta = 0.16, p < 0.001), global quality of life (Beta = - 0.21, p < 0.001) and cognitive function (Beta = - 0.30, p < 0.001), had the strongest association with depression and anxiety. CONCLUSIONS: For the prevention of depression and anxiety in long-term cancer survivors, individual treatment of physical and psychological symptoms is as important as social support and professional counselling. Post-treatment, cognitive limitations should be carefully assessed in long-term cancer survivorship to distinguish them from symptoms of a mental disorder, especially since younger cancer survivors of working age and female survivors seem to be more affected by depression and anxiety.

[Supportive Care and Information Needs of Cancer Survivors: A Comparison of Two Cohorts of Longterm Cancers Survivors 5 and 10 Years after Primary Cancer Diagnosis]. / Bedürfnisse nach Information und Unterstützung bei Krebspatienten: ein Kohortenvergleich von Langzeitüberlebenden fünf und zehn Jahre nach einer Krebsdiagnose.

OBJECTIVES: Addressing information and supportive care needs could enhance cancer survivors' ability to cope with the long-term and/or late effects of their disease. The study examines how long-term cancer survivors evaluate information received during the course of cancer and aims to identify supportive care needs. METHODS: The data were collected in a cross-sectional cancer registry cohort study including 1002 patients (participation rate 53%, five years post diagnosis n=660 (65.9%), 10 years post diagnosis n=342 (34.1%), mean age 66.7 years, male 52.9%, prostate cancer 25.5%). The survey instruments used included the SCNS-SF34-G, the PHQ-9, GAD-7, the Distress-Thermometer (DT) and a questionnaire measuring comorbidities. Descriptive and inference statistics were applied. RESULTS: Cancer Survivors perceived information on treatment decision-making as most helpful, whereas information about support offers was perceived as least helpful. One in 5 patients (19.6%) expressed a desire for further information. The majority of patients (81.3%) indicated at least one specific unmet supportive care need, on average 11 (SD=7.14) unmet supportive care needs. Most frequent supportive care needs are related to fear of cancer progression or recurrence, physical comorbidities and the wish for one member of the professional health care team with whom they can talk to continuously about medical issues across the treatment period. Higher physical comorbidity and distress are associated with an increased likelihood of further supportive care needs (p<0.001). CONCLUSION: There is a need for survivorship care models that take into account medical aspects and psychosocial needs through a multidisciplinary approach.

Depression and anxiety in older patients with hematological cancer (70+) - Geriatric, social, cancer- and treatment-related associations.

OBJECTIVES: Older patients are often underrepresented in clinical and epidemiological studies and the knowledge of the effect of hematologic cancer on mental health in the elderly is sparse. Objectives of our study are to provide information on depression and anxiety in older patients with hematological cancer (HCP), compared to a community sample (CS), and to investigate factors associated with depression and anxiety. MATERIALS AND METHODS: We conducted a prospective study with interview assessments of HCP (ICD: C81 - C96) age ≥ 70 years to assess depressive symptoms (PHQ-9) and anxiety (GAD-7) in comparison to a CS matched by age and sex. Hierarchical Regression analysis was used to determine the association of depression and anxiety with quality of life (QoL) as well as geriatric, social, cancer- and treatment-related factors. RESULTS: 200 patients (response rate 50.5%, Mean age = 76 years, 64% male) and 225 citizens (response rate 44.5%) were interviewed. Compared to the CS, HCP showed significantly higher levels of depression. There was no difference in levels of anxiety between the two groups. Geriatric characteristics including limited mobility, need for care, comorbidity, as well as ongoing chemotherapy, lack of partnership, and low QoL were associated with depression. Anxiety in HCP was associated with detrimental social interaction, cognitive and emotional functioning, poor nutrition, and comorbidity. CONCLUSIONS: Older patients with hematologic cancer are at high risk to experience depressive symptoms and low QoL. Health care professionals should assess geriatric symptoms and screen for depression to allow for early interventions and improve treatment outcomes.

Fear of progression and its role in the relationship of cancer-related fatigue with physical functioning and global quality of life - A register-based study among hematological cancer survivors.

