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Gao WL, Chen HM, Liu CY, Huang TH, Li CP, Hsu SJ, Lee PC, Lee KC. Effects of Auricular Acupressure on Fatigue, Sleep Quality, Physical Activity, and Quality of Life in Pancreatic Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial. Cancer Nurs 2025:00002820-990000000-00382. [PMID: 40179142 DOI: 10.1097/ncc.0000000000001498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025]
Abstract
BACKGROUND Patients with pancreatic cancer exhibit various symptoms and numerous physiological and psychological complications. Therefore, designing intervention measures to alleviate symptoms is crucial. OBJECTIVE This study explored the effectiveness of a 4-week auricular acupressure intervention for reducing fatigue and improving quality of life, sleep quality, and physical activity in patients receiving chemotherapy for pancreatic cancer. METHODS This randomized controlled trial was conducted at a medical center in northern Taiwan. The study participants comprised 80 patients undergoing chemotherapy for pancreatic cancer. The experimental group received auricular acupressure therapy for 4 weeks, which targeted the shenmen (TF4), sympathetic (AH6), liver (CO12), spleen (CO13), and subcortex (AT4) acupoints, and the control group received routine care. The European Organization for Research and Treatment of Cancer Quality of Life Group Core Questionnaire-C30, European Organization for Research and Treatment of Cancer Quality of Life Group Core Questionnaire-PAN26, Brief Fatigue Inventory-Taiwanese version, Pittsburgh Sleep Quality Index, and 3-day Physical Activity Record were used for assessment. RESULTS After auricular acupressure therapy for 4 weeks, the experimental group exhibited significant improvements in insomnia symptoms during weeks 1 to 4, as measured using the European Organization for Research and Treatment of Cancer Quality of Life Group Core Questionnaire-C30 (all P < .01), and improvements in sleep quality by week 4, as measured using the Pittsburgh Sleep Quality Index ( P < .036). CONCLUSIONS After auricular acupressure therapy for 4 weeks, significant improvements were observed in patients' sleep quality and quality of life in terms of insomnia. IMPLICATIONS FOR PRACTICE Auricular acupressure can improve sleep quality and other aspects of quality of life among patients undergoing chemotherapy for pancreatic cancer. The study findings indicate the potential of auricular acupressure as an adjunctive cancer care treatment.
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Affiliation(s)
- Wei-Ling Gao
- Author Affiliations: Department of Nursing, Taipei Veterans General Hospital (Ms Gao); School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences (Dr Chen); Institute of Community Health Care, National Yang Ming Chiao Tung University (Dr Liu), Taipei; and Department of Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Xiamen Chang Gung Hospital, China (Dr Huang); and Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, and School of Medicine, College of Medicine, National Yang Ming Chiao Tung University (Drs Li, Hsu, P.-C. Lee, and K.-C. Lee); Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital (Dr Li), Taipei, Taiwan
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Strang P, Schultz T. High Frequency of Depression in Advanced Cancer with Concomitant Comorbidities: A Registry Study. Cancers (Basel) 2025; 17:1214. [PMID: 40227770 PMCID: PMC11987968 DOI: 10.3390/cancers17071214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Revised: 03/26/2025] [Accepted: 04/01/2025] [Indexed: 04/15/2025] Open
Abstract
Background/objectives: Depression is a common complication of cancer and is associated with distress and reduced participation in medical care. The prevalence is still uncertain in advanced cancer due to methodological problems. Our aim was to study depression in the last year of life and related variables. Methods: We used an administrative database and analyzed clinically verified diagnoses of depression during the last year of life for 27,343 persons (nursing home residents excluded) and related the data to age, sex, socioeconomic status on an area level (Mosaic system), and frailty risk as calculated by the Hospital Frailty Risk Score (HFRS). T-tests, chi-2 tests, and binary logistic regression models were used. Results: During the last year of life, a clinical diagnosis of depression was found in 1168/27,343 (4.3%) cases and more frequently seen in women (4.8% vs. 3.8%, p = 0.001), in the elderly aged 80 years or more, p = 0.03, and especially in persons with a frailty risk according to the HFRS, with rates of 3.3%, 5.3% and 7.8% in the low-risk, intermediate and high-risk groups, respectively (p < 0.001), whereas no differences were found based on socioeconomic status. In a multiple logistic regression model, being female (aOR 1.30, 95% CI 1.16-1.46) or having an intermediate (1.66, 1.46-1.88) or high frailty risk (2.57, 2.10-3.14) retained the predictive value (p < 0.001, respectively). Conclusions: Depression is more common in women and, above all, in people with multimorbidity. Depression affects the amount of health care needed, including the need for psychiatric care. Therefore, it should be included in clinical decision-making, especially as depression is associated with poorer prognosis in cancer.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
- Research and Development Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden;
| | - Torbjörn Schultz
- Research and Development Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden;
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Anderson T, Mitchell G, Prue G, McLaughlin S, Graham-Wisener L. The psychosocial impact of pancreatic cancer on caregivers: a scoping review. BMC Cancer 2025; 25:511. [PMID: 40114110 PMCID: PMC11924831 DOI: 10.1186/s12885-025-13891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 03/10/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Family caregivers are essential members of the care team of someone with pancreatic cancer, supporting their physical and psychological needs. Caregivers are often unprepared for this which may cause substantial psychosocial impact. This may be exacerbated by the short life-expectancy and rapid deterioration associated with pancreatic cancer. A scoping review was conducted to identify, from the existing literature, what is currently known about the psychosocial impact of pancreatic cancer on caregivers across the disease trajectory. METHODS A Joanna Briggs Institute (JBI) mixed methods scoping review was conducted across four databases (CINAHL, EMBASE, MEDLINE, PsycINFO). All identified citations were uploaded to Covidence, and were screened independently by two reviewers. Data were extracted and synthesised following a deductive approach guided by 'The Cancer Family Caregiving Experience' model (Fletcher et al., 2012). RESULTS 42 studies were included: 22 qualitative, 15 quantitative, 5 mixed methods. Results of the included studies were collated into the proposed constructs of Fletcher et al.'s (2012) model: primary stressors, secondary stressors, appraisal, cognitive-behavioural responses, health and wellbeing outcomes, as well as the influence of disease trajectory and contextual factors. The literature highlighted pancreatic cancer caregivers experienced stress related to caregiving activities, disruptions in their daily life and family relationships, high levels of unmet need, and poorer quality of life compared to other cancer caregivers. They were also at increased risk for various psychiatric disorders and reported a persistent lack of support which exacerbated the psychosocial impact. CONCLUSIONS Pancreatic cancer caregivers experience negative psychosocial impacts, exacerbated by the disease's trajectory. Feelings of a lack of support were reflected throughout the included literature and emphasise the need for future research into how pancreatic cancer caregivers may be best supported, and sign-posted to existing support, to minimise the substantial psychosocial impact they may experience.
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Affiliation(s)
- Tara Anderson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gillian Prue
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Jiang L, Chen XP. Treatment of choice for malignant gastric outlet obstruction: More than clearing the road. World J Gastrointest Endosc 2024; 16:587-594. [PMID: 39600555 PMCID: PMC11586723 DOI: 10.4253/wjge.v16.i11.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 10/02/2024] [Accepted: 10/20/2024] [Indexed: 10/30/2024] Open
Abstract
In this editorial, we comment on the in-press article in the World Journal of Gastrointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction (mGOO). The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage. Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients, with substantial morbidity and a considerable rate of delayed gastric emptying. Endoscopic stenting was introduced as an alternative minimally invasive procedure with less procedural morbidity and rapid clinical improvement; however, it presented a high rate of long-term recurrence. Therefore, challenges remain in the treatment of mGOO patients to improve clinical outcomes. Endoscopic ultrasound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy, whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical procedure to reduce the rate of delayed gastric emptying. In decision-making regarding the treatment of choice, it should be taken into account that mGOO might be accompanied by a variety of pathological conditions, including cancer cachexia, anorexia, malabsorption, and etc., all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO. The treatment plan should consider comprehensive aspects of patients to achieve practical improvements in prognosis and the quality of life.
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Affiliation(s)
- Li Jiang
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
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Sitte A, Goess R, Tüfekçi T, Pergolini I, Pfitzinger PL, Salvo-Romero E, Mota Reyes C, Tokalov S, Safak O, Steenfadt H, Gürcinar IH, Yurteri Ü, Goebel-Stengel M, Mazzuoli-Weber G, Stengel A, Erkan M, Friess H, Istvanffy R, Ceyhan GO, Demir E, Demir IE. Correlation of intratumoral mast cell quantity with psychosocial distress in patients with pancreatic cancer: the PancStress study. Sci Rep 2024; 14:26285. [PMID: 39487177 PMCID: PMC11530627 DOI: 10.1038/s41598-024-77010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 10/18/2024] [Indexed: 11/04/2024] Open
Abstract
Mast cells are commonly found in pancreatic ductal adenocarcinoma (PDAC), yet their role in the disease remains uncertain. Although mast cells have been associated with depression in several diseases, their connection to PDAC in this context remains unclear. This study explored the correlation between mast cells and psychosocial stress in patients with PDAC. Prior to surgery, 40 patients with PDAC (n = 29 primary resected, n = 11 neoadjuvant treated) completed four questionnaires assessing stress and quality of life. Immunostaining was performed on the resected tumor tissue. Spearman analysis was employed to correlate mast cells with distress and neuropeptides serotonin and beta-endorphin serum and tissue levels. Patients with PDAC exhibited elevated levels of distress and worry. Lower number of mast cells within the tumor correlated with greater psychological burden. Among primary resected patients, mast cell count moderately correlated with joy and inversely with worries. Following neoadjuvant chemotherapy, strong inverse correlation was observed between anxiety, depression, and mast cell quantity. No correlation was found between mast cells and serotonin or beta-endorphin levels. In summary, mast cell presence inversely correlates with psychosocial stress, suggesting a link between immune cells and psychological well-being in pancreatic cancer. Targeting mast cells might offer therapeutic avenues for addressing cancer-induced depression and anxiety.
