1
|
Zhang R, Wang J, Zhang P, Zhang Z, Miao R. Pancreatic cancer progression and mortality predicted by depression and anxiety: a systematic review and meta-analysis protocol. Front Psychiatry 2024; 14:1266502. [PMID: 38274428 PMCID: PMC10808776 DOI: 10.3389/fpsyt.2023.1266502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Although the relationship between psychological factors and pancreatic cancer outcomes has been widely discussed, controversy remains. We will for the first time systematically summarize the literature to explore the correlation of anxiety and depression to the prognosis of patients with pancreatic cancer. The findings will fill existing research gaps, informing healthcare providers about better psychological care and medical treatment. The following databases will be retrieved from their inception to July 2023: Cochrane Library, MEDLINE (PubMed), Web of Science, EMBASE, and four Chinese databases (Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and Chongqing VIP Chinese Science and Technology Periodical Database). The World Health Organization Clinical Trials Registry, Chinese Clinical Registry, and ClinicalTrials.gov will be searched to identify other related studies. A manual search will be performed to identify missing eligible studies based on the reference list of selected articles. The search will focus on studies published in Chinese or English. To assess the risk of bias in the selected articles, Newcastle-Ottawa Quality Assessment Scale (NOS) will be used for the cohort study. Funnel plots and Egger's test will be used to assess whether publication bias exists. Moreover, the Grading of Recommendations Assessment Development and Evaluation (GRADE) will be utilized to analyze the credibility of the results from selected articles. Two independent evaluators will implement the study selection and data extraction, as well as evaluate the risk of bias and evidence quality. Data will be analyzed using Stata 16.0. Trial registration: PROSPERO registration number is CRD42022366232.
Collapse
Affiliation(s)
- Ruoqi Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Peitong Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zheng Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Rui Miao
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
2
|
Tarasiuk A, Mirocha G, Fichna J. Current status of Complementary and Alternative Medicine Interventions in the Management of Pancreatic Cancer - An Overview. Curr Treat Options Oncol 2023; 24:1852-1869. [PMID: 38079061 PMCID: PMC10781793 DOI: 10.1007/s11864-023-01146-4] [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] [Accepted: 10/24/2023] [Indexed: 01/11/2024]
Abstract
OPINION STATEMENT Pancreatic cancer (PC) remains the deadliest cancer worldwide. Most patients are diagnosed at the advanced or metastatic stage, leading to a poor prognosis. Awareness of the limitations of current therapy and accompanying pain, depression, malnutrition, and side effects of chemoradiotherapy may lead patients and physicians towards complementary and alternative medicine (CAM). CAM refers to a diverse set of medical and healthcare practices, products, and systems that are not part of conventional Western medicine. Despite the low-quality evidence supporting the efficacy of these methods, they remain appealing due to patients' beliefs, fear of death, and the slow development of conventional therapy. Hence, the possibility of using natural products for pancreatic cancer is increasing. CAM options such as: medical cannabis, plants, fungi, herbal formulas, and injections, which originate primarily from traditional Chinese or Japanese medicine i.e. Curcuma longa, Panax ginseng, Poria cocos, Hochuekkito, Juzentaihoto, and Rikkunshito, Shi-quan-da-bu-tang/TJ-48, Huang-qin-tang, Shuangbai San, Wen Jing Zhi Tong Fang, Xiang-Sha-Liu-jun-zi-tang, Aidi injection, Brucea javanica oil emulsion/Yadanziyouru injection, Compound Kushen injection, Huachansu injection, Kangai injection and Kanglaite injections are becoming promising candidates for the management of pancreatic cancer. The abovementioned substances/medications are the most popular or potentially effective in PC treatment and consequently CAM-based adjuvant therapy through improving patients' quality of life, might be a useful addition in the treatment of pancreatic cancer patients.
Collapse
Affiliation(s)
- Aleksandra Tarasiuk
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Mazowiecka 5, 92-215, Lodz, Poland.
| | - Grzegorz Mirocha
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Mazowiecka 5, 92-215, Lodz, Poland
| | - Jakub Fichna
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Mazowiecka 5, 92-215, Lodz, Poland
| |
Collapse
|
3
|
Michoglou K, Ravinthiranathan A, San Ti S, Dolly S, Thillai K. Pancreatic cancer and depression. World J Clin Cases 2023; 11:2631-2636. [PMID: 37214569 PMCID: PMC10198113 DOI: 10.12998/wjcc.v11.i12.2631] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/10/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Pancreatic cancer is a highly devastating disease with high mortality rates. Even patients who undergo potential curative surgery have a high risk for recurrence. The incidence of depression and anxiety are higher in patients with cancer than the general population. However, patients with pancreatic cancer are at most of risk of both depression and anxiety and there seems to be a biological link. In some patients, depression seems to be a precursor to pancreatic cancer. In this article we discuss the biological link between depression anxiety and hepatobiliary malignancies and discuss treatment strategies.
Collapse
Affiliation(s)
- Kalliopi Michoglou
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London Se1 9RT, United Kingdom
| | | | - Saw San Ti
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London Se1 9RT, United Kingdom
| | - Saoirse Dolly
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London Se1 9RT, United Kingdom
| | - Kiruthikah Thillai
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London Se1 9RT, United Kingdom
| |
Collapse
|
4
|
A feasibility study of a peer discussion group intervention for patients with pancreatobiliary cancer and their caregivers. Palliat Support Care 2021; 20:527-534. [PMID: 34593073 DOI: 10.1017/s1478951521001474] [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: 11/05/2022]
Abstract
OBJECTIVES The purpose of this feasibility study was to examine the impacts of a peer discussion group intervention called "the pancreatobiliary cancer salon" on psychological distress among patients with pancreatobiliary cancer and their caregivers. METHODS We recruited patients with pancreatic or biliary tract cancer and their caregivers. We conducted a within-group pre-post comparison study. Participants were grouped by the type of cancer and treatment. Each group consisted of four to five patients or caregivers. Hospital staff members facilitated group discussions where participants freely talked for 1 h. We evaluated participants' psychological condition using the Profile of Mood States (POMS) and their impressions of the pancreatobiliary cancer salon. RESULTS We analyzed data from 42 patients and 27 caregivers who joined the salon for the first time. Thirty-five patients (83.3%) had pancreatic cancer. Thirty-one patients (71.4%) had unresectable pancreatobiliary cancer and 14 patients (33.3%) were being treated with second-line or third-line chemotherapy at the time of the survey. Twenty-two patients (52.4%) participated in the salon within 6 months after diagnosis. Most participating caregivers were the patient's spouse/partner (51.9%) or child (34.6%). Both patients and caregivers experienced high levels of satisfaction with the pancreatobiliary cancer salon. Both patients and caregivers had significantly lower psychological distress as assessed by POMS after the salon. SIGNIFICANCE OF RESULTS A peer discussion group intervention might be well-received and has potential to benefit for patients with pancreatobiliary cancer and their caregivers.