OBJECTIVE: Fear of progression (FoP) is a frequent symptom among cancer patients, but data among hematological cancer survivors are scarce. Furthermore, theory assumes that FoP serves as link between bodily symptoms and different aspects of quality of life. However, this model has not been tested with the bodily symptom cancer-related fatigue (CRF) so far. Therefore, we investigated (i) levels of FoP stratified by type of and time since diagnosis and (ii) whether FoP mediates relationships of CRF with physical functioning (PF) and global quality of life (QoL). METHODS: This cross-sectional study recruited long-term survivors of hematological malignancies (mean time since diagnosis: 9 years) via two regional cancer registries. We applied analyses of (co-)variance and mediation analyses to identify indirect effects. RESULTS: 922 survivors participated. There was no overall effect of type of diagnosis on FoP (Fconditional = 1.6, p = .15). However, we found an overall effect of time since diagnosis on FoP (Fconditional = 8.5, p < .001), with FoP being significantly elevated in the group closest to diagnosis. As hypothesized, we found an indirect (mediating) effect of FoP in the associations of CRF with QoL (ß = -0.13, 97.5 %-CI = [-0.17; -0.09]) and PF (ß = -0.12, 97.5 %-CI = [-0.17; -0.08]). CONCLUSION: Among long-term survivors of hematological malignancies, a shorter time since diagnosis seems to be associated with elevated levels of FoP. Addressing FoP in psycho-oncological interventions may help to buffer the detrimental effects of CRF. However, longitudinal data is needed to validate our findings.

[Development of an evaluation system for online self-help groups by using the example of German-speaking cancer forums]. / Erstellung eines Bewertungssystems für virtuelle Selbsthilfegruppen am Beispiel deutschsprachiger Krebsforen.

Development of an evaluation system for online self-help groups by using the example of German-speaking cancer forums Objectives: This paper pursues the question how the quality of forums can be evaluated. Therefor a grading system was designed and 23 German-speaking cancer forums were evaluated by content and formal criteria Methods: Using a keyword-based internet search, 23 forums were identified. Data was gathered about: number of themes, posts and members, structure, key subjects and type of financing. Furthermore, an evaluation system was developed, with which the forums where assessed. Results: The forums were divided in forums with (n = 10) and without (n = 9) focus on a type of cancer. Four are health portals with forum-function. The quality of online cancer forums is heterogeneous, the evaluation resulted an average quality index of 2.7 for the total cancer forums Conclusion: A good information editing, moderation, data protection and transparency are important quality criteria. The evaluation of forums may help the patients, to autonomously value the quality of the presented information.

Perceived social support and associations with health-related quality of life in young versus older adult patients with haematological malignancies.

BACKGROUND: This study compared the perceived social support of young and older adult cancer patients, examining possible influencing factors as well as associations with health-related quality of life. METHODS: A total of 179 young patients (18-39 years) and 200 older adult patients (> 70 years) with haematological malignancies completed questionnaires on their perceived social support (ISSS-8, scales: Positive Support and Detrimental Interactions, range 0-16) and health-related quality of life (EORTC QLQ-C30). Tests for mean differences, correlations and regression analyses to determine associated variables of social support were performed. RESULTS: No difference was reported between young (M = 13.40, SD = 2.81) and older adult patients (M = 13.04, SD = 3.82; p = .313) for Positive Support. However, young patients (M = 4.16, SD = 3.10) reported having had more Detrimental Interactions than older patients did (M = 1.63, SD = 2.42; p < .001, Cohen's d = .910). Comparison of the EORTC QLQ-C30 Function scales showed poorer outcomes for young patients on Emotional, Cognitive and Social Functions and a higher outcome on Physical Function compared with older adult patients. Regression analyses indicated that age (young vs. older adult patients) significantly explained proportions of variance in all models, with young age having a negative impact on Emotional, Cognitive and Social Functions and a positive impact on Physical and Role Functions compared with old age. Significant associations between Detrimental Interactions and all the scales examined except Cognitive Function were found. CONCLUSIONS: The difference in negative perceptions of social support in young vs. older adult patients and its impact on health-related quality of life emphasises the necessity of differentiating between positive and negative social support. Negative interactions should be addressed through psychosocial care, particularly with young cancer patients.

Fear of cancer recurrence across the survivorship trajectory: Results from a survey of adult long-term cancer survivors.

