An adaptation of meaning-centered psychotherapy integrating "essential care": A pilot study.

INTRODUCTION: There is a growing interest in the emotional state of cancer patients. The main objective of this pilot study is to assess the feasibility, acceptability, and preliminary efficacy of Meaning-Centered Psychotherapy and Essential Care (MCP-EC) in patients with advanced cancer compared with usual psychological support. We define "Essential Care" as the promotion of patient care and self-care through the recall of good care experiences and discussion of the concepts: responsibility, self-compassion, kindness, and attitude. METHOD: Pilot, single-center, and prospective study of 30 patients with advanced cancer and emotional distress. Our adaptation consisted in three session Meaning-Centered Psychotherapy-Palliative Care, plus a fourth session named "Essential Care". The study was carried out in two phases. First, 20 patients were randomized to one of the two arms: individual MCP-EC (experimental, n = 10) or usual psychological supportive (control, n = 10). In a second phase, 10 patients were assigned consecutively to Group MCP-EC (n = 10). All patients were evaluated at baseline (pre-) and post-intervention with questionnaires for sociodemographic data and clinical scales. RESULTS: Nineteen patients completed the 4 sessions of MCP-EC, 9 individual format and 10 group format. Usual supportive intervention was delivered to 10 control patients. Total 28 patients completed pre- and post-treatment evaluations. There were no pre- vs. post-differences in the evaluations of the control group. In the experimental group, significant pre- vs. post-differences were found in EQ-5D-3L, HADS, FACIT, DM, HAI, SCS-SF, and TD questionnaires. These results indicated that MCP-EC reduced anxiety and depression symptoms, hopelessness, demoralization, as well as increased spiritual well-being and sense of meaning. Participants were satisfied and found the MCP-EC intervention positively. CONCLUSIONS: This pilot study suggests that the MCP-EC has feasibility, acceptability, and preliminary efficacy reducing the emotional distress in advanced cancer patients. Larger studies are warranted to clarify the strengths and limitations of this psychotherapy.

Cáncer y paro / Cancer and unemployment

La falta de trabajo es una realidad dramática cada vez más frecuente en la época que estamos viviendo. La experiencia diaria de los clínicos nos aporta importantes indicios que nos hacen pensar en la existencia de una relación directa entre situaciones prolongadas de paro y la predisposición a padecer graves problemas de salud, y en concreto a padecer determinados tipos de cáncer. El presente trabajo pretende hacer una revisión de los principales estudios epidemiológicos que han abordado la relación entre cáncer y paro laboral, especialmente aquellos que analizan la relación entre situaciones de paro y aumento de la mortalidad por cáncer. Los resultados de esta revisión permiten formular diversas hipótesis derivadas de le intensa relación existente entre el paro y el cáncer. En nuestro país son necesarios estudios de incidencia poblacionales con suficiente tamaño muestral que analicen esta relación ajustando por otros factores de riesgo que actúan como confusores (AU)

The lack of work is a increasingly dramatic situation in the times we are living. Daily experience of clinicians provides us with important clues that remind us of the existence of a direct relationship between prolonged unemployment and predisposition to serious health problems, in particular to suffering certain types of cancer. This paper aims to review the major epidemiological studies that have dealt the relationship between cancer and unemployment. Several hypotheses may be formulated with the results of this review arising from the possible etiological relationship between unemployment and development (or poor prognosis) of neoplastic processes (AU)

[Cancer and unemployment]. / Cáncer y paro.

The lack of work is a increasingly dramatic situation in the times we are living. Daily experience of clinicians provides us with important clues that remind us of the existence of a direct relationship between prolonged unemployment and predisposition to serious health problems, in particular to suffering certain types of cancer. This paper aims to review the major epidemiological studies that have dealt the relationship between cancer and unemployment. Several hypotheses may be formulated with the results of this review arising from the possible etiological relationship between unemployment and development (or poor prognosis) of neoplastic processes.

El uso de fentanilo transdérmico por una unidad de atención domiciliaria en pacientes oncológicos en el final de la vida / Use of transdermic fentanyl by a department of home medical care of terminal oncologic patients

• Propósito: Se ha realizado un estudio observacional y retrospectivo para evaluar el modo de utilizacióny los efectos secundarios de fentanilo transdérmico (FTTS) en pacientes oncológicos en situación terminal.• Material y métodos: Se han evaluado estadísticamente pacientes incluidos en un programa de AtenciónDomiciliaria que recibieron tratamiento con FTTS.• Resultados: 112 pacientes (p) recibieron tratamiento con FTTS. Mediana de edad de 71.5 años (29-88).102p presentaban dolor y 10 disnea. Tipo de dolor: visceral 55% p, óseo 25% p, neuropático 12.5%, muscular5% p y otro 2.5% p. EVA inicial: media 5.9. La analgesia previa a la utilización de fentanilo fue: 31% p AINES,32.2% p tramadol, 5.6% p codeína y 31% p morfina. La dosis mediana inicial de fentanilo fue 50mgr/hora(25-300). La dosis mediana final fue 75 mgr/hora (25-400). EVA final media: 3,3. La mediana de la duracióndel tratamiento fue de 44 días (1-372). 35 p (31%) presentaron náuseas G2-3, somnolencia 5 p, agitacióny/o delirio 13 p. 81 p (72%) precisaron laxantes. En 10 p fue necesario rotar a otro opioide: 4 p por toxicidad y6 p por mal control del dolor.• Conclusiones: El FTTS es un analgésico bien tolerado en pacientes terminales y proporciona una analgesiaadecuada (91%), a un bajo coste en cuanto a yatrogenia intolerable (4%), tanto con paso previo conopioides como directamente desde primer escalón analgésico OMS

• Purpose: An observational and retrospective study was performed in order to evaluate the activity andtoxicity of transdermal fentanyl in patients with advanced cancer.• Material and methods: 112 patients treated by a home palliative care unit were studied. Thecharacteristics of patients, analgesic treatments, and opioid rotation were analysed from the beginning offentanyl administration to the death.• Results: The mean age of the patients (p) was 71.5 years (range, 29-88). The indication for opioidadministration was pain in 102 and dyspnea in 10 patients. The type of pain was visceral in 56 p (55%), bonyin 25 p (25%), neuropatic in 13 p (12.8%), muscular in 5 p (5%), and others in 3 p (2.1%). The baseline meanvalue of the pain analogical visual scale (AVS) was 5.9. The analgesics administered before fentanyl was givenwere tramadol (32.2%), NSAIDs (31%), morphine (31%) and codeine (5.6%). The median initial dose offentanyl was 50 µg (range, 25-300). The final mean dose at the time of death was 75 µg (25-400). The finalmean AVS was 3.3. The median treatment duration was 44 days (range, 1 to 372). It caused G2-3 nausea in 35p (31%), somnolence in 13 p, and agitation in 5 p; 81 patients received laxatives. Opioid rotation withmorphine was necessary in 10 p because of toxicity, and in 6 p because uncontrolled pain.• Conclusions: Transdermal fentanyl is a well tolerated analgesic in patients with advanced cancer,providing a good analgesia in up to 91% of the patients previously treated with opioids, as well as of thepatients proceeding directly from the first or second step of the WHO ladder