Collapse
|
5
|
Morreale M. Psychosocial Aspects of Cancer Pain. Cancer Treat Res 2021; 182:273-280. [PMID: 34542888 DOI: 10.1007/978-3-030-81526-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given the biopsychosocial model of pain, it is not surprising that a strong degree of association exists between cancer pain and psychological distress.
Collapse
Affiliation(s)
- Mary Morreale
- Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Drive, Detroit, MI, 48201, USA.
| |
Collapse
|
6
|
Venkatachalapathy SV, James MW, Huggett MT, Paranandi B, Pereira SP, Johnson G, Aravinthan AD, Aithal GP. Utility of palliative EUS-guided biliary drainage using lumen-apposing metal stents: a prospective multicenter feasibility study (with video). Gastrointest Endosc 2021; 94:321-328. [PMID: 33545136 DOI: 10.1016/j.gie.2021.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/24/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Biliary drainage with ERCP is successful in only 80% to 90% of cases of extrahepatic cholangiocarcinoma and pancreatic cancer. We present the results of a multicenter prospective study assessing the safety, feasibility, and quality of life of patients after EUS-guided biliary drainage (EUS-BD) with lumen-apposing metal stents after failed ERCP. METHODS All consecutive adults with a dilated common bile duct (CBD) ≥14 mm secondary to inoperable malignant distal CBD stricture and failed ERCP biliary drainage were screened and recruited from 3 tertiary UK centers. Technical success of EUS-BD using lumen-apposing metal stents was the primary endpoint. Improvement in serum bilirubin level, 30-day mortality, procedure-related adverse events, and quality of life were secondary endpoints. Improvement in quality of life was measured using a validated questionnaire (EORTC QLQ-BIL21). RESULTS Twenty patients were included in the analysis. EUS-BD was technically successful in all patients and the clinical success rate was 95% (19 of 20) at day 7 (>50% reduction in bilirubin level) and 92.3% (12 of 13) at day 30 (bilirubin <50 μmol/L). There were significant improvements in overall quality of life score (49 vs 42, P = .03) at day 30. All-cause 30-day mortality was 20% and the moderate adverse event rate was 10% (1 cholangitis and 1 stent migration). CONCLUSION EUS-BD has acceptable technical success and safety as a second-line palliative treatment for inoperable malignant distal CBD strictures. Randomized controlled studies comparing EUS-BD with percutaneous transhepatic biliary drainage are needed to determine their effectiveness in clinical practice. (ISCRTN registration number: ISRCTN13196704.).
Collapse
Affiliation(s)
- Suresh Vasan Venkatachalapathy
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Martin W James
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Matthew T Huggett
- Leeds Teaching Hospitals NHS Trust - Gastroenterology, Leeds, United Kingdom
| | - Bharat Paranandi
- Leeds Teaching Hospitals NHS Trust - Gastroenterology, Leeds, United Kingdom
| | - Stephen P Pereira
- UCL Institute for Liver & Digestive Health, University College London, London, United Kingdom; Department of Gastroenterology, University College Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gavin Johnson
- Department of Gastroenterology, University College Hospitals NHS Foundation Trust, London, United Kingdom
| | - Aloysious D Aravinthan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
7
|
Partelli S, Sclafani F, Barbu ST, Beishon M, Bonomo P, Braz G, de Braud F, Brunner T, Cavestro GM, Crul M, Trill MD, Ferollà P, Herrmann K, Karamitopoulou E, Neuzillet C, Orsi F, Seppänen H, Torchio M, Valenti D, Zamboni G, Zins M, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Pancreatic Cancer. Cancer Treat Rev 2021; 99:102208. [PMID: 34238640 DOI: 10.1016/j.ctrv.2021.102208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Pancreatic cancer is an increasing cause of cancer mortality and has wide variation in treatment and care in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must be carried out only in pancreatic cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
Collapse
Affiliation(s)
- Stefano Partelli
- European Society of Surgical Oncology (ESSO); IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Sclafani
- European Organisation for Research and Treatment of Cancer (EORTC); Institut Jules Bordet, Brussels, Belgium
| | - Sorin Traian Barbu
- Pancreatic Cancer Europe (PCE); Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy
| | - Pierluigi Bonomo
- Flims Alumni Club (FAC); Careggi University Hospital, Florence, Italy
| | - Graça Braz
- European Oncology Nursing Society (EONS); Portuguese Oncology Institute, Porto, Portugal
| | - Filippo de Braud
- Organisation of European Cancer Institutes (OECI); IRCCS Foundation National Cancer Institute of Milan, Milan, Italy
| | - Thomas Brunner
- European Society for Radiotherapy and Oncology (ESTRO); Otto von Guericke University, Magdeburg, Germany
| | - Giulia Martina Cavestro
- European Hereditary Tumour Group (EHTG); IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mirjam Crul
- European Society of Oncology Pharmacy (ESOP); Amsterdam University Medical Centre, Netherlands
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Piero Ferollà
- International Neuroendocrine Cancer Alliance (INCA); Umbria Regional Cancer Network, Perugia, Italy
| | - Ken Herrmann
- European Association of Nuclear Medicine (EANM); University Hospital Essen, Essen, Germany
| | - Eva Karamitopoulou
- European Society of Pathology (ESP); Institute of Pathology, University of Bern, Bern, Switzerland
| | - Cindy Neuzillet
- International Society of Geriatric Oncology (SIOG), Institut Curie, Saint-Cloud, France
| | - Franco Orsi
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); European Institute of Oncology, Milan, Italy
| | - Hanna Seppänen
- Association of European Cancer Leagues (ECL); Helsinki University Hospital, Helsinki, Finland
| | - Martina Torchio
- Organisation of European Cancer Institutes (OECI); IRCCS Foundation National Cancer Institute of Milan, Milan, Italy
| | - Danila Valenti
- European Association for Palliative Care (EAPC); Palliative Care Network, AUSL Bologna, Bologna, Italy
| | - Giulia Zamboni
- European Society of Oncologic Imaging (ESOI); University Hospital Verona, Verona, Italy
| | - Marc Zins
- European Society of Radiology (ESR); Groupe hospitalier Paris Saint-Joseph, Paris, France
| | | | - Philip Poortmans
- European Cancer Organisation (ECCO); Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
| |
Collapse
|
8
|