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Affiliation(s)
- Alicia Sitte
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Ruediger Goess
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Tutku Tüfekçi
- Department of Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ilaria Pergolini
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Paulo Leonardo Pfitzinger
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Eloísa Salvo-Romero
- Laboratory of Neuro-Immuno-Gastroenterology, Digestive System Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Carmen Mota Reyes
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
- Neural Influences in Cancer (NIC) International Research Consortium, Munich, Germany
| | - Sergey Tokalov
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Okan Safak
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Hendrik Steenfadt
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Ibrahim H Gürcinar
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Ümmügülsüm Yurteri
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Miriam Goebel-Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Internal Medicine, Helios Klinik Rottweil, Rottweil, Germany
| | | | - Andreas Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charite - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Mert Erkan
- HPB-Unit, Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Rouzanna Istvanffy
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
- Neural Influences in Cancer (NIC) International Research Consortium, Munich, Germany
| | - Güralp Onur Ceyhan
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- HPB-Unit, Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Elke Demir
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
- CRC 1321 Modelling and Targeting Pancreatic Cancer, Munich, Germany.
- Else Kröner Clinician Scientist Professor for Translational Pancreatic Surgery, Munich, Germany.
- Neural Influences in Cancer (NIC) International Research Consortium, Munich, Germany.
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Ristau P, Oetting-Roß C, Büscher A. Coping in patients with pancreatic cancer: a scoping review and narrative synthesis. BMJ Support Palliat Care 2024; 13:e695-e706. [PMID: 34880064 DOI: 10.1136/bmjspcare-2021-003266] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pancreatic cancer is a malignant disease with one of the highest cancer-specific mortality rates. Coping with it probably differs from other malignant diseases. This scoping review was intended to explore and characterise academic literature related to the coping in patients with pancreatic cancer. METHODS Eight databases were searched for primary and secondary studies and reviews reporting on coping with pancreatic cancer (adenocarcinoma) in adults in English or German language, regardless of publication date or study design, which were then analysed and summarised by narrative synthesis. RESULTS Of 1472 publications identified, 9 articles and book contributions published from 1989 to 2020 in the USA, Europe and Australia met the inclusion criteria. The two main aspects covered were the confrontation with coping tasks, and the reciprocally associated coping with these challenges. In particular, the coping tasks revealed some pancreatic cancer-specific features, such as an increased incidence of depression and anxiety or certain digestive problems, whereas applying of coping strategies seems to be more like the coping behaviours known from the literature for other severe or cancer diseases. CONCLUSIONS Patients with pancreatic cancer experience various health issues and face various quality of life changes and coping tasks. Disease-specific contextual factors, usually consisting of late diagnosis at an advanced stage, rapid progression and often poor prognosis, as well as disease-specific challenges are major differences compared with other malignancies or serious illnesses. However, the coping strategies applied do not seem to differ in principle. Currently, no pancreatic cancer-specific coping model exists.
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Affiliation(s)
- Patrick Ristau
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | | | - Andreas Büscher
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
- Faculty of Business Management and Social Sciences, Osnabrück University of Applied Sciences, Osnabrück, Germany
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Luo F, Lu Y, Chen C, Chang D, Jiang W, Yin R. Analysis of the Risk Factors for Negative Emotions in Patients with Esophageal Cancer During the Peri-Radiotherapy Period and Their Effects on Malnutrition. Int J Gen Med 2023; 16:6137-6150. [PMID: 38162686 PMCID: PMC10757788 DOI: 10.2147/ijgm.s444255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024] Open
Abstract
Background Esophageal cancer has a high incidence in China. Many patients also have a heavy psychological burden due to clinical features such as wasting and choking on food. This study analyzed the risk factors of negative emotions in esophageal cancer patients during the peri-radiotherapy period and its effects on malnutrition. Methods We retrospectively analyzed 339 patients with esophageal cancer during the peri-radiotherapy who received treatment at our hospital from April 2017 to April 2020, and followed up for 3 years. t test and Chi-square test were used to analyze the relationship between patients' negative emotions and clinical data. Binary logistics regression was performed to analyze the independent risk factors for the occurrence of negative mood and malnutrition in the patients. Kaplan-Meier survival curves were used to analyze survival rates. Results Our results showed that 18.3% of patients undergoing radiotherapy for esophageal cancer had negative emotions, and 41.9% suffered from malnutrition. The results of the binary logistic regression analysis showed that monthly household income (OR = 0.470, P = 0.022), the TNM stage (OR = 2.030, P = 0.044), concomitant gastrointestinal symptoms (OR = 2.071, P = 0.024), sleep status (OR = 2.540, P = 0.003), swallowing disorders (OR = 1.919, P = 0.048), and post-radiotherapy complications were independent risk factors for the development of negative emotions in patients. Negative emotions (OR = 2.547, P = 0.038) were also a risk factor for malnutrition in patients with esophageal cancer. Conclusion Many patients with esophageal cancer suffer from anxiety and depression in the peri-radiotherapy period, which might lead to complications such as malnutrition or aggravate and affect the prognosis of patients. Therefore, psychological care should be provided based on conventional care to effectively relieve their psychological pressure, and improve their prognosis and quality of life.
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Affiliation(s)
- Feng Luo
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Yingying Lu
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Chen Chen
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Dongdong Chang
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Wei Jiang
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Ronghua Yin
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
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Ji Y, Chen H, Yang Y, Zhou Y, Li H, Jin H, Xie J, Shen B. Health-related quality of life and survival outcomes for patients with major depressive disorder and anxiety: A longitudinal study in pancreatic ductal adenocarcinoma. Cancer Med 2023; 12:20070-20080. [PMID: 37746894 PMCID: PMC10587956 DOI: 10.1002/cam4.6577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) and anxiety were recognized in treating pancreatic ductal adenocarcinoma (PDAC). This longitudinal study identified risk factors for MDD and anxiety and established associations with patients' quality of life (QoL) and survival outcomes. MATERIALS AND METHODS We used PHQ-9 and GAD-7 questionnaires to diagnose MDD and anxiety in PDAC patients between October 2021 and March 2022 at a Chinese center. Characteristics and clinical data were analyzed for risk factors and EORTC QLQ-C30 questionnaire was administered for QoL before the first chemotherapy. Furthermore, chemotherapy compliance and 1-year survival were compared during follow-up. RESULTS MDD and anxiety occurred in 51.8% and 44.7% of 114 patients over the half-year period. Employment at work (odds ratio [OR]: 5.514, p = 0.001; OR: 3.420, p = 0.011) was an independent risk factor, while radical surgery (OR: 0.342, p = 0.034; OR: 0.238, p = 0.004) was a protective factor. Several aspects of decreased QoL were discovered after their onsets. Higher incidences of physical disorders (p = 0.004; p < 0.001), mental disorders (p = 0.001; p < 0.001), anti-therapy emotions (p = 0.002; 0.001), and chemotherapy suspensions (p = 0.001; p = 0.043) were observed. Furthermore, the 1-year mortalities for all patients and those receiving radical surgeries were correlated with MDD (p = 0.007; 0.036) and anxiety (p = 0.010; 0.031). CONCLUSIONS MDD and anxiety are common in PDAC patients and correlated with poor QoL and survivals. Therefore, appropriate mental management is required in future.
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Affiliation(s)
- Yuchen Ji
- Department of General Surgery, Pancreatic Disease Center, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Translational Medicine, Shanghai Jiao Tong UniversityShanghaiChina
- Research Institute of Pancreatic DiseaseShanghai Jiao Tong University School of MedicineShanghaiChina
- State Key Laboratory of Oncogenes and Related GenesShanghaiChina
| | - Haoda Chen
- Department of General Surgery, Pancreatic Disease Center, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Translational Medicine, Shanghai Jiao Tong UniversityShanghaiChina
- Research Institute of Pancreatic DiseaseShanghai Jiao Tong University School of MedicineShanghaiChina
- State Key Laboratory of Oncogenes and Related GenesShanghaiChina
| | - Yuxuan Yang
- Department of General Surgery, Pancreatic Disease Center, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Translational Medicine, Shanghai Jiao Tong UniversityShanghaiChina
- Research Institute of Pancreatic DiseaseShanghai Jiao Tong University School of MedicineShanghaiChina
- State Key Laboratory of Oncogenes and Related GenesShanghaiChina
| | - Yiran Zhou
- Department of General Surgery, Pancreatic Disease Center, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Translational Medicine, Shanghai Jiao Tong UniversityShanghaiChina
- Research Institute of Pancreatic DiseaseShanghai Jiao Tong University School of MedicineShanghaiChina
- State Key Laboratory of Oncogenes and Related GenesShanghaiChina
| | - Hongzhe Li
- Department of General Surgery, Pancreatic Disease Center, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Translational Medicine, Shanghai Jiao Tong UniversityShanghaiChina
- Research Institute of Pancreatic DiseaseShanghai Jiao Tong University School of MedicineShanghaiChina
- State Key Laboratory of Oncogenes and Related GenesShanghaiChina
| | - Haiyan Jin
- Department of PsychiatryRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Junjie Xie
- Department of General Surgery, Pancreatic Disease Center, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Translational Medicine, Shanghai Jiao Tong UniversityShanghaiChina
- Research Institute of Pancreatic DiseaseShanghai Jiao Tong University School of MedicineShanghaiChina
- State Key Laboratory of Oncogenes and Related GenesShanghaiChina
| | - Baiyong Shen
- Department of General Surgery, Pancreatic Disease Center, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Institute of Translational Medicine, Shanghai Jiao Tong UniversityShanghaiChina
- Research Institute of Pancreatic DiseaseShanghai Jiao Tong University School of MedicineShanghaiChina
- State Key Laboratory of Oncogenes and Related GenesShanghaiChina
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Cipora E, Czerw A, Partyka O, Pajewska M, Badowska-Kozakiewicz A, Fudalej M, Sygit K, Kaczmarski M, Krzych-Fałta E, Jurczak A, Karakiewicz-Krawczyk K, Wieder-Huszla S, Banaś T, Bandurska E, Ciećko W, Kosior DA, Kułak P, Deptała A. Quality of Life in Patients with Pancreatic Cancer-A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4895. [PMID: 36981803 PMCID: PMC10048931 DOI: 10.3390/ijerph20064895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Pancreatic cancer is the malignant disease with the highest mortality rate, and it ranks third in the world after lung and colon cancer. Identified factors that increase the risk of developing pancreatic cancer include chronic pancreatitis, radiation therapy to the pancreatic area due to another cancer, diabetes mellitus, obesity, smoking, and age. The objective of this study was to present the current state of knowledge on the quality of life of patients diagnosed with pancreatic cancer, factors that determine QoL, and ways of coping with the disease. The low curability and low survival rates of pancreatic cancer significantly affect the quality of life of patients, often in the form of significant deterioration, especially in terms of mental changes, cognitive functions, and coping with the disease. Cognitive decline with comorbid depression is also typical for patients with this type of cancer. Research has shown that the health-related quality of life of patients with pancreatic cancer is low, so further research is needed to improve the situation in this area.