OBJECTIVE: Our study analysed fear of cancer recurrence (FoR) in long-term cancer survivors in relation to medical variables, depression, anxiety, and quality of life. METHODS: We present data obtained from 1,002 cancer survivors (53% male, mean age=68 years, 26% prostate cancer, 22% breast cancer) across all cancer types 5 (N=660) and 10 (N=342) years after diagnosis, who were recruited via a large Clinical Cancer Registry in Germany in a cross-sectional study. FoR, depression, and anxiety were measured using validated self-report questionnaires (12-item short version of the Fear of Progression Questionnaire [FoP-Q-SF], Patient Health Questionnaire-9 [PHQ-9[, and General Anxiety Disorder-7 [GAD-7]). Hierarchical regression models were carried out with FoR as dependent variable and time since diagnosis as control variable. RESULTS: We found high FoR-values in 17% of the cancer survivors (FoP-Q-SF total score>33). FoR was higher in the 5-year cohort (P=.028, d=0.153). Cancer survivors were most worried about the future of the family; they report being nervous prior to doctor's appointment and being afraid of relying on strangers help. Higher FoR was related to female gender (Beta=.149, P<.001), younger age (Beta=-.103, P<.001), low social (Beta=-.129, P<.001) and emotional functioning (Beta=-.269, P<.001), received hormone therapy (P=.025, d=0.056), and high anxiety levels (Beta=.227, P<.001). CONCLUSIONS: Even though FoR declines slightly over time, it is still a common mental health problem for long-term survivors even 10 years after cancer diagnosis. Since FoR is associated with reduced emotional and social quality of life, patients who are at greater risk of experiencing FoR must be identified and supported. Particularly at risk are younger women who received hormone therapy.

The relationship between acceptance, fatigue, and subjective cognitive impairment in hematologic cancer survivors.

Background/Objective: Cancer and its treatment can have a detrimental impact on psychological well-being. Acceptance as the basis of acceptance and commitment therapy (ACT) has shown beneficial effects on depression and anxiety. However, its relationship to fatigue and cognitive impairment has not been investigated. A protective effect of acceptance may open up a new target for psychological intervention. Method: A cross-sectional postal survey was undertaken. 922 hematological cancer survivors (≥ 2.5 years post diagnosis) were recruited through two regional cancer registries in Germany. Acceptance (AAQ-II), fatigue (BFI) and subjective cognitive impairment (AFI) were assessed. Results: Higher levels of acceptance were negatively associated with fatigue and subjective cognitive impairment (R2 = .34 and R2 = .26, respectively). The relationship between fatigue and fatigue-related impairment of daily life was weaker for survivors with high acceptance. Conclusions: Acceptance is strongly associated with fatigue and subjective cognitive impairment. ACT may be useful to reduce symptoms of fatigue and subjective cognitive impairment in cancer survivors.

Antecedentes/Objetivo: El cáncer y su tratamiento pueden tener un impacto perjudicial sobre el bienestar psicológico. La aceptación, base de la terapia de aceptación y compromiso (ACT), ha mostrado efectos beneficiosos sobre la depresión y la ansiedad. Sin embargo, su relación con la fatiga y el deterioro cognitivo no ha sido investigada. Un efecto protector de la aceptación puede abrir un nuevo objetivo para la intervención psicológica.Método: Se llevó a cabo un estudio transversal de encuesta por correo. Un total de 922 supervivientes al cáncer hematológico (≥ 2,5 años después del diagnóstico) fueron reclutados a través de dos registros regionales en Alemania. Se evaluaron la aceptación (AAQ-II), la fatiga (BFI) y el deterioro cognitivo subjetivo (AFI).Resultados: Los niveles elevados de aceptación se asociaron negativamente con la fatiga y el deterioro cognitivo subjetivo (R2 = 0,34 y R2 = 0,26, respectivamente). La relación entre fatiga y deterioro ede la vida diaria relacionado con la fatiga fue más débil en supervivientes con una mayor aceptación.Conclusiones: La aceptación se asocia fuertemente con la fatiga y el deterioro cognitivo subjetivo. La ACT puede ser útil para reducir los síntomas de fatiga y el deterioro cognitivo subjetivo en supervivientes al cáncer.

The relationship between acceptance, fatigue, and subjective cognitive impairment in hematologic cancer survivors

Background/Objective: Cancer and its treatment can have a detrimental impact on psychological well-being. Acceptance as the basis of acceptance and commitment therapy (ACT) has shown beneficial effects on depression and anxiety. However, its elationship to fatigue and cognitive impairment has not been investigated. A protective effect of acceptance may open up a new target for psychological intervention. Method: A cross-sectional postal survey was undertaken. 922 hematological cancer survivors (≥ 2.5 years post diagnosis) were recruited through two regional cancer registries in Germany. Acceptance (AAQ-II), fatigue (BFI) and subjective cognitive impairment (AFI) were assessed. Results: Higher levels of acceptance were negatively associated with fatigue and subjective cognitive impairment (R2= .34 and R2= .26, respectively). The relationship between fatigue and fatigue-related impairment of daily life was weaker for survivors with high acceptance. Conclusions: Acceptance is strongly associated with fatigue and subjective cognitive impairment. ACT may be useful to reduce symptoms of fatigue and subjective cognitive impairment in cancer survivors