Dengsø KE, Andersen EW, Thomsen T, Hansen CP, Christensen BM, Hillingsø J, Dalton SO. Increased psychological symptom burden in patients with pancreatic cancer: A population-based cohort study. Pancreatology 2020; 20:511-521. [PMID: 31973981 DOI: 10.1016/j.pan.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE To investigate the psychological symptom burden in patients with pancreatic cancer. METHODS We used Danish population-based registries to identify 10,793 pancreatic cancer patients and 109,238 age and gender matched cancer-free comparison persons between the years 2000-2016. The cohorts were followed up to five years for first prescription for antidepressants, anxiolytics or hypnotics as proxies for the psychological symptom burden of depression, anxiety or insomnia. Cumulated incidence proportions were analysed using the pseudo-value approach and hazards were estimated with Cox regression models adjusted for potential confounders. RESULTS The highest HR for first antidepressant use was seen in the first six months after diagnosis (HR 8.73 (95% CI: 7.57; 10.06)). Within the first two years the overall estimated cumulated probability of 12.9% (95% CI: 12%; 13.8%) in pancreatic cancer patients, and 4.6% (95% CI: 4.5%; 4.8%) in comparisons, and 20.4% and 31.4% patients received first prescription of anxiolytics or hypnotics, respectively. We found no difference in HRs of first antidepressant by gender, year of diagnosis, cohabitation, education or comorbidity in the patient cohort, however younger age (<59 years) was associated with depression. CONCLUSIONS Pancreatic cancer patients are at risk for first antidepressant, anxiolytic and hypnotic use up to five years after diagnosis. Patients younger than 59 years, newly diagnosed with advanced pancreatic cancer, and not treated with surgery were more likely to have first antidepressant use. The study calls for interventions to reduce the psychological burden in advanced pancreatic cancer patients which may improve quality of life and survival.
Collapse
Affiliation(s)
| | - Elisabeth Wreford Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark
| | - Thordis Thomsen
- Herlev Acute, Critical and Emergency Care Science Unit, Department of Anaesthesiology, Herlev and Gentofte Hospital, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- Department of Surgery, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Bo Marcel Christensen
- Department of Surgery, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Jens Hillingsø
- Department of Surgery, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Unit of Survivorship, Danish Cancer Society & Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| |
Collapse
|
9
|
Mazzella Ebstein AM, Joseph SJ, Hernandez M. Psychological stress and pancreatic cancer patients: a qualitative systematic review protocol. JBI Evid Synth 2020; 18:576-582. [PMID: 32197017 DOI: 10.11124/jbisrir-d-18-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The primary objective of this review is to analyze and synthesize the best available evidence on the experiences and perceptions of psychological stress reported by pancreatic cancer patients at any time point from pre-diagnosis, diagnosis, treatment, post-treatment and/or follow-up care. INTRODUCTION A cancer diagnosis is known to be life-threatening, altering and limiting, and negatively affects an individual's activities of daily living. Despite developments in treatment options for pancreatic cancer patients, it represents the highest mortality and morbidity among cancers. Stress is a subjective phenomenon that negatively impacts an individual's psychological and emotional well-being, and interferes with the ability to cope with cancer symptoms and treatments. Identifying a patient's experience of stress could facilitate educational, spiritual and social resources to address his or her emotional and psychological needs. INCLUSION CRITERIA Qualitative studies that include individuals with pancreatic cancers, regardless of age, sex or ethnicity, will be considered for inclusion in this review. METHODS The databases to be searched include PubMed, CINAHL, Cochrane, Web of Science, Embase, Scopus, BioMed Central and PsycINFO. The search for gray literature will include Biosis, OpenGrey, Open Access Theses and Dissertations, and WorldCat. This systematic review will consider all published and unpublished studies with no date limitations. Selected studies will be assessed for methodological quality by two independent reviewers. Coding will be assigned to synthesize any differences in the experiences and perceptions of psychological stress at four time points. Where textual pooling is not possible, conclusions will be presented in narrative form.
Collapse
Affiliation(s)
- Ann M Mazzella Ebstein
- Memorial Sloan Kettering Cancer Center, New York, USA.,The Center for Translational Research: a Joanna Briggs Institute Centre of Excellence
| | - Simi Jesto Joseph
- The Center for Translational Research: a Joanna Briggs Institute Centre of Excellence.,GI Solutions, Inc, Chicago, USA
| | | |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
|
12
|
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.
Collapse
|
13
|
|
14
|
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.
Collapse
|
15
|
Abstract
BACKGROUND Psychological distress is highly prevalent in patients with pancreatic cancer (PC), yet little is known about the pathophysiology underlying the relationship between these 2 diseases. Our aim was to systematically review the evidence examining the pathophysiological mechanisms of the association between PC and psychological distress. METHODS A systematic review of the literature was conducted using MEDLINE, Embase, PsychINFO, and CINAHL databases and reported according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies examining the pathophysiological mechanisms between PC and psychological distress were included for analysis. RESULTS Eight studies were identified that fulfilled inclusion criteria. Four mechanisms were identified accounting for the possible relationship between psychological distress and PC, including (1) stress-induced β-adrenergic signaling, (2) interleukin-6-mediated effects, (3) kynurenine pathway upregulation, and (4) altered cerebral glucose metabolism. CONCLUSIONS The relationship between psychological distress and PC is complex, and our understanding of these mechanisms may have implications for holistic clinical management and oncological outcome. The evidence exploring the pathophysiology of this interaction is sparse, but most well established with regard to the stress-induced β-adrenergic signaling mechanism. Further studies in larger cohorts are required to elucidate the relationship between PC and psychological distress to be able to identify therapeutic targets for both conditions.
Collapse
|
16
|
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: 19] [Impact Index Per Article: 2.7] [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.