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Affiliation(s)
- Elżbieta Cipora
- Medical Institute, Jan Grodek State University in Sanok, 38-500 Sanok, Poland
| | - Aleksandra Czerw
- Department of Economic and System Analyses, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Olga Partyka
- Department of Economic and System Analyses, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Monika Pajewska
- Department of Economic and System Analyses, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
| | | | - Marta Fudalej
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Katarzyna Sygit
- Faculty of Health Sciences, Calisia University, 62-800 Kalisz, Poland
| | - Mateusz Kaczmarski
- Medical Institute, Jan Grodek State University in Sanok, 38-500 Sanok, Poland
| | - Edyta Krzych-Fałta
- Department of Basic Nursing, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Anna Jurczak
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | | | - Sylwia Wieder-Huszla
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Tomasz Banaś
- Department of Radiotherapy, Maria Sklodowska-Curie Institute-Oncology Centre, 31-115 Cracow, Poland
| | - Ewa Bandurska
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdansk, 80-204 Gdansk, Poland
| | - Weronika Ciećko
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdansk, 80-204 Gdansk, Poland
| | - Dariusz Artur Kosior
- Mossakowski Medical Research Institute, Polish Academy of Science, 02-106 Warsaw, Poland
| | - Piotr Kułak
- Department of Cardiology and Hypertension with Electrophysiological Lab, Central Research Hospital, The Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - Andrzej Deptała
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland
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10
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Relevant Study: Patient and Clinician Perspectives on Clinically-Meaningful Outcomes in Advanced Pancreatic Cancer. Cancers (Basel) 2023; 15:cancers15030738. [PMID: 36765698 PMCID: PMC9913496 DOI: 10.3390/cancers15030738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/14/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis and significant symptom burden. This prospective observational study aimed to evaluate expectations and priorities of patients with advanced PDAC and their clinicians through a study survey and two quality of life (QoL) questionnaires (QLQ-C30 and PAN26) at three time-points: baseline (T1), before (T2) and after (T3) their 1st on-treatment CT scan. Over a 1-year period, 106 patients were approached, 71 patients and 12 clinicians were recruited. Choosing between treatment options, patients prioritised: 54% overall survival (OS), 26% balance between side-effects and OS, 15% could not choose and 5% favoured symptom control. These were significantly different from the clinician's answers (p < 0.001). Patients who prioritised OS had higher symptom burden (p = 0.03) and shorter OS compared to those who prioritised balance (p = 0.01). Most (86%) patients had personal goals they wanted to reach; clinicians knew of these in 12% of instances. Patient and clinicians' views regarding survival improvement from chemotherapy were significantly different: 81% of clinicians and 12% of patients thought 1-2 or 3-6 months extension, 58% of patients and 0% physicians thought 1-5 or >5 years (p < 0.001). At T1, patients had low QoL and worst symptoms were: 'Future worries', 'planning of activities', fatigue and pain. Patients were willing to accept significantly higher amounts of side-effects as a trade-off for extra time, than clinicians thought (p < 0.001). Overall, there are significant discrepancies between patient and clinicians' views about the aims, priorities and expected extension of life.
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11
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Hue JJ, Graor HJ, Zarei M, Katayama ES, Ji K, Hajihassani O, Loftus AW, Vaziri-Gohar A, Winter JM. IDO1 Is a Therapeutic Target for Pancreatic Cancer-Associated Depression. Mol Cancer Ther 2022; 21:1810-1822. [PMID: 36190971 DOI: 10.1158/1535-7163.mct-22-0055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 01/12/2023]
Abstract
Metabolites of tryptophan degradation are known to alter mood. Their effects have only been superficially examined in the context of pancreatic cancer. Herein, we study the role of indoleamine 2,3-dioxygenase 1 (IDO1), an enzyme important in the conversion of tryptophan to kynurenine, in a murine model of pancreatic cancer-associated depression. Behavioral tests (open field, forced swim, tail suspension, and elevated plus maze) and biochemical assays (LC-MS metabolomics) were used to characterize a depressive-phenotype in tumor-bearing mice (relative to non-tumor-bearing mice). In addition, we determine whether pharmacologic blockade of IDO1 affects mood in tumor-bearing mice. Immunocompetent mice bearing orthotopic pancreatic tumors exhibit depressive-like behavior relative to non-tumor-bearing mice. Pancreatic tumors strongly express IDO1. Consequently, serum kynurenine levels in tumor-bearing mice are elevated relative to non-tumor-bearing mice. Tumor-bearing mice treated with epacadostat, an IDO1 inhibitor, exhibited improved mood relative to mice receiving vehicle. There was a 95% reduction in serum kynurenine levels in mice receiving epacadostat relative to mice treated with vehicle. As confirmatory evidence of on-target activity, tumors of mice treated with epacadostat exhibited a compensatory increase in IDO1 protein levels. Escitalopram, an approved antidepressant, was ineffective at improving mood in tumor-bearing mice as measured by behavioral assays and did not affect kynurenine levels. Neither epacadostat, nor escitalopram, affected overall survival relative to vehicle. Mice with pancreatic cancer exhibit depressive-like behavior. Epacadostat was effective as an antidepressant for pancreatic cancer-associated depression in mice. These data offer a rationale to consider IDO1 inhibition as a therapeutic strategy to mitigate depressive symptoms in patients with pancreatic cancer.
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Affiliation(s)
- Jonathan J Hue
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hallie J Graor
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Mehrdad Zarei
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | | | - Karen Ji
- Case Western Reserve University, Cleveland, Ohio
| | - Omid Hajihassani
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Alexander W Loftus
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ali Vaziri-Gohar
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jordan M Winter
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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12
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Tan DJH, Quek SXZ, Yong JN, Suresh A, Koh KXM, Lim WH, Quek J, Tang A, Tan C, Nah B, Tan E, Keitoku T, Muthiah MD, Syn N, Ng CH, Kim BK, Tamaki N, Ho CSH, Loomba R, Huang DQ. Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis. Clin Mol Hepatol 2022; 28:864-875. [PMID: 36263668 PMCID: PMC9597225 DOI: 10.3350/cmh.2022.0136] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Depression and anxiety are associated with poorer outcomes in patients with hepatocellular carcinoma (HCC). However, the prevalence of depression and anxiety in HCC are unclear. We aimed to establish the prevalence of depression and anxiety in patients with HCC. METHODS MEDLINE and Embase were searched and original articles reporting prevalence of anxiety or depression in patients with HCC were included. A generalized linear mixed model with Clopper-Pearson intervals was used to obtain the pooled prevalence of depression and anxiety in patients with HCC. Risk factors were analyzed via a fractional-logistic regression model. RESULTS Seventeen articles involving 64,247 patients with HCC were included. The pooled prevalence of depression and anxiety in patients with HCC was 24.04% (95% confidence interval [CI], 13.99-38.11%) and 22.20% (95% CI, 10.07-42.09%) respectively. Subgroup analysis determined that the prevalence of depression was lowest in studies where depression was diagnosed via clinician-administered scales (16.07%;95% CI, 4.42-44.20%) and highest in self-reported scales (30.03%; 95% CI, 17.19-47.01%). Depression in patients with HCC was lowest in the Americas (16.44%; 95% CI, 6.37-36.27%) and highest in South-East Asia (66.67%; 95% CI, 56.68-75.35%). Alcohol consumption, cirrhosis, and college education significantly increased risk of depression in patients with HCC. CONCLUSION One in four patients with HCC have depression, while one in five have anxiety. Further studies are required to validate these findings, as seen from the wide CIs in certain subgroup analyses. Screening strategies for depression and anxiety should also be developed for patients with HCC.
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Affiliation(s)
- Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sabrina Xin Zi Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adithya Suresh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ansel Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Caitlyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Eunice Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Taisei Keitoku
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Mark D. Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Cyrus Su Hui Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rohit Loomba
- NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA
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13
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Davis NE, Hue JJ, Kyasaram RK, Elshami M, Graor HJ, Zarei M, Ji K, Katayama ES, Hajihassani O, Loftus AW, Shanahan J, Vaziri-Gohar A, Rothermel LD, Winter JM. Prodromal depression and anxiety are associated with worse treatment compliance and survival among patients with pancreatic cancer. Psychooncology 2022; 31:1390-1398. [PMID: 35470512 DOI: 10.1002/pon.5945] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the frequency of depression or anxiety preceding a diagnosis of pancreatic cancer (PC). Further, to examine the association of PC-associated depression or anxiety with treatment compliance and survival. METHODS 856 patients with PC from a single institution were identified using International Classification of Diseases (ICD) codes. For each case, two non-cancer age- and sex-matched controls were included. Dates of depression or anxiety diagnosis identified using ICD codes were compared to the date of PC diagnosis. The medical record was queried to further explore psychiatric symptoms. Multivariable analyses were performed to examine if prediagnosis depression or anxiety was associated with receipt of treatment or survival. RESULTS A greater proportion of patients with PC experienced depression or anxiety in the year preceding diagnosis than the overall frequency in controls (4.6% vs. 2.6%, p = 0.005) based on ICD codes. Patients with PC exhibited signs of prodromal depression or anxiety based on ICD codes, clinical documentation of psychiatric symptoms, or initiation of new psychiatric medications more often than controls (20.7% vs. 6.7%, p < 0.001). Prediagnosis depression or anxiety was associated with a reduced likelihood of receiving chemotherapy (OR = 0.58, p = 0.04). There was an associated decrease in overall survival among patients with metastatic disease who experienced depression or anxiety before PC diagnosis (HR = 1.32, p = 0.04). CONCLUSIONS The frequency of depression or anxiety among patients with PC was higher than the general population. Prediagnosis psychiatric symptoms were associated with reduced chemotherapy utilization and worse overall survival. Thus, timely identification and treatment of these symptoms may improve outcomes.