Antecedentes/Objetivo: El cáncer y su tratamiento pueden tener un impacto perjudicial sobre el bienestar psicológico. La aceptación, base de la terapia de aceptación y compromiso (ACT), ha mostrado efectos beneficiosos sobre la depresión y la ansiedad. Sin embargo, su relación con la fatiga y el deterioro cognitivo no ha sido investigada. Un efecto protector de la aceptación puede abrir un nuevo objetivo para la intervención psicológica. Método: Se llevó a cabo un estudio transversal de encuesta por correo. Un total de 922 supervivientes al cáncer hematológico (≥ 2,5 años después del diagnóstico) fueron reclutados a través de dos registros regionales en Alemania. Se evaluaron la aceptación (AAQ-II), la fatiga (BFI) y el deterioro cognitivo subjetivo (AFI). Resultados: Los niveles elevados de aceptación se asociaron negativamente con la fatiga y el deterioro cognitivo subjetivo (R2= 0,34 y R2= 0,26, respectivamente). La relación entre fatiga y deterioro ede la vida diaria relacionado con la fatiga fue más débil en supervivientes con una mayor aceptación. Conclusiones: La aceptación se asocia fuertemente con la fatiga y el deterioro cognitivo subjetivo. La ACT puede ser útil para reducir los síntomas de fatiga y el deterioro cognitivo subjetivo en supervivientes al cáncer

Risk for depression and anxiety in long-term survivors of hematologic cancer.

OBJECTIVE: An increasing number of hematologic cancer patients outlive 10 years past diagnosis. Nevertheless, few studies investigated psychological strain in this patient group beyond 5 years after diagnosis. We conducted a registry-based investigation of risk for depression and anxiety among long-term hematologic cancer survivors up to 26 years after diagnosis compared to the general population. METHODS: In this cross-sectional postal survey, cancer survivors were recruited through 2 regional cancer registries in Germany. Depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) were assessed. Survivor data were compared to age- and gender-matched comparison groups (CG) randomly drawn from large representative samples (N > 5,000). RESULTS: Out of 2,001 eligible patients, 46% participated (n = 922). Survivors were significantly more likely than the CG to report elevated depressive (relative risk [RR] = 3.1; 95% confidence interval [CI]: 2.2-4.3) and anxious symptomatology (RR = 1.7; 95% CI: 1.2-2.3). Depression scores remained high even in the survivor Group 12-26 years after diagnosis. RR for anxiety decreased to values comparable to the CG. Younger and middle-aged survivors (≤65 years) were at highest relative and absolute risk to be psychologically impaired. CONCLUSION: This study shows that depression rather than anxiety is a prominent problem in long-term survivors of hematologic cancer. The results stress the importance of monitoring patients even years after diagnosing and supplying psychosocial support to patients in need. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Polypharmacy, limited activity, fatigue and insomnia are the most frequent symptoms and impairments in older hematological cancer survivors (70+): Findings from a register-based study on physical and mental health.

OBJECTIVES: Although the median age at cancer diagnosis is about 70 years, few studies have evaluated physical and mental health in older patients. The main objectives of our study are to provide information about depression, functional disabilities and symptom burden in older hematological cancer patients (HCP), compared to a community sample (CS) of older individuals. MATERIALS AND METHODS: We conducted a prospective study with interview assessments at a meantime of 26 month (range 1-60) after diagnosis or relapse of hematologic cancer (ICD: C81 - C96). Participants were 70 years or older. We assessed depressive symptoms (GDS-15), comorbid conditions, and physical symptom burden (EORTC QLQ-C30, Geriatric Screening) in comparison to a community sample matched by age and sex. RESULTS: 200 patients (response rate 50.5%, Mean age = 76 years, 64% male) and 225 citizens (response rate 44.5%) were interviewed. HCP were more depressed than CS (GDS-15 Mean-score = 3.0 vs. 2.3; p = 0.006). Both HCP and CS had an average of 5 comorbid conditions. In comparison to CS, HCP were found to have higher levels of polypharmacy and limited activity, higher prevalence in polyneuropathy, and higher symptom burden of fatigue, insomnia, and appetite loss. The comorbidity-index was particularly high in older patients, in patients with low education level as well as in patients with a high depression-score. CONCLUSIONS: Older HCP are at increased risk for depression and a variety of physical impairments compared to control population. Specific knowledge about disabilities and symptom burden could help to develop adequate survivorship-programs in this group of patients.