Collapse
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.
| |
Collapse
|
17
|
Dose A, Hubbard J, Mansfield A, McCabe P, Krecke C, Sloan J. Feasibility and Acceptability of a Dignity Therapy/Life Plan Intervention for Patients With Advanced Cancer. Oncol Nurs Forum 2017; 44:E194-E202. [DOI: 10.1188/17.onf.e194-e202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
18
|
Janda M, Neale RE, Klein K, O'Connell DL, Gooden H, Goldstein D, Merrett ND, Wyld DK, Rowlands IJ, Beesley VL. Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 2017; 17:321-327. [PMID: 28153446 DOI: 10.1016/j.pan.2017.01.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with pancreatic cancer have high levels of anxiety and depression and reduced quality of life (QoL), but few studies have assessed these outcomes for patient-carer dyads. We therefore investigated these issues in an Australian population-based study. METHODS Patients with pancreatic cancer (n = 136) and many of their carers (n = 84) completed the Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of Cancer Therapy QoL questionnaire at a median of three months after diagnosis. Overall QoL and well-being subscales (physical, social, emotional, functional) were compared with general population norms. Intraclass correlation coefficients were used to compare anxiety, depression and QoL scores of patients and their respective carers. RESULTS Fifteen percent of patients and 39% of carers had HADS scores indicative of anxiety and 15% of patients and 14% of carers of depression, respectively. Overall, 70% of patients and 58% of carers had QoL scores below the Queensland population average. Patients' anxiety, depression, overall QoL, social, emotional and functional wellbeing scores were significantly related to those scores in their carers. Among patients and carers, accessing psychological help was associated with elevated anxiety. Not receiving chemotherapy was associated with elevated depression among patients and younger age was associated with poorer outcomes in carers. CONCLUSIONS More carers had symptoms of anxiety than patients with pancreatic cancer, but symptoms of depression were similarly common in patients and carers. Further research is needed to assess whether interventions to reduce patients' distress could also improve QoL among carers, or whether carer-focussed interventions are required.
Collapse
Affiliation(s)
- Monika Janda
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kerenaftali Klein
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Helen Gooden
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - David Goldstein
- University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Neil D Merrett
- South Western Sydney Upper GI Surgical Unit, Bankstown Hospital, Sydney, Australia; Discipline of Surgery, University of Western Sydney, Sydney, Australia
| | - David K Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ingrid J Rowlands
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| |
Collapse
|
19
|
Low JA, Kwek SK, Pang WS. The Psychopathology of Depression in the Advanced Cancer Patient. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1080/09699260.2001.11746910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
20
|
Tozzi L, Carballedo A, Lavelle G, Doolin K, Doyle M, Amico F, McCarthy H, Gormley J, Lord A, O'Keane V, Frodl T. Longitudinal functional connectivity changes correlate with mood improvement after regular exercise in a dose-dependent fashion. Eur J Neurosci 2016; 43:1089-96. [PMID: 26929085 DOI: 10.1111/ejn.13222] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 01/18/2023]
Abstract
Exercise increases wellbeing and improves mood. It is however unclear how these mood changes relate to brain function. We conducted a randomized controlled trial investigating resting-state modifications in healthy adults after an extended period of aerobic physical exercise and their relationship with mood improvements. We aimed to identify novel functional networks whose activity could provide a physiological counterpart to the mood-related benefits of exercise. Thirty-eight healthy sedentary volunteers were randomised to either the aerobic exercise group of the study or a control group. Participants in the exercise group attended aerobic sessions with a physiotherapist twice a week for 16 weeks. Resting-state modifications using magnetic resonance imaging were assessed before and after the programme and related to mood changes. An unbiased approach using graph metrics and network-based statistics was adopted. Exercise reduced mood disturbance and improved emotional wellbeing. It also induced a decrease in local efficiency in the parahippocampal lobe through strengthening of the functional connections from this structure to the supramarginal gyrus, precentral area, superior temporal gyrus and temporal pole. Changes in mood disturbance following exercise were correlated with those in connectivity between parahippocampal gyrus and superior temporal gyrus as well as with the amount of training. No changes were detected in the control group. In conclusion, connectivity from the parahippocampal gyrus to motor, sensory integration and mood regulation areas was strengthened through exercise. These functional changes might be related to the benefits of regular physical activity on mood.
Collapse
Affiliation(s)
- Leonardo Tozzi
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Angela Carballedo
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Grace Lavelle
- Department of Physiotherapy, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Kelly Doolin
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Myles Doyle
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Francesco Amico
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Hazel McCarthy
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - John Gormley
- Department of Physiotherapy, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Anton Lord
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Veronica O'Keane
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Thomas Frodl
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland.,Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
21
|
Akizuki N, Shimizu K, Asai M, Nakano T, Okusaka T, Shimada K, Inoguchi H, Inagaki M, Fujimori M, Akechi T, Uchitomi Y. Prevalence and predictive factors of depression and anxiety in patients with pancreatic cancer: a longitudinal study. Jpn J Clin Oncol 2015; 46:71-7. [PMID: 26590013 DOI: 10.1093/jjco/hyv169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/21/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE It is known that depression and anxiety occur more frequently in pancreatic cancer patients than in those with other malignancies. However, few studies have assessed depression and anxiety using reliable psychiatric diagnostic tools. The purpose of this study was to determine the prevalence of depression and anxiety among pancreatic cancer patients before and 1 month after the start of anticancer treatment using reliable psychiatric diagnostic tools, and to identify factors that predict their occurrence. METHODS Pancreatic cancer patients were consecutively recruited. Structured clinical interviews were used to determine the presence of affective disorders, anxiety disorders and adjustment disorders. Baseline interviews were performed prior to initiation of anticancer treatment, while follow-up interviews were performed 1 month after treatment was started. Medical, demographic and psychosocial backgrounds were also assessed as predictive factors. RESULTS One hundred and ten patients participated in the baseline interview and 91 in the follow-up interview. Depression and anxiety were observed in 15 patients (13.6%) at the baseline, and 15 patients (16.5%) at the follow-up. Lack of confidants was associated with depression and anxiety at the baseline. At the baseline, sadness, lower Karnofsky Performance Status and prior experience with the death of a family member due to cancer predicted newly diagnosed depression and anxiety at the follow-up. CONCLUSION A considerable percentage of pancreatic cancer patients experienced depression and anxiety. Multidimensional psychosocial predictive factors were found and optimal psychological care should incorporate early detection of sadness.