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Affiliation(s)
- Nathaniel E Davis
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ravi K Kyasaram
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mohamedraed Elshami
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Hallie J Graor
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mehrdad Zarei
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Karen Ji
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Omid Hajihassani
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexander W Loftus
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John Shanahan
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ali Vaziri-Gohar
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
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14
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Drageset J, Sandvik RK, Eide LSP, Austrheim G, Fox M, Beisland EG. Quality of life among cancer inpatients 80 years and older: a systematic review. Health Qual Life Outcomes 2021; 19:98. [PMID: 33743742 PMCID: PMC7980558 DOI: 10.1186/s12955-021-01685-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this systematic review was to summarize and assess the literature on quality of life (QoL) among cancer patients 80 years and older admitted to hospitals and what QoL instruments have been used. Methods We searched systematically in Medline, Embase and Cinahl. Eligibility criteria included studies with any design measuring QoL among cancer patients 80 years and older hospitalized for treatment (surgery, chemotherapy or radiation therapy). Exclusion criteria: studies not available in English, French, German or Spanish. We screened the titles and abstracts according to a predefined set of inclusion criteria. All the included studies were assessed according to the Critical Appraisal Skills Programme checklists, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement checklist was used to ensure rigor in conducting and reporting. This systematic review was registered in PROSPERO (CRD42017058290). Results We included 17 studies with 2005 participants with various cancer diagnoses and Classification of Malignant Tumors stages (TNM). The included studies used a range of different QoL instruments and had different aims and outcomes. Both cancer-specific and generic instruments were used. Only one of the 17 studies used an age-specific instrument. All the studies included patients 80 years and older in their cohort, but none specifically analyzed QoL outcomes in this particular subgroup. Based on findings in the age-heterogeneous population (age range 20–100 years), QoL seems to be correlated with the type of diagnosed carcinoma, length of stay, depression and severe symptom burden. Conclusion We were unable to find any research directly exploring QoL and its determinants among cancer patients 80 years and older since none of the included studies presented specific analysis of data in this particular age subgroup. This finding represents a major gap in the knowledge base in this patient group. Based on this finding, we strongly recommend future studies that include this increasingly important and challenging patient group to use valid age- and diagnosis-specific QoL instruments.
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Affiliation(s)
- Jorunn Drageset
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063, Bergen, Norway. .,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | - Reidun Karin Sandvik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063, Bergen, Norway
| | - Leslie Sofia Pareja Eide
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063, Bergen, Norway
| | - Gunhild Austrheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063, Bergen, Norway
| | - Mary Fox
- York University, Toronto, Canada
| | - Elisabeth Grov Beisland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, 5063, Bergen, Norway
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15
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Liu YJ, Schandl A, Markar S, Johar A, Lagergren P. Psychological distress and health-related quality of life up to 2 years after oesophageal cancer surgery: nationwide population-based study. BJS Open 2021; 5:6073387. [PMID: 33609371 PMCID: PMC7893460 DOI: 10.1093/bjsopen/zraa038] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients are at higher risk of suffering from psychological distress and reduced health-related quality of life (HRQoL) after oesophageal cancer surgery. This Swedish nationwide population-based longitudinal study aimed to evaluate the association between psychological distress and HRQoL up to 2 years after oesophageal cancer surgery. METHODS The study included patients with oesophageal cancer who had survived for 1 year after oesophageal cancer surgery. The exposure was psychological distress measured using the Hospital Anxiety and Depression Scale. Patients scoring at least 8 on either the anxiety or the depression subscale were classified as having psychological distress. The outcome was HRQoL assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire generic and disease-specific questionnaires (EORTC QLQ-C30 and QLQ-OG25). Exposure and outcome were measured at 1, 1.5, and 2 years after operation. Fixed-effects models with adjustment for all time-invariant confounding and potential time-varying confounders were used to examine the mean score difference in HRQoL between patients with and without psychological distress. RESULTS In total, 180 patients were analysed. Clinically relevant, statistically significant and time-constant mean score differences were found in emotional function, social function, dyspnoea, anxiety, eating difficulty, eating in front of others, and weight loss (mean score difference range 10-29). Mean score differences for global quality of life, cognitive function, appetite loss, EORTC QLQ-C30 summary score, and trouble with taste increased over time, and reached clinical and statistical significance at 1.5 and/or 2 years after surgery. For body image, there was a clinically relevant decrease in mean score difference over time. CONCLUSION Psychological distress was associated with several aspects of poor HRQoL up to 2 years after surgery for oesophageal cancer.
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Affiliation(s)
- Y J Liu
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Schandl
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - S Markar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P Lagergren
- Correspondence to: Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius väg 13 a, Level 4, 171 77 Stockholm, Sweden (e-mail: )
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16
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Park HY. [Emotional Support and Palliative Care for Distressed Patients Suffering from Pancreatic Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 74:95-100. [PMID: 31438661 DOI: 10.4166/kjg.2019.74.2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 11/03/2022]
Abstract
Pancreatic cancer is associated with a poor prognosis and high mortality. Thus, distress that includes depression and anxiety is a relatively common comorbidity for patients suffering from pancreatic cancer. However, these psychological symptoms are likely to be under-detected and undertreated. Regarding high levels of unmet needs of psychological support for patients with pancreatic cancer, early screening for distress and adequate interventions should be considered in palliative care settings. Suicide, a common but preventable cause of mortality for patients with pancreatic cancer, also deserves the further attention of care providers. Still, there have been limited studies that have documented psychological support for this population. Future research is needed to elucidate appropriate psychological care and models of services for patients suffering from pancreatic cancer.
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Affiliation(s)
- Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
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17
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Sreedharan L, Kumar B, Jewell A, Banim P, Koulouris A, Hart AR. Bridging clinic: The initial medical management of patients with newly diagnosed pancreatic cancer. Frontline Gastroenterol 2019; 10:261-268. [PMID: 31288251 PMCID: PMC6583575 DOI: 10.1136/flgastro-2018-101002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 02/04/2023] Open
Abstract
Pancreatic cancer is the 11th most common cancer in the UK and has the worst prognosis of any tumour with minimal improvements in survival over recent decades. As most patients are either ineligible for surgery or may decline chemotherapy, the emphasis is on control of symptoms and management of complications such as poor nutritional status. The time period between informing the patient of their diagnosis and commencing cancer treatments presents a valuable opportunity to proactively identify and treat symptoms to optimise patients' overall well-being. The 'bridging clinic', delivered by a range of healthcare professionals from gastroenterologists to nurse practitioners, can provide this interface where patients are first informed of their diagnosis and second supportive therapies offered. In this article, we provide a structure for instituting such supportive therapies at the bridging clinic. The components of the clinic are summarised using the mnemonic INDASH (Information/Nutrition/Diabetes and Depression/Analgesia/Stenting/Hereditary) and each is discussed in detail below.
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Affiliation(s)
| | - Bhaskar Kumar
- Upper GI Surgery, Norfolk and Norwich Hospital, Norwich, UK
| | | | - Paul Banim
- James Paget University Hospitals, Great Yarmouth, Norfolk, UK
| | - Andreas Koulouris
- Academic Clinical Fellow in Gastroenterology, Norfolk and Norwich Hospital, Norwich, UK
| | - Andrew R Hart
- Gastroenterology, Norfolk and Norwich Hospital, Norwich, UK
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18
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Abstract
This review aimed to inventory and analyze previous studies regarding quality of life (QoL) and psychological outcomes in relation to pancreatectomy. PubMed and PsycInfo databases were reviewed using the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Thirteen studies were selected, 9 of which focused on the QoL after surgery. Quality of life significantly improved 3 to 6 months after surgery. Regarding the postoperative experience, one study reported high fear of recurrence of cancer, whereas another emphasized various expressions of patient needs. One study explained how strategy and ability to adapt are not related to the type, the cause, nor the physical condition, but are mainly influenced by the age and the subjective experience of the patients. A last study showed that depression did not affect survival rate after surgery. Our systematic review found only few studies regarding the psychological condition after pancreatectomy and highlights the need to describe and characterize the patients' psychological characteristics in this setting.
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19
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Ryu JS, Choi SW, Yun SS, Koo BH, Choi IS, Kim SJ, Park JS, Seok JH, Yoon DS. Preliminary Findings on the Effectiveness of Meaning-Centered Psychotherapy in Patients with Pancreatobiliary Cancer. Yonsei Med J 2018; 59:1107-1114. [PMID: 30328326 PMCID: PMC6192895 DOI: 10.3349/ymj.2018.59.9.1107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study investigated the effectiveness of meaning-centered psychotherapy (MCP), which is known to be a helpful psychotherapeutic intervention in distressing conditions, for patients with pancreatobiliary cancer. MATERIALS AND METHODS We recruited 37 patients with pancreatobiliary cancer from three university general hospitals and assessed their psychological characteristics. Patients who reported clinically significant emotional distress were recommended to undergo MCP. Patients who consented to MCP were provided four sessions of the therapy. Patient psychological characteristics were assessed again 2 months after MCP. For statistical comparison, outcome variables included anxiety, depression, mental adjustment to cancer, and quality of life (QoL), as well as the degree of stress and physical symptoms. RESULTS Sixteen patients completed the MCP and the final assessment 2 months later. In the initial assessment, the patients receiving MCP showed higher levels of anxiety and depression than those not receiving MCP, and QoL was also lower in terms of role function, emotional function, social function, and global QoL. At the 2-month follow-up, the MCP group showed a significant improvement in anxiety (p=0.007), depression (p=0.010), and anxious preoccupation (p<0.001). In addition, QoL significantly improved in the MCP group, while there was no significant change in the non-MCP group. CONCLUSION In this study, MCP showed potential therapeutic benefits against emotional distress in patients with pancreatobiliary cancer, improving their QoL.
