Psychological characteristics of early-stage melanoma patients: a cross-sectional study on 204 patients.

The presence of psychological distress has a negative impact not only on cancer patients' quality of life but also on the course of the disease, with slower recovery and increased morbidity. These issues are of particular importance in melanoma patients (MP), who remain at risk of disease progression for many years after diagnosis. This study aimed to investigate psychological distress, coping strategies, and their possible relationships with demographic-clinical features in patients with early-stage melanoma in follow-up. The investigation focused in particular on whether the psychological profile differed between patients at different melanoma stages. Data of 118 patients with melanoma in the Tis-Ia stages (MP_Tis-Ia) and 86 patients with melanoma in the Ib-IIa-IIb stages (MP_Ib-II) were gathered through a self-administered survey and compared using a cross-sectional design. The results evidenced a high percentage of anxiety (25%) and distress symptoms (44%), whereas depressive symptoms seemed less frequent (8%). Psychological distress was higher in women than in men, and in patients with a higher educational level. Nevertheless, no significant differences were found between MP_Tis-Ia and MP_Ib-II. With respect to coping style, the patients in this sample adopted predominantly positive and active strategies. Correlational analyses showed that maladaptive coping strategies such as behavioral disengagement, denial, self-distraction, and self-blame were most strongly related to increased levels of psychological distress. The high presence of anxiety and distress symptoms, their relationship, and the use of negative coping strategies underline the importance of psychological distress screening also in early-stage MP, including at long-term follow-up.

Pharmacological management of depression in patients with cancer: practical considerations.

This article provides an overview of the prevalence, pathogenesis and diagnosis of, and treatment strategies for, depression in cancer patients. Untreated depression can increase the burden of oncology symptoms and worsen the cancer prognosis through the relationship between mood and immunity. The issues to consider when treating a patient with cancer who has depression include when to introduce pharmacotherapy, the criteria for choosing an antidepressant, and the necessary caution regarding side effects and drug interactions. The choice of an antidepressant is a complex decision that has to balance previous pharmacological experiences, different clusters of target symptoms, pharmacological interactions, and objective and subjective risks of side effects, with the aim of tailoring a strategy for each patient.

Antidepressant up-titration: pharmacological and psychological considerations.

The use of antidepressant up-titration in starting therapies is useful in reducing side effects, but can induce delays in clinical response. Several aspects concerning slow or more aggressive titration have to be considered when using this strategy, such as pharmacological aspects (e.g., synaptic up-regulation) and psychological/clinical aspects (e.g., adherence to antidepressant treatment, and the temperament and expectations of patients). Data from the literature are controversial, and so the choice between rapid and slow titration must be tailored more to the patient, rather than to the drug.

Second-year Italian medical students' attitudes toward care of the dying patient: an exploratory study.

To our knowledge, no other study has investigated Italian medical students' attitudes toward care of the dying patient. The purpose of this study is to investigate those attitudes among second-year Italian medical students. Two-hundred students completed the Italian version of the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD Form B). Students obtained a mean total score on FATCOD Form B of 112.8 (the possible total score ranges from 30 to 150). On some items, statistically significant differences (p < 0.05) emerged for gender and personal previous experiences with terminally ill people. This study shows poor attitudes toward care of the dying patient among second-year Italian medical students, as measured by FATCOD Form B. The need to establish tailored methods in End-of-Life Care education to make students aware of their relationship patterns and to improve students' attitudes toward dying patients is discussed.

Symptom cluster: Depression and pain.

Pain and depression are two frequently associated aspects in oncology. The reciprocal influence of both pathologies is discussed under both the point of view of the underlying biological mechanisms as well as its emotional and cognitive aspects. Mood depression somatic symptoms include pain, just as chronic pain emotional aspects are strictly related to anxiety and depressed mood. Pharmacological treatment for pain with antidepressant drugs (ADs) is discussed, since such drugs offer a direct and an indirect mitigating action on pain perception, and also allow positive changes in the cognitive attitude toward pain. The social and emotional aspects of pain are also discussed bringing evidences of how combined antalgic therapies (analgesics, antidepressants, psychotherapies among others), especially on elderly oncological patients, are more effective than each treatment alone.

Psychological aspects of PSA testing.

The process of PSA screening and subsequent monitoring of PSA levels may represent a great source of emotional distress to patients, the majority of whom are not adequately informed about the screening process and the implications of an abnormal result. The need remains for education of patients on the subject, but no consensus has been reached as to the content of information men should be offered. Helping patients to attribute a different meaning to a potentially stressful event can avoid the development of emotional distress, and physicians can have an important role in this process. Informing patients is essential to allow the development of positive coping styles, and establishing good doctor-patient communication leads to improved compliance and the improvement of patients' psychological wellbeing.