Collapse
Affiliation(s)
| | - Ken Shimizu
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo
| | - Mariko Asai
- Graduate School of Clinical Psychology, Teikyo Heisei University, Chiba
| | - Tomohito Nakano
- Psychiatry Division, Kitasato University Kitasato Institute Hospital, Tokyo
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo
| | - Kazuaki Shimada
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo
| | - Hironobu Inoguchi
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo
| | | | - Maiko Fujimori
- Section of Medical Research for Suicide, Center for Suicide Prevention, National Institute of Mental Health, National Center for Neurology & Psychiatry, Tokyo
| | - Tatsuo Akechi
- Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Aichi Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center, Tokyo, Japan
| |
Collapse
|
22
|
Botwinick IC, Pursell L, Yu G, Cooper T, Mann JJ, Chabot JA. A biological basis for depression in pancreatic cancer. HPB (Oxford) 2014; 16:740-3. [PMID: 24467653 PMCID: PMC4113256 DOI: 10.1111/hpb.12201] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/15/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with pancreatic adenocarcinoma frequently present with depression the symptoms of which may precede cancer diagnosis, suggesting that the pathophysiology of depression in pancreatic adenocarcinoma may result from biological changes that are induced by the presence of the tumour itself. The present study was conducted to test a hypothesized relationship with the kynurenine pathway, which has been implicated in both depression and tumour-induced immunosuppression. METHODS 17 patients with pancreatic adenocarcinoma were recruited and completed mood questionnaires (Functional Assessment of Cancer Therapy -Pancreatic Cancer, Beck Depression Inventory and the Beck Anxiety Inventory) and blood testing for serum levels of tryptophan, kynurenine, kynurenic acid and quinolinic acid. Tumour burden was determined from pathology reports (tumour size and nodal involvement). RESULTS Findings indicated a negative correlation between mood scores and the plasma kynurenic acid : tryptophan ratio in plasma, and a positive correlation between tumour burden and plasma kynurenine level. CONCLUSIONS This study suggests that pancreatic cancer may influence mood via the kynurenine pathway. The relationship of the kynurenine pathway with pancreatic tumour burden should be explored further in large multicentre studies because a better understanding of this physiology might have significant clinical benefit.
Collapse
Affiliation(s)
| | - Lisa Pursell
- Department of Surgery, Columbia University Medical CenterNew York, NY, USA
| | - Gary Yu
- Department of Surgery, Columbia University Medical CenterNew York, NY, USA
| | - Tom Cooper
- Department of Analytical Psychopharmacology Laboratory, Nathan Kline InstituteOrangeburg, NM, USA
| | - J John Mann
- Department of Surgery, Columbia University Medical CenterNew York, NY, USA
| | - John A Chabot
- Department of Surgery, Columbia University Medical CenterNew York, NY, USA
| |
Collapse
|
23
|
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.
Collapse
|
24
|
Boyd CA, Benarroch-Gampel J, Sheffield KM, Han Y, Kuo YF, Riall TS. The effect of depression on stage at diagnosis, treatment, and survival in pancreatic adenocarcinoma. Surgery 2012; 152:403-13. [PMID: 22938900 DOI: 10.1016/j.surg.2012.06.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 06/07/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Depression has been associated with delayed presentation, inadequate treatment, and poor survival in patients with cancer. METHODS Using Surveillance, Epidemiology and End Results and Medicare linked data (1992-2005), we identified patients with pancreatic adenocarcinoma (N = 23,745). International classification of diseases, 9th edition, clinical modification codes were used to evaluate depression during the 3 to 27 months before the diagnosis of cancer. The effect of depression on receipt of therapy and survival was evaluated in univariate and multivariate models. RESULTS Of patients with pancreatic cancer in our study, 7.9% had a diagnosis of depression (N = 1,868). Depression was associated with increased age, female sex, white race, single or widowed status, and advanced stage disease (P < .0001). In an adjusted model, patients with locoregional disease and depression had 37% lower odds of undergoing surgical resection (odds ratio, 0.63; 95% confidence interval, 0.52-0.76). In patients with locoregional disease, depression was associated with lower 2-year survival (hazard ratio, 1.20; 95% confidence interval, 1.09-1.32). After adjusting for surgical resection, this association was attenuated (hazard ratio, 1.14; 95% confidence interval, 1.04-1.26). In patients who underwent surgical resection, depression was a significant predictor of survival (hazard ratio, 1.34; 95% confidence interval, 1.04-1.73). Patients with distant disease and depression had 21% lower odds of receiving chemotherapy (odds ratio, 0.79; 95% confidence interval, 0.70-0.90). After adjusting for chemotherapy for distant disease, depression was no longer a significant predictor of survival (hazard ratio, 1.03; 95% confidence interval, 0.97-1.09). CONCLUSION The decreased survival associated with depression appears to be mediated by a lower likelihood of appropriate treatment in depressed patients. Accurate recognition and treatment of pancreatic cancer patients with depression may improve treatment rates and survival.
Collapse
Affiliation(s)
- Casey A Boyd
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0541, USA.
| | | | | | | | | | | |
Collapse
|
25
|
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.
Collapse
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.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Li R, Hou J, Xu Q, Liu QJ, Shen YJ, Rodin G, Li M. High level interleukin-6 in the medium of human pancreatic cancer cell culture suppresses production of neurotransmitters by PC12 cell line. Metab Brain Dis 2012; 27:91-100. [PMID: 22109853 DOI: 10.1007/s11011-011-9270-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 11/08/2011] [Indexed: 01/17/2023]
Abstract
It has been suggested that pancreatic cancer is associated with a greater prevalence of depression than many other cancers, but the mechanism accounting for this potential association has not yet been illustrated. In the present study, conditioned media (CM) from three pancreatic cancer cell lines and primary pancreatic cancer cells from two patients were added to culture system of differentiated pheochromocytoma cell line PC12. The release of dopamine (DA) and norepinephrine (NE) by PC12 was significantly inhibited after CM treatment (P < 0.05), similar to what happened after recombinant interleukin 6(IL-6) treatment. Furthermore, pretreatment with anti-IL-6 antibody significantly blocked the inhibitory effects of pancreatic cancer CM on DA and NE production (P < 0.05). We also demonstrated that tyrosine hydroxylase (TH), the rate-limiting enzyme for synthesis of catecholamine, was reduced after exposure to IL-6, which was accompanied by JAK-STAT3 pathway activation. Our results demonstrated that IL-6 in CM from pancreatic cancer down-regulated the production of DA and NE by PC12 cell. The possible underlying mechanisms might be decreasing TH production via activation of JAK-STAT3 signal transduction pathway. The present study might help to better understand the close relationship between pancreatic cancer and depression.