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Affiliation(s)
- Jin Sun Ryu
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Woo Choi
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Su Yun
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Bon Hoon Koo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
| | - In Seok Choi
- Department of Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Seung Jun Kim
- Department of Psychiatry, Konyang University College of Medicine, Daejeon, Korea
| | - Joon Seong Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Ho Seok
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.
| | - Dong Sup Yoon
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
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Abstract
The prevalence of major depressive disorder (MDD) in pancreatic cancer (PC) has been reported up to 7 times higher than the general population. Despite repeated studies that show worse quality of life, survival outcomes, and treatment compliance in cancer patients with depression, baseline antidepressant use ranges from 15% to 27%. A meta-analysis of 6 prospective trials specific to PC estimates that 43% of patients with PC experience depression after diagnosis. This is especially alarming in patients with PC, who may experience a prodrome of symptoms including depression and loss of drive. In fact, this prodrome of symptoms may very well be due to an overexpression of indoleamine 2,3-dioxgenase, an enzyme in the kynurenine pathway that leads to serotonin depletion and the buildup of cytotoxic metabolites in the brain. In this literature review, we outline all previous studies pertinent to PC and depression, as well as the molecular underpinnings that may contribute to states of depression, and report on previous randomized control trials in cancer populations that investigate the use of antidepressants to treat depressive symptoms and improve quality of life both prophylactically and after the onset of major depressive disorder. In addition, we detail a case report outlining the precipitous decline in health in 1 patient with PC and depression.
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21
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Sato N, Hasegawa Y, Saito A, Motoi F, Ariake K, Katayose Y, Nakagawa K, Kawaguchi K, Fukudo S, Unno M, Sato F. Association between chronological depressive changes and physical symptoms in postoperative pancreatic cancer patients. Biopsychosoc Med 2018; 12:13. [PMID: 30288172 PMCID: PMC6162953 DOI: 10.1186/s13030-018-0132-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background Pancreatic cancer (PC) has poorer prognosis and higher surgical invasiveness than many other cancers, with associated psychiatric symptoms including depression and anxiety. Perioperative depression has not been investigated in PC patients regarding surgical stress and relevant interventions. Methods We evaluated chronological depressive changes and subjective physical symptoms in surgically treated PC patients preoperatively and at 3 and 6 months postoperatively. Enrolled patients undergoing pancreatic tumor surgery completed questionnaires based on the Self-Rating Depression Scale (SDS) and Functional Assessment of Cancer Therapy for Patients with Hepatobiliary Cancer (FACT-Hep) preoperatively, and at 3 and 6 months postoperatively. Responses were analyzed with JMP® Pro using one-way and two-way ANOVA, Spearman’s rank correlation coefficient, and multiple regression analysis. Results Malignancy was diagnosed in 73 of 101 patients postoperatively; SDS score was significantly higher in these patients than in those with benign tumors at all timepoints: malignant/benign, 41.8/37.9 preoperatively (p = 0.004); 43.5/37.8 3 months postoperatively (p = 0.006); and 42.9/37.7 6 months postoperatively (p = 0.020). SDS scores were significantly higher in patients < 65 years old with malignancy at 3 months than at 6 months postoperatively (44.6/42.5, p = 0.046) and in patients with malignancy who underwent pancreaticoduodenectomy at 3 months postoperatively than preoperatively (43.4/41.1; p = 0.028). SDS scores moderately correlated with 8 physical symptom-related FACT-Hep items 3 months postoperatively (p < 0.05), showing low-to-moderate correlation with 16 physical symptom-related FACT-Hep items at 6 months postoperatively (p < 0.05). Multiple regression analysis of FACT-Hep symptoms significantly correlated with SDS scores revealed the following significant variables: “lack of energy” (p < 0.000) and “pain” (p = 0.018) preoperatively (R2 = 0.43); “able to perform usual activities” (p = 0.031) and “lack of energy” (p < 0.000) at 3 months postoperatively (R2 = 0.51); and “stomach swelling or cramps” (p = 0.034) and “bowel control” (p = 0.049) at 6 months postoperatively (R2 = 0.52). Conclusions PC patients experience persistently high levels of depression preoperatively through 6 months postoperatively, with associated subjective symptoms including pain and gastrointestinal symptoms. Trial registration UMIN Clinical Trials Registry 000009592, Registered 20 December 2012.
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Affiliation(s)
- Naoko Sato
- 1Department of Oncology Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan.,5Department of Oncology Nursing, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575 Japan
| | - Yoshimi Hasegawa
- 2Department of Nursing, Tohoku University School of Health Sciences, Sendai, Japan
| | - Asami Saito
- 1Department of Oncology Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fuyuhiko Motoi
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kyohei Ariake
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Katayose
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Nakagawa
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Kawaguchi
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin Fukudo
- 4Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- 3Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fumiko Sato
- 1Department of Oncology Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
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Wong SS, George TJ, Godfrey M, Le J, Pereira DB. Using photography to explore psychological distress in patients with pancreatic cancer and their caregivers: a qualitative study. Support Care Cancer 2018; 27:321-328. [PMID: 29959574 DOI: 10.1007/s00520-018-4330-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The quality of life (QOL) experiences of patients with pancreatic cancer and their caregivers is poorly understood. Psychological distress is high, but few studies examine the factors associated with psychological distress. The purpose of this study is to gain a richer understanding of the factors associated with psychological distress from patient and caregiver perspectives. METHODS Twenty participants (13 patients, 7 caregivers) completed group discussions on the experiences of living with pancreatic cancer. Using photovoice methods, participants took photographs and provided narratives depicting the distress they experienced. Participant-produced photographs and group discussion transcripts were analyzed to identify key themes using thematic analysis. RESULTS Commonalities between patient and caregiver sources of distress emerged despite their distinct roles. Findings revealed four major areas of distress: diagnosis of an unexpected advanced cancer, changes in roles and identity, management of weight loss and gastrointestinal problems, and fear of the future. Participants also discussed unique perspectives such as the stigma of pancreatic cancer and caregiver guilt. CONCLUSIONS Photovoice provides a unique insight into the lives of patients with pancreatic cancer and their caregivers. Our findings contribute to the gap in the current literature by providing a better understanding of the factors surrounding pancreatic cancer distress. We also identify several clinical recommendations to improve cancer care delivery and areas for future research.
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Affiliation(s)
- Shan S Wong
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Thomas J George
- Division of Hematology-Oncology, University of Florida College of Medicine, 2000 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Melyssa Godfrey
- Center for Musculoskeletal Pain Research, Division of Rheumatology, University of Florida, PO Box 100221, Gainesville, FL, 32610-0221, USA
| | - Jennifer Le
- Foundation for Applied Molecular Evolution, 13709 Progress Blvd, Box 7, Alachua, FL, 32615, USA
| | - Deidre B Pereira
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
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Parental Migration and Left-Behind Children's Depressive Symptoms: Estimation Based on a Nationally-Representative Panel Dataset. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061069. [PMID: 29795049 PMCID: PMC6025488 DOI: 10.3390/ijerph15061069] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 11/17/2022]
Abstract
China's rapid urbanization in the past several decades have been accompanied by rural labor migration. An important question that has emerged is whether rural labor migration has a positive or negative impact on the depressive symptoms of children left behind in the countryside by their migrating parents. This paper uses a nationally representative panel dataset to investigate whether parental migration impacts the prevalence of depressive symptoms among left-behind children in China. Using DID and PSM-DID methods, our results show that parental migration significantly increases the depression scores of 10 and 11-year-old children by 2 points using the CES-D depression scale. Furthermore, we also find that the negative effect of decreased parental care is stronger than the positive effect of increased income in terms of determining the depressive symptoms status of children in rural China.
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Cao Y, Chen X, Xie H, Zou L, Hu LJ, Zhou XJ. Correlation between Electroencephalogram Alterations and Frontal Cognitive Impairment in Esophageal Cancer Patients Complicated with Depression. Chin Med J (Engl) 2018; 130:1785-1790. [PMID: 28748850 PMCID: PMC5547829 DOI: 10.4103/0366-6999.211552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Some esophageal cancer patients complicated with depression exhibit cognitive impairments. Frontal electroencephalogram (EEG) may be used as a reliable biomarker for prefrontal-mediated cognitive functions. This study was to investigate alterations of EEG and frontal cognitive impairment in esophageal cancer patients complicated with depression and to assess their correlation. METHODS Sixty-five esophageal cancer patients with depression (study group) and 62 healthy controls (control group) were included in this study. The study group were assigned into psychotic depressed (PD, n = 32) and nonpsychotic depressed (NPD, n = 33) subgroups based on complication with psychotic symptoms (Brief Psychiatric Rating Scale [BPRS] >35). EEG examination, Beck self-rating depression scale, and BPRS were used to assess clinical symptoms. Chi-square test, two independent sample t-test, one-way analysis of variance, and Kruskal-Wallis test were utilized to compare the variables between two groups. EEG abnormalities and scores of frontal cognitive function test were analyzed by partial correlation analysis in the PD and NPD subgroups. RESULTS Compared with control group, the study group displayed greater scores either in the Stroop test (19.89 ± 2.05 vs. 24.12 ± 2.19, P = 0.006) or Color Trails Test (CTT; 11.92 ± 1.01 vs. 15.02 ± 1.63, P = 0.008), and reduced score (35.05 ± 2.01 vs. 32.11 ± 2.38, P = 0.007) in the verbal fluency test (VFT). Compared to NPD subgroup, PD subgroup exhibited increased scores in Stroop test (22.89 ± 2.07 vs. 25.38 ± 2.32, P = 0.009) and CTT (13.16 ± 1.71 vs. 15.82 ± 1.13, P = 0.008). Moreover, increased scores in Stroop test and CTT as well as scores in VFT were associated with the severity of depression. The study group had an abnormal frontal EEG, such as α forward, α asymmetry, α moderation, and increased θ activity relative to control group. Similarly, compared with NPD subgroup, PD subgroup displayed α forward, α asymmetry, and α moderation. The correlation test revealed that α forward and α asymmetry were negatively associated with VFT score, but positively correlated with the scores of CTT and the Stroop test in PD subgroup. In addition, α asymmetry in NPD subgroup was positively related to CTT scores. CONCLUSION This study indicated that frontal cognitive impairment in esophageal cancer patients complicated with depression is associated with EEG alterations.
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Affiliation(s)
- Yin Cao
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Xia Chen
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Hui Xie
- Electroencephalogram Laboratory, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Ling Zou
- Department of Automation, School of Information Science and Engineering, Changzhou University, Changzhou, Jiangsu 213000, China
| | - Li-Jun Hu
- Department of Radiotherapy, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
| | - Xian-Ju Zhou
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China
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Abstract
Little is known about quality of life (QOL) of patients with pancreatic cancer and their caregivers compared with adults with other cancers. This systematic review summarizes the available evidence base, identifies its limitations, and recommends directions for research and clinical application. A systematic review was conducted of research on QOL in adults with pancreatic cancer and their caregivers. Quality of life was examined in the following specific domains: psychological, physical, social, sexual, spiritual, and general. Of the 7130 articles reviewed, 36 studies met criteria for inclusion. Compared with healthy adults or population norms, adults with pancreatic cancer had worse QOL across all domains. Compared with patients with other cancer types, patients with pancreatic cancer evidenced worse psychological QOL. Physical and social QOL were either similar or more compromised than in patients with other cancers. Limited data preclude conclusions about sexual, spiritual, and caregiver QOL. Patients with pancreatic cancer evidence decrements in multiple QOL domains, with particular strain on psychological well-being. Methodological limitations of available studies restrict definitive conclusions. Future research with well-defined samples, appropriate statistical analyses, and longitudinal designs is needed. Findings from this review support the merits of distress screening, integration of mental health professionals into medical teams, and attention to caregiver burden.
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Tang CC, Draucker C, Tejani M, Von Ah D. Symptom experiences in patients with advanced pancreatic cancer as reported during healthcare encounters. Eur J Cancer Care (Engl) 2018; 27:e12838. [DOI: 10.1111/ecc.12838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 01/09/2023]
Affiliation(s)
- C.-C. Tang
- National Taiwan University; Taipei Taiwan
| | - C. Draucker
- Angela Barron McBride Endowed Professorship in Mental Health Nursing; Indiana University School of Nursing; Indianapolis IN USA
| | - M. Tejani
- University of Rochester Medical Center; Rochester NY USA
| | - D. Von Ah
- Department of Community & Health Systems; Indiana University School of Nursing; Indianapolis IN USA
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27
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Lewis AR, Pihlak R, McNamara MG. The importance of quality-of-life management in patients with advanced pancreatic ductal adenocarcinoma. Curr Probl Cancer 2018; 42:26-39. [PMID: 29631711 DOI: 10.1016/j.currproblcancer.2018.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/15/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis, and as such, a focus on quality of life is vital. This review will discuss various aspects of quality of life in patients with PDAC and their treatment. Pancreatic exocrine and endocrine insufficiency may result in issues related to nutrition, and pain and fatigue are other common symptoms, and may be managed with pharmaceutical or nonpharmaceutical methods. It has also been reported that low mood is a particular problem for patients with PDAC compared to patients with other cancers; however, the data supporting this is inconsistent. Data regarding improvements in quality of life in patients with PDAC receiving chemotherapy is also reviewed, which in some cases suggests a benefit to chemotherapy, particularly in the presence of a radiological response. Furthermore, the importance of early palliative care is discussed and the benefits reported including improved quality of life and mood, reduced aggressive interventions at the end of life and improved survival. Areas for future development may include increased use of quality of life as a trial outcome and the use of patient-reported outcomes to improve symptomatic care of patients, and particularly in those receiving active systemic treatment.
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Affiliation(s)
- Alexandra R Lewis
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Rille Pihlak
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK.
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Gillespie J, Kacikanis A, Nyhof-Young J, Gallinger S, Ruthig E. Information Needs of Hepato-Pancreato-Biliary Surgical Oncology Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:589-595. [PMID: 27075195 DOI: 10.1007/s13187-016-1034-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A marked knowledge gap exists concerning the information needs of hepato-pancreato-biliary (HPB) surgical oncology patients. We investigated the comprehensive information needs of this patient population, including the type and amount of information desired, as well as the preferred method of receiving information. A questionnaire was administered to patients being treated surgically for cancers of the liver, pancreas, gallbladder, or bile ducts at Toronto General Hospital, part of the University Health Network, in Toronto, Canada. The questionnaire examined patients' information needs across six domains of information: medical, practical, physical, emotional, social, and spiritual. Among 36 respondents, the importance of information and amount of information desired differed significantly by domain (both p < 0.001). This group of patients rated information in the medical and physical domains as most important, though they also desired specific items of information from the emotional, practical, and social domains. Patients' overwhelming preference was to receive information via a one-on-one consultation with a healthcare provider. It is important for healthcare providers working with HPB surgical oncology patients to be comprehensive when providing information related to patients' cancer diagnosis, prognosis, associated symptoms, and side effects of treatment. Certain emotional, practical, and social issues (e.g., fears of cancer recurrence, drug coverage options, relationship changes) should be addressed as well. Face-to-face interactions should be the primary mode of delivering information to patients. Our findings are being used to guide the training of healthcare providers and the development of educational resources specific to HPB surgical oncology patients.
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Affiliation(s)
- Jacqueline Gillespie
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Anna Kacikanis
- Sprott Department of Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada
- Present Address: St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Joyce Nyhof-Young
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Helliwell Medical Education Centre, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada
| | - Steven Gallinger
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Sprott Department of Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada
| | - Elke Ruthig
- Patient and Family Education Program, Toronto General Hospital, University Health Network, 200 Elizabeth St., 9NU-908, Toronto, ON, M5G 2C4, Canada.
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Muircroft W. An Australasian perspective on the curative treatment of patients with pancreatic cancer, supportive care, and future directions for management. Ecancermedicalscience 2016; 10:700. [PMID: 28105071 PMCID: PMC5221644 DOI: 10.3332/ecancer.2016.700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Indexed: 11/06/2022] Open
Abstract
The management of patients with pancreatic cancer requires an individualised approach and the support of a multidisciplinary team to accurately stage patients and determine their suitability for curative treatment. Guidelines have been developed in Australasia to define the operability for patients who have been diagnosed with pancreatic cancer. This is supported by advances in pancreatic cancer genetics, which show potential for developing targeted therapies for pancreatic cancer. Both surgery and targeted therapies aim to extend the overall survival of patients. Patients who are cured of their cancer may live with permanent changes in gut anatomy and physiology leading to distressing symptoms that may not be addressed. Patients who cannot be cured of pancreatic cancer may have supportive care issues that are often complex, and a strategic approach to manage these needs for patients with pancreatic cancer is underdeveloped in Australasia. Supportive care services need to be in a position to adapt patient care as the evidence base develops.
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Affiliation(s)
- Wendy Muircroft
- Southern Adelaide Palliative Service, Adelaide 5041, Australia
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31
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Mikan F, Wada M, Yamada M, Takahashi A, Onishi H, Ishida M, Sato K, Shimizu S, Matoba M, Miyashita M. The Association Between Pain and Quality of Life for Patients With Cancer in an Outpatient Clinic, an Inpatient Oncology Ward, and Inpatient Palliative Care Units. Am J Hosp Palliat Care 2016; 33:782-90. [PMID: 26873926 DOI: 10.1177/1049909116630266] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This study was designed to clarify the association between pain and quality of life (QOL) of Japanese patients with cancer using a cancer-specific QOL scale (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C15-PAL) in 3 care settings (outpatient, inpatient, and palliative care units [PCUs]). METHODS We examined the above-mentioned purpose for the total of 404 patients. RESULTS In outpatients, physical, emotional functioning (EF), and global health status/QOL (QL item) were significantly correlated with average pain, and their correlation coefficients were -0.37 to -0.46 (P < .0001). In inpatients, they were -0.33 (P = .006), -0.26 (P = .030), and -0.31 (P = .012). In the PCU patients, they were -0.12 (P = .316), -0.30 (P = .009), and -0.28 (P = .015). CONCLUSION Patients' pain had an association with physical and emotional QOL, and the association was smaller in the PCU patients than the others.
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Affiliation(s)
- Fukiko Mikan
- Department of Clinical Nursing, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Kagoshima University, Kagoshima, Japan Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Makoto Wada
- Department of Psycho-Oncology and Palliative Medicine Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan Department of Psycho-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Michiko Yamada
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Ayaka Takahashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hideki Onishi
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mayumi Ishida
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Sachiko Shimizu
- Department of Clinical Nursing, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Kagoshima University, Kagoshima, Japan
| | - Motohiro Matoba
- Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Tobias K, Rosenfeld B, Pessin H, Breitbart W. Measuring sickness behavior in the context of pancreatic cancer. Med Hypotheses 2015; 84:231-7. [PMID: 25659492 DOI: 10.1016/j.mehy.2015.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
Abstract
Sickness behavior has been widely recognized as a symptom cluster that is associated with pro-inflammatory cytokine activation resulting from diverse conditions. The symptoms that comprise sickness behavior overlap substantially with major depressive disorder (MDD), which raises questions about the relationship between these two constructs, both of which occur frequently in patients with cancer. The construct of sickness behavior, while well-established in animal research, has rarely been applied to studies examining cytokines and depression in humans, perhaps because no reliable or validated measure of sickness behavior has been developed. We developed a version of a sickness behavior measure (the Sickness Behavior Inventory or SBI) and conducted a preliminary examination of its scale properties. Specifically, we hypothesized that a measure of sickness behavior would be significantly associated with five biomarkers of immune functioning (serum IL-6, TNF-α, IL-1b, IL-4, IL-10) in a human sample. The sample was comprised of four groups: individuals with pancreatic cancer and MDD (n = 16), individuals with pancreatic cancer and who did not have a diagnosis of MDD (n =2 6), individuals without cancer who had MDD (n = 7), and individuals who did not have cancer or MDD (n = 25). The SBI demonstrated moderate reliability (Cronbach's alpha = .66), and total scores were significantly correlated with IL-6 (rs = .26, p = .03), but not with other markers of immune functioning. Factor analysis supported a 3-factor model of sickness behavior with different associations between the three SBI factors and cytokines. These results highlight the need to further refine symptom measurement to better understand the relationships among immune functioning, cancer, depression, and sickness behavior.