Collapse
Affiliation(s)
- Rong Li
- Department of Hematology, Chang Zheng Hospital, Second Military Medical University, Shanghai 200003, China
| | | | | | | | | | | | | |
Collapse
|
27
|
Culleton S, Dennis K, Koo K, Zhang L, Zeng L, Nguyen J, Jon F, Holden L, Barnes E, Tsao M, Danjoux C, Sahgal A, Chow E. Gender Difference in Symptom Presentations Among Patients With Bone Metastases in Gender-Specific and Gender-Neutral Primary Cancers. World J Oncol 2011; 2:102-112. [PMID: 29147234 PMCID: PMC5649663 DOI: 10.4021/wjon306w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2011] [Indexed: 01/06/2023] Open
Abstract
Background Studies have assessed gender differences on symptoms commonly experienced by cancer patients at various stages in their disease trajectory using heterogeneous cancer populations with different tumor types. The purpose of our study was to evaluate the effect of gender on symptoms among patients with bone metastases while controlling for gender-specific malignancies. Methods A retrospective review of patients receiving palliative radiotherapy for bone metastases was conducted on patients that completed the Brief Pain Inventory (BPI) or Edmonton Symptom Assessment System (ESAS) questionnaires from 1999 - 2004. Baseline and follow-up BPI and ESAS symptom scores were compared between males and females, with and without controlling for gender-specific tumors. Results A total of 900 patients completed baseline questionnaires: ESAS (n = 508) or BPI (n = 392). The most common tumor types were lung (26%), breast (25%) and prostate (24%). In all ESAS patients, females had significantly greater severity of tiredness, nausea, depression, anxiety and breathlessness. In the subgroup analysis when gender-specific primary cancers were removed (i.e., breast, prostate and gynecological), no significant differences in ESAS symptoms were found between genders. The BPI functional item of walking ability was significantly worse for females in both the overall and subgroup analyses. Females had worse symptoms at follow-up prior to the removal of gender-specific primaries in both ESAS and BPI. Conclusions Gender-specific cancers may significantly bias gender studies of cancer-related symptoms when primary tumor type is not taken into account. Gender differences are best assessed in gender-neutral primaries.
Collapse
Affiliation(s)
- Shaelyn Culleton
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Kristopher Dennis
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Kaitlin Koo
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Liying Zhang
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Liang Zeng
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Janet Nguyen
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Florencia Jon
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Lori Holden
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Elizabeth Barnes
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - May Tsao
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Cyril Danjoux
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Arjun Sahgal
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Canada
| |
Collapse
|
28
|
Medeiros M, Oshima CTF, Forones NM. Depression and anxiety in colorectal cancer patients. J Gastrointest Cancer 2011; 41:179-84. [PMID: 20180047 DOI: 10.1007/s12029-010-9132-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cancer has been seen negatively by the people that disclose fear and anxiety face to the disease closely associated with distress, aggressive treatments, and death. Colorectal cancer is one of the most prevalent cancer and few assays were developed studying depression and anxiety in patients after surgical resection of tumor and before adjuvant therapy. AIM This research aims to study the prevalence of depression and anxiety in patients with colorectal cancer before and after adjuvant chemotherapy. PATIENTS AND METHODS After surgical resection of colorectal cancer, 37 patients were included according to the kind of treatment: chemotherapy group (CHG) and the other one without indication of chemotherapy, the control group (CG). Questionnaires of Depression and Anxiety were done at the beginning and at the end of the treatment in the CHG (n = 19) and at the first and after 6 months of follow-up (n = 18) in the CG. RESULTS No difference on gender, age, or site was observed among the groups. Stage III tumor was more frequent in the CHG group. Mild or moderate depression was diagnosed in 31.6% of the CHG patients in the first evaluation and in 38.6% at the second one. In the CG no depression was observed in both evaluations. About the State-Trait Anxiety Inventory, the results were similar before and after chemotherapy treatment. There was a higher number of patients with moderate state or trait anxiety in the CHG when compared to the CG in both evaluations. No correlation was found about the inventories of anxiety and depression and site of tumor or stage. CONCLUSION After surgical treatment of colorectal cancer, depression and indexes of anxiety were higher in the group of patients treated with chemotherapy when compared to the control group.
Collapse
Affiliation(s)
- Marta Medeiros
- Oncology Division, Gastroenterology Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | |
Collapse
|
29
|
Clark KL, Loscalzo M, Trask PC, Zabora J, Philip EJ. Psychological distress in patients with pancreatic cancer-an understudied group. Psychooncology 2010; 19:1313-20. [DOI: 10.1002/pon.1697] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
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: 44] [Impact Index Per Article: 2.9] [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.
Collapse
Affiliation(s)
- Martina Mayr
- Internal Medicine II, Klinikum Rechts der Isar, Technical University of Munich, Germany.
| | | |
Collapse
|
31
|
Turaga KK, Malafa MP, Jacobsen PB, Schell MJ, Sarr MG. Suicide in patients with pancreatic cancer. Cancer 2010; 117:642-7. [PMID: 20824626 DOI: 10.1002/cncr.25428] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression is highly prevalent in patients with pancreatic cancer and can result in fatal outcomes from suicides. The authors report suicide rates among patients with pancreatic cancer in the United States and identify factors associated with greater suicide rates. METHODS The current study reviewed data in the SEER database for patients diagnosed with pancreatic adenocarcinoma from 1995-2005. Logistic regression models were used to perform multivariate modeling for factors associated with suicide, while Kaplan-Meier analysis was used to assess factors affecting survival. RESULTS Among 36,221 patients followed for 22,145 person-years, the suicide rate was 135.4 per 100,000 person-years. The corresponding rate in the US population aged 65-74 years was 12.5 per 100,000 person-years, with a Standardized Mortality Ratio (SMR) of 10.8 (95% CI, 9.2-12.7). Greater suicide rates were noted in males (Odds Ratio (OR) 13.5 [95% CI, 3.2-56.9, P < .001]) and, among males, in patients undergoing an operative intervention (OR 2.5 [95% CI, 1.0-6.5, P = .05]). Married men had a lesser risk of committing suicide (OR 0.3 [95% CI, 0.1-0.6, P = .002]). Median survival among patients undergoing operative intervention was 2 months for those who committed suicide compared with 10 months for those who did not commit suicide. CONCLUSIONS Male patients with pancreatic adenocarcinoma have a risk of suicide nearly 11 times that of the general population. Patients who undergo an operative intervention are more likely to commit suicide, generally in the early postoperative period.