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Affiliation(s)
| | | | - Hayley Pessin
- Memorial Sloan Kettering Cancer Center, United States
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Moningi S, Walker AJ, Hsu CC, Reese JB, Wang JY, Fan KY, Rosati LM, Laheru DA, Weiss MJ, Wolfgang CL, Pawlik TM, Herman JM. Correlation of clinical stage and performance status with quality of life in patients seen in a pancreas multidisciplinary clinic. J Oncol Pract 2015; 11:e216-21. [PMID: 25563703 DOI: 10.1200/jop.2014.000976] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The objectives of this study were to evaluate quality of life (QoL) in patients presenting to the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC), and to examine associations between disease status, performance status, and QoL in order to identify patient subgroups that are most at risk for reduced QoL. PATIENTS AND METHODS Data from 77 patients were evaluated. At initial presentation, disease and performance status were assessed, as well as QoL, which was obtained with the European Organisation for Research and Treatment of Cancer QLQ-PAN26 questionnaire. Statistical analyses examined associations between QoL, disease status, and performance status. RESULTS Digestive symptoms (P < .003) significantly differed by pancreatic disease status (resectable, resected, locally advanced, and metastatic). Patients with a worse performance status, defined as Eastern Cooperative Oncology Group ≥ 1, were more likely to report symptomatic pancreatic pain (P = .001), digestive symptoms (P = .017), cachexia (P = .004), and ascites (P < .001) compared with patients with a performance status of 0. The majority (92%) of patients reported a significant fear of future health problems, regardless of disease status or performance status. CONCLUSION Although several measures of QoL have been observed in all patients, certain measures appear to correlate specifically with worse disease status. Therefore, routine assessment of QoL is suggested in order to guide treatment decisions. Further investigation on optimizing the use of QoL measures and patient-reported outcomes to better tailor management is warranted.
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Affiliation(s)
- Shalini Moningi
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Amanda J Walker
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Charles C Hsu
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Jennifer Barsky Reese
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Jing-Ya Wang
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Katherine Y Fan
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Lauren M Rosati
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Daniel A Laheru
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Matthew J Weiss
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Christopher L Wolfgang
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Timothy M Pawlik
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
| | - Joseph M Herman
- Johns Hopkins University School of Medicine, Baltimore, MD; and University of California, San Francisco, San Francisco, CA
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Janberidze E, Hjermstad MJ, Haugen DF, Sigurdardottir KR, Løhre ET, Lie HC, Loge JH, Kaasa S, Knudsen AK. How are patient populations characterized in studies investigating depression in advanced cancer? Results from a systematic literature review. J Pain Symptom Manage 2014; 48:678-98. [PMID: 24681108 DOI: 10.1016/j.jpainsymman.2013.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/22/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Prevalence rates of depression in patients with advanced cancer vary considerably. This may be because of heterogeneous samples and use of different assessment methods. Adequate sample descriptions and consistent use of measures are needed to be able to generalize research findings and apply them to clinical practice. OBJECTIVES Our objective was twofold: First, to investigate which clinically important variables were used to describe the samples in studies of depression in patients with advanced cancer; and second, to examine the methods used for assessing and classifying depression in these studies. METHODS PubMed, PsycINFO, Embase, and CINAHL were searched combining search term groups representing "depression," "palliative care," and "advanced cancer" covering 2007-2011. Titles and abstracts were screened, and relevant full-text articles were evaluated independently by two authors. Information on 32 predefined variables on cancer disease, treatment, sociodemographics, depression-related factors, and assessment methods was extracted from the articles. RESULTS After removing duplicates, 916 citations were screened of which 59 articles were retained. Age, gender, and stage of the cancer disease were the most frequently reported variables. Depression-related variables were rarely reported, for example, antidepressant use (17%) and previous depressive episodes (12%). Only 25% of the studies assessed and classified depression according to a validated diagnostic system. CONCLUSION Current practice for describing sample characteristics and assessing depression varies greatly between studies. A more standardized practice is recommended to enhance the generalizability and utility of findings. Stakeholders are encouraged to work toward a common standard for sample descriptions.
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Affiliation(s)
- Elene Janberidze
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Erik Torbjørn Løhre
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Håvard Loge
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Hu LY, Ku FC, Wang YP, Shen CC, Hu YW, Yeh CM, Chen PM, Chiang HL, Lu T, Chen TJ, Teng CJ, Liu CJ. Anxiety and depressive disorders among patients with esophageal cancer in Taiwan: a nationwide population-based study. Support Care Cancer 2014; 23:733-40. [PMID: 25179690 DOI: 10.1007/s00520-014-2403-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/11/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND The comorbidity of depression with anxiety disorders is associated with poorer treatment outcomes, worse quality of life, poorer adherence to treatment, and greater suicide risk in cancer patients. OBJECTIVE To assess the risk of comorbid anxiety and depressive disorders after the diagnosis of esophageal cancer compared with a matched cohort by using the Taiwan National Health Insurance Research Database (NHIRD). METHODS We conducted a retrospective study of 28,454 patients (14,227 patients with esophageal cancer and 14,227 matched patients) who were selected from the NHIRD. Patients were observed for a maximum of 12 years to determine the incidence of new-onset anxiety and depressive disorders for which antidepressants had been prescribed. A Cox regression analysis was performed to identify the risk factors associated with anxiety and depressive disorders in esophageal cancer patients. RESULTS The cumulative incidence of anxiety and depressive disorders in the esophageal cancer patients was significantly higher than that in the matched cohort (P < .001). The adjusted hazard ratio (HR) was 2.24 (95 % confidence interval, CI = 1.95-2.56, P < .001) in the esophageal cancer cohort compared with the matched cohort. Independent risk factors for developing anxiety and depressive disorders among the patients with esophageal cancer included cirrhosis, cerebrovascular disease, and surgical treatment. CONCLUSION Esophageal cancer may be a prominent risk factor for anxiety and depressive disorders. Based on our data, we suggest that attention should be focused on esophageal cancer patients with comorbid cirrhosis and cerebrovascular disease and those who have received surgical interventions.
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Affiliation(s)
- Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Zhao L, Li X, Zhang Z, Song C, Guo C, Zhang Y, Zhang Y, Li L, Lu G, Zheng G, Wang K, Pei W, Han L. Prevalence, correlates and recognition of depression in Chinese inpatients with cancer. Gen Hosp Psychiatry 2014; 36:477-82. [PMID: 24961793 DOI: 10.1016/j.genhosppsych.2014.05.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/18/2014] [Accepted: 05/01/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the prevalence, correlates and recognition rates of depressive disorders (DDs) in Chinese inpatients with cancer. METHODS Four hundred and sixty cancer inpatients were recruited from the oncology ward of a university hospital in Beijing, China. Patients were interviewed with a Chinese version of the Mini International Neuropsychiatric Interview 5.0 by eight trained psychiatrists. Case records of inpatients with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) DDs were reviewed to determine whether treating oncologists made a diagnosis of depression, prescribed antidepressant medications and/or recommended psychiatric consultation/referral. RESULTS The 1-month prevalence rates (95% confidence intervals) of DDs and major depressive disorder (MDD) were 25.9% (21.9%-29.9%) and 12.6% (9.6%-15.6%), respectively. In our multiple logistic regression analysis, being unmarried [odds ratio (OR)=1.41], cancer stage of metastasis (OR=2.35), time since cancer diagnosis ≤20 months (OR=2.05), frequent pain (OR=1.99~6.83) and being scored between two and four on the Eastern Cooperative Oncology Group Scale (OR=2.25~4.97) were independently associated with depression. Only 6.9% of patients with MDD were recognized by treating oncologists. CONCLUSIONS DDs are very common among Chinese inpatients with cancer. The high prevalence rate and low recognition rate of depression in cancer patients indicate a pressing need for routine screening, evaluation and treatment of depression in this patient population.
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Affiliation(s)
- Libo Zhao
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xiurong Li
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Zhiguo Zhang
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Chunqing Song
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Caihong Guo
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yinghua Zhang
- Department of Interventional Radiology, Beijing You'an Hospital, Capital Medical University Beijing, China
| | - Ying Zhang
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Li Li
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Guilong Lu
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Guowen Zheng
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China
| | - Kesong Wang
- Department of Oncology, Beijing Shunyi Hospital, Beijing, China
| | - Wenzhong Pei
- Department of Oncology, The Luhe Teaching Hospital of the Capital Medical University, Beijing, China
| | - Lei Han
- Department of Oncology, Daxing Hospital Affiliated to Capital Medical University, Beijing, China.
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Prodromal depression in pancreatic cancer: Retrospective evaluation on ten patients. Palliat Support Care 2014; 13:801-7. [DOI: 10.1017/s1478951514000728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Since the description by Yaskin in 1931, it has been observed that pancreatic cancer and depression are two clinical entities that share a high affinity. This observation relies on the higher incidence of depressive syndromes associated with pancreatic cancer than in any other type of digestive tumor, and on the possible occurrence of depressive symptoms several months before the diagnosis of cancer. We present here a series of cases whose screening returned positive for depression-related diagnoses in the months prior to revelation of the cancer.Method:We employed a structured psychiatric interview based on DSM–IV criteria (SCID–I). The diagnoses considered were major depressive episode, minor depressive episode, and subsyndromal depression. All subjects were free of psychiatric history.Results:Some 15 patients were initially included: 10 presented compatible criteria for a past depressive episode, 2 presented a major depressive episode, 4 met the diagnosis of minor depression, and 4 evidenced subsyndromal depression over the one-year period prior to cancer diagnosis.Significance of results:This series of cases is consistent with previous work on the subject that suggested an increased vulnerability to depressive events in the premorbid phase of pancreatic cancer. If the possibility of depressive syndromes constituting the early stages of neoplastic disease is a common idea, it is still impossible to determine the natural history of these two disorders and therefore their causal linkage.
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Valiengo LCL, Benseñor IM, Lotufo PA, Fraguas R, Brunoni AR. Transcranial direct current stimulation and repetitive transcranial magnetic stimulation in consultation-liaison psychiatry. Braz J Med Biol Res 2013; 46:815-23. [PMID: 24141608 PMCID: PMC3854309 DOI: 10.1590/1414-431x20133115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 07/15/2013] [Indexed: 11/22/2022] Open
Abstract
Patients with clinical diseases often present psychiatric conditions whose
pharmacological treatment is hampered due to hazardous interactions with the
clinical treatment and/or disease. This is particularly relevant for major
depressive disorder, the most common psychiatric disorder in the general
hospital. In this context, nonpharmacological interventions could be useful
therapies; and, among those, noninvasive brain stimulation (NIBS) might be an
interesting option. The main methods of NIBS are repetitive transcranial
magnetic stimulation (rTMS), which was recently approved as a nonresearch
treatment for some psychiatric conditions, and transcranial direct current
stimulation (tDCS), a technique that is currently limited to research scenarios
but has shown promising results. Therefore, our aim was to review the main
medical conditions associated with high depression rates, the main obstacles for
depression treatment, and whether these therapies could be a useful intervention
for such conditions. We found that depression is an important and prevalent
comorbidity in a variety of diseases such as epilepsy, stroke, Parkinson's
disease, myocardial infarction, cancer, and in other conditions such as
pregnancy and in patients without enteral access. We found that treatment of
depression is often suboptimal within the above contexts and that rTMS and tDCS
therapies have been insufficiently appraised. We discuss whether rTMS and tDCS
could have a significant impact in treating depression that develops within a
clinical context, considering its unique characteristics such as the absence of
pharmacological interactions, the use of a nonenteral route, and as an
augmentation therapy for antidepressants.
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Affiliation(s)
- L C L Valiengo
- Centro de Pesquisas Clínicas, Hospital Universitário, Universidade de São Paulo, São PauloSP, Brasil
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Gooden HM, White KJ. Pancreatic cancer and supportive care--pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 2013; 21:1835-41. [PMID: 23397095 DOI: 10.1007/s00520-013-1729-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/28/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE Pancreatic cancer is a fatal cancer with a median survival from diagnosis of around 5 months Speer et al. (Med J Aust 196(8):511-515, 2012). Given the short survival time for people with pancreatic cancer, effective supportive care is imperative to enable best quality of life. This article presents an unexpected finding from research into the psychosocial supportive care needs of people affected by pancreatic cancer that management of pancreatic exocrine insufficiency is an area of unmet need that severely impacts on quality of life and increases carer burden in people affected by pancreatic cancer. METHODS A qualitative inquiry framework was used to explore participants' perspectives and experience. Two groups of participants (N = 35) were recruited across Australia from people accessing the Cancer Helpline or direct referral from clinicians/nurses: patients diagnosed with pancreatic cancer (N = 12) and carers/family (N = 23) including a subgroup of bereaved participants (N = 14). Sampling continued until saturation. A thematic content analysis was conducted. RESULTS The findings revealed that the major quality of life theme was difficulty in managing gut symptoms and complex dietary issues. Issues were related to lack of information about malabsorption and managing symptoms of pancreatic exocrine insufficiency. This was compounded by a lack of routine dietary consultation: perceived reluctance of clinicians to prescribe enzyme supplements and poor understanding of dose to diet guidelines. CONCLUSION Participants expressed distress relating to the effects of pancreatic exocrine insufficiency. Pancreatic enzyme supplement therapy with clear dosage guidelines and associated dietary advice could resolve symptoms of malabsorption and markedly improve quality of life. For people affected by pancreatic cancer, this is an essential supportive care.
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Affiliation(s)
- H M Gooden
- Cancer Nursing Research Unit, Sydney Nursing School, University of Sydney, Camperdown, Australia.
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Auriemma WS, Berger AC, Bar-Ad V, Boland PM, Cohen SJ, Roche-Lima CMS, Morris GJ. Locally Advanced Pancreatic Cancer. Semin Oncol 2012; 39:e9-22. [DOI: 10.1053/j.seminoncol.2012.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Jiang SM, Wu JH, Jia L. Intervention of Mirtazapine on gemcitabine-induced mild cachexia in nude mice with pancreatic carcinoma xenografts. World J Gastroenterol 2012; 18:2867-71. [PMID: 22719198 PMCID: PMC3374993 DOI: 10.3748/wjg.v18.i22.2867] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 04/24/2012] [Accepted: 04/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of Mirtazapine on tumor growth, food intake, body weight, and nutritional status in gemcitabine-induced mild cachexia.
METHODS: Fourteen mice with subcutaneous xenografts of a pancreatic cancer cell line (SW1990) were randomly divided into Mirtazapine and control groups. Either Mirtazapine (10 mg/kg) or saline solution was orally fed to the mice every day after tumor implantation. A model of mild cachexia was then established in both groups by intraperitoneal injection of Gemcitabine (50 mg/kg) 10 d, 13 d, and 16 d after tumor implantation. Tumor size, food intake, body weight, and nutritional status were measured during the experiment. All mice were sacrificed at day 28.
RESULTS: (1) After 7 d of gemcitabine administration, body-weight losses of 5%-7% which suggested mild cachexia were measured; (2) No significant difference in tumor size was detected between the Mirtazapine and control groups (P > 0.05); and (3) During the entire experimental period, food intake and body weight were slightly greater for the Mirtazapine group compared with controls (although these differences were not statistically significant). After 21 d, mice in the Mirtazapine group consumed significantly more food than control mice (3.95 ± 0.14 g vs 3.54 ± 0.10 g, P = 0.004). After 25 d, mice in the Mirtazapine group were also significantly heavier than control mice (17.24 ± 0.53 g vs 18.05 ± 0.68 g, P = 0.014).
CONCLUSION: Mild cachexia model was successfully established by gemcitabine in pancreatic tumor-bearing mice. Mirtazapine can improve gemcitabine-induced mild cachexia in pancreatic tumor-bearing mice. It was believed to provide a potential therapeutic perspective for further studies on cachexia.
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Boyd AD, Brown D, Henrickson C, Hampton J, Zhu B, Almani F, Ben-Josef E, Zalupski M, Simeone DM, Taylor JMG, Armitage R, Riba M. Screening for depression, sleep-related disturbances, and anxiety in patients with adenocarcinoma of the pancreas: a preliminary study. ScientificWorldJournal 2012; 2012:650707. [PMID: 22666142 PMCID: PMC3366237 DOI: 10.1100/2012/650707] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/14/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. Screening for depression, sleep-related disturbances, and anxiety in patients with diagnosed adenocarcinoma of the pancreas. Materials and Methods. Patients were evaluated at initial consultation and subsequent visits at the multidisciplinary pancreatic cancer clinic at our University Cancer Center. Cross-sectional and longitudinal psychosocial distress was assessed utilizing Personal Health Questionnaire 9 (PHQ9) to screen for depression and monitor symptoms, the Penn State Worry Questionnaire (PSWQ) for generalized anxiety, and the University of Michigan Sleep Questionnaire to monitor sleep symptoms. Results. Twenty-two patients diagnosed with pancreatic cancer participated during the 6-month pilot study with longitudinal followup for thirteen patients. In this study, mild-to-moderate depressive symptoms, anxiety, and potential sleep problems were common. The main finding of the study was 23% of the patients who were part of this pilot project screened positive for moderately severe major depressive symptoms, likely anxiety disorder or a potential sleep disorder during the study. One patient screened positive for moderately severe depressive symptoms in longitudinal followup. Conclusions. Depression, anxiety, and sleep problems are evident in patients with pancreatic cancer. Prospective, longitudinal studies, with larger groups of patients, are needed to determine if these comorbid symptoms impact outcome and clinical course.
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Affiliation(s)
- Andrew D Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, 1919 W Taylor Street MC 530, Chicago, IL 60612, USA.
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Tada Y, Matsubara M, Kawada S, Ishida M, Wada M, Wada T, Onishi H. Psychiatric disorders in cancer patients at a university hospital in Japan: descriptive analysis of 765 psychiatric referrals. Jpn J Clin Oncol 2012; 42:183-8. [PMID: 22259217 DOI: 10.1093/jjco/hyr200] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE In cancer patients, adjustment disorders, delirium and depression have been identified as common psychiatric disorders. Although a comparable result was reported in the National Cancer Center in Japan, the nature of patients in that hospital may differ from that in local hospitals. There is a possibility to expand the findings of psycho-oncology by evaluation of the data from a local university hospital and comparison with the National Cancer Center data. METHODS We retrospectively reviewed the medical records of cancer patients who were referred to the Department of Psycho-Oncology at Saitama Medical University International Medical Center. We identified their characteristics and psychiatric diagnoses and compared these with the National Cancer Center data. RESULTS During the study period, 765 cancer patients were referred. The numbers of inpatients and outpatients were almost the same. The most common psychiatric diagnosis was adjustment disorders (24%), followed by delirium (16%) and then major depressive disorder (12%). The rank of these three was the same as that at the National Cancer Center. Outpatients constituted more than 80% of the patients with major depressive disorder. The proportion of cancer patients with schizophrenia in this study (4.3%) was higher than that in the National Cancer Center (1.6%). CONCLUSIONS This study revealed basic information about the consultation data of cancer patients at a local university hospital in Japan. The importance of communication with outpatients was suggested. It seems that cancer treatment for patients with schizophrenia in a local hospital is also important.
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Affiliation(s)
- Yukio Tada
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Yamane, Hidaka City, Saitama, Japan.
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Kim GD, Jang HJ. Effects of Pain, Sleep Disturbance, and Fatigue on the Quality of Life in Patients with Pancreatic Cancer Undergoing Chemotherapy. ASIAN ONCOLOGY NURSING 2012. [DOI: 10.5388/aon.2012.12.2.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gyung Duck Kim
- Department of Nursing, Dongyang University, Yeongju, Korea
| | - Hyun Jin Jang
- Pancreaticobiliary Cancer Clinic, Severance Hospital, Seoul, Korea
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Mayr M, Schmid RM. Pancreatic cancer and depression: myth and truth. BMC Cancer 2010; 10:569. [PMID: 20961421 PMCID: PMC2976753 DOI: 10.1186/1471-2407-10-569] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 10/20/2010] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Various studies reported remarkable high incidence rates of depression in cancer patients compared with the general population. Pancreatic cancer is still one of the malignancies with the worst prognosis and therefore it seems quite logical that it is one of the malignancies with the highest incidence rates of major depression.However, what about the scientific background of this relationship? Is depression in patients suffering from pancreatic cancer just due to the confrontation with a life threatening disease and its somatic symptoms or is depression in this particular group of patients a feature of pancreatic cancer per se? DISCUSSION Several studies provide evidence of depression to precede the diagnosis of pancreatic cancer and some studies even blame it for its detrimental influence on survival. The immense impact of emotional distress on quality of life of cancer patients enhances the need for its early diagnosis and adequate treatment. Knowledge about underlying pathophysiological mechanisms is required to provide the optimal therapy. SUMMARY A review of the literature on this issue should reveal which are the facts and what is myth.
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Affiliation(s)
- Martina Mayr
- Internal Medicine II, Klinikum Rechts der Isar, Technical University of Munich, Germany.
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