Collapse
Affiliation(s)
- Kiran K Turaga
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.
| | | | | | | | | |
Collapse
|
32
|
Affiliation(s)
- Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, Calif, USA
| |
Collapse
|
33
|
Haensel A, Norman D, Natarajan L, Bardwell WA, Ancoli-Israel S, Dimsdale JE. Effect of a 2 week CPAP treatment on mood states in patients with obstructive sleep apnea: a double-blind trial. Sleep Breath 2008; 11:239-44. [PMID: 17503102 DOI: 10.1007/s11325-007-0115-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Obstructive sleep apnea (OSA) is a common disease with significant medical and psychiatric comorbidities. The literature documenting the effects of continuous positive airway pressure (CPAP) treatment on mood in OSA patients is mixed. We previously observed that 1 week of CPAP treatment did not result in improvements in mood beyond those observed in a group treated with placebo-CPAP. This study examined the effect of a 2 week CPAP treatment on mood in a placebo-controlled design in OSA patients. Fifty patients with untreated sleep apnea were evaluated by polysomnography and completed the Profile of Mood States (POMS) pre-/post-treatment. The patients were randomized for 2 weeks to either therapeutic CPAP or placebo-CPAP (at insufficient pressure). Both the therapeutic CPAP and the placebo-CPAP groups showed significant improvements in POMS total score, tension, fatigue, and confusion. No significant time x treatment effect was observed for either group. We could not show a specific beneficial impact of CPAP treatment on mood in OSA patients.
Collapse
Affiliation(s)
- Alexander Haensel
- Department of General Internal Medicine, University Hospital Berne, Bern, Switzerland.
| | | | | | | | | | | |
Collapse
|
34
|
Kapfhammer HP. Depressive und Angststörungen bei somatischen Krankheiten. PSYCHIATRIE UND PSYCHOTHERAPIE 2008. [PMCID: PMC7122024 DOI: 10.1007/978-3-540-33129-2_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.
Collapse
|
35
|
Gagliese L, Gauthier LR, Rodin G. Cancer pain and depression: a systematic review of age-related patterns. Pain Res Manag 2007; 12:205-11. [PMID: 17717612 PMCID: PMC2670711 DOI: 10.1155/2007/150126] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pain is a common and debilitating symptom experienced by cancer patients of all ages. Cancer pain is associated with elevated levels of depression; however, age-related patterns in this relationship remain unclear. This information is important to provide effective palliation of pain and depression to the growing numbers of older cancer patients. OBJECTIVE To provide a systematic review of the literature regarding age-related patterns in the intensity or prevalence of depression among cancer patients with pain. METHODS Medical and psychological literature databases were searched to identify eligible studies. The methodological quality and outcomes of the studies were compiled and systematically reviewed. RESULTS Five articles, describing four studies, met the inclusion and exclusion criteria. Due to high levels of cross-study methodological variability, a qualitative review was undertaken. Three of the four studies did not find evidence for age-related patterns in depression. The fourth study found that depression increased with age. CONCLUSION The weight of the evidence suggests that younger and older cancer patients with pain report comparable levels of depression. However, this conclusion remains preliminary due to the methodological limitations of the available studies. Research is needed to more adequately address this important issue.
Collapse
Affiliation(s)
- Lucia Gagliese
- School of Kinesiology and Health Science, York University, Toronto, Canada.
| | | | | |
Collapse
|
36
|
Verslype C, Van Cutsem E, Dicato M, Cascinu S, Cunningham D, Diaz-Rubio E, Glimelius B, Haller D, Haustermans K, Heinemann V, Hoff P, Johnston PG, Kerr D, Labianca R, Louvet C, Minsky B, Moore M, Nordlinger B, Pedrazzoli S, Roth A, Rothenberg M, Rougier P, Schmoll HJ, Tabernero J, Tempero M, van de Velde C, Van Laethem JL, Zalcberg J. The management of pancreatic cancer. Current expert opinion and recommendations derived from the 8th World Congress on Gastrointestinal Cancer, Barcelona, 2006. Ann Oncol 2007; 18 Suppl 7:vii1-vii10. [PMID: 17600091 DOI: 10.1093/annonc/mdm210] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This article summarizes the expert discussion on the management of pancreatic cancer, which took place during the 8th World Congress on Gastrointestinal Cancer in June 2006 in Barcelona. A multidisciplinary approach to a patient with pancreatic cancer is essential, in order to guarantee an optimal staging, surgery, selection of the appropriate (neo-)adjuvant strategy and chemotherapeutic choice management. Moreover, optimal symptomatic management requires a dedicated team of health care professionals. Quality control of surgery and pathology is especially important in this disease with a high locoregional failure rate. There is now solid evidence in favour of chemotherapy in both the adjuvant and palliative setting, and gemcitabine combined with erlotinib, capecitabine or platinum compounds seems to be slightly more active than gemcitabine alone in advanced pancreatic cancer. There is a place for chemoradiotherapy in selected patients with locally advanced disease, while the role in the adjuvant setting remains controversial. Those involved in the care for patients with pancreatic cancer should be encouraged to participate in well-designed clinical trials, in order to increase the evidence-based knowledge and to make further progress.
Collapse
Affiliation(s)
- C Verslype
- Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Patten SB, Williams JVA. Assessment of physical etiologies for mood and anxiety disorders in structured diagnostic interviews. Soc Psychiatry Psychiatr Epidemiol 2007; 42:462-6. [PMID: 17450450 DOI: 10.1007/s00127-007-0195-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Structured diagnostic inter- views include items that evaluate physical etiologies for mood and anxiety disorders. The objective of this article was to assess the impact of such items. METHOD A mental health survey in Canada collected data from n = 36,984 household residents. The lifetime prevalence of mood and anxiety disorders was calculated with and without exclusions due to physical causes. RESULTS Approximately 10% of subjects with a lifetime depressive disorder reported that all of their episodes were due to one or more physical cause. Many of the reported etiologies were implausible given the DSM-IV requirement that the disturbance be a "direct physiological consequence" of the physical cause. The results were similar for manic episodes and anxiety disorders. CONCLUSIONS Structured diagnostic interviews assess physical etiologies in ways that are subject to inconsistency and inaccuracy. Physical etiology items may bias estimates by introducing etiological opinions into the assessment of disorder frequency.
Collapse
Affiliation(s)
- Scott B Patten
- Dept. of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary (AB) Canada T2N 4N1.
| | | |
Collapse
|
38
|
Abstract
BACKGROUND Persons with cancer commit suicide more frequently than those without, and males generally commit suicide more frequently than females. A population-based analysis of cancer patients was carried out here, comparing suicide risk between the genders, to elucidate the features specific to each gender. PATIENTS AND METHODS A total of 1.3 million cancer cases from the Surveillance, Epidemiology, and End Results program were analyzed. Cox proportional hazards models were fitted to personal, tumor-related, and social variates. RESULTS A total of 265 female and 1307 male suicides were enumerated, reflecting 0.04% and 0.19% from each gender, and providing an overall hazard ratio for male suicide of 6.2 [95% confidence interval (CI) 5.4-7.1]. Females with colorectal (P = 0.01) and cervical (P < 0.0001) cancers showed decreased suicide rates. Males with head and neck cancers (P < 0.0001) and myeloma (P = 0.02) had increased rates, whereas rates were decreased in males with lung cancer (P = 0.01), liver (P = 0.01), brain tumors (P = 0.04), and leukemia (P = 0.007). The hazard ratio associated for male suicide with distant metastasis was 2.84 (95% CI 2.49-3.24); for married status, 0.46 (95% CI 0.39-0.54); and for African-American ancestry, 0.24 (95% CI 0.17-0.34)-comparable ratios were seen here for female suicides. In head and neck cancers, with both genders analyzed together, the suicide hazard was increased if surgery was contraindicated (3.0, 95% CI 1.3-6.8), but not if refused. CONCLUSIONS The high-risk patient was male, with head and neck cancer or myeloma, advanced disease, little social or cultural support, and limited treatment options. Oncologists and allied health professionals should be aware of the potential for suicide in cancer patients and their associated risk factors.
Collapse
Affiliation(s)
- W S Kendal
- Division of Radiation Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
| |
Collapse
|
39
|
Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry 2006; 28:396-402. [PMID: 16950374 DOI: 10.1016/j.genhosppsych.2006.05.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 05/18/2006] [Accepted: 05/18/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study was to compare the effect of depression on the risk of death in adults with and without cancer and by specific cancer site among those with cancer. RESEARCH DESIGN AND METHODS We analyzed data on 10,025 participants in the population-based National Health and Nutrition Examination Survey (NHANES) 1 Epidemiologic Follow-up Study. Four groups were created based on cancer and depression status in 1982: (a) no cancer, no depression (reference group; no CA, no DEP); (b) depression but no cancer (DEP, no CA); (c) cancer but no depression (CA, no DEP); and (d) cancer and depression (CA+DEP). Six CA sites were defined: lung, breast, gastrointestinal (GI), genitourinary (GU), skin and other. Cox proportional models were used to calculate adjusted hazard for death for each group compared with the reference group and by cancer site. RESULTS Over 8 years (78,433 person-years of follow-up), 1925 deaths were documented. The mortality rate per 1000 person-years of follow-up was highest in the CA+DEP group. Compared to the reference group, the hazard ratios (HRs) for all-cause mortality were as follows: CA, no DEP: 1.43 [95% confidence interval (95% CI)=1.23-1.67]; DEP, no CA: 1.44 (95% CI=1.28-1.63); CA+DEP: 1.87 (95% CI=1.49-2.34). HRs for depression by site were as follows: lung: 1.30 (95% CI=0.49-3.99); breast: 1.27 (95% CI=0.58-2.79); GI: 1.47 (95% CI=0.58-3.75); GU: 0.93 (95% CI=0.50-1.74); skin: 1.07 (95% CI=0.67-1.69); other: 2.13 (95% CI=0.55-8.25). CONCLUSION The coexistence of cancer and depression is associated with a significantly increased risk of death, and the effect of depression on the risk of death differs by cancer site.
Collapse
Affiliation(s)
- Adedayo A Onitilo
- Department of Hematology/Oncology, Marshfield Clinic-Wausau Center, Wausau, WI 54401, USA
| | | | | |
Collapse
|
40
|
Abstract
As medical science progresses and the life spans of patients with serious illnesses increase, the process that leads to death is becoming more feared than death itself. This fear is particularly intense in technologically advanced cultures with access to advanced medical care. The lives of patients who previously would have died rapidly are now often extended. As a result, images of suffering, such as dying in isolation and experiencing great pain, often are at the forefront of concerns about those struggling with terminal illnesses. This article provides medical practitioners with an overview of the issues and symptoms common in terminal illness, to help them work most effectively with their mental health colleagues.
Collapse
Affiliation(s)
- Christopher A Gibson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
| | | | | | | |
Collapse
|
41
|
Tsunoda A, Nakao K, Hiratsuka K, Yasuda N, Shibusawa M, Kusano M. Anxiety, depression and quality of life in colorectal cancer patients. Int J Clin Oncol 2005; 10:411-7. [PMID: 16369745 DOI: 10.1007/s10147-005-0524-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 07/28/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few studies have examined psychological distress and its relationship with quality of life (QL) dimensions in colorectal cancer patients. METHODS One hundred and twenty-eight outpatients were given psychological tests for anxiety and depression (Hospital Anxiety and Depression Scale; HADS) and QL The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ-C30) on the same occasion. The association between the patients' emotional function (EF) scoring on EORTC QLQ-C30 and their HADS scores was analyzed by multiple linear regression. RESULTS Statistically significant negative relationships were found between EF and HADS-A (anxiety), HADS-D (depression), and HADS-T (total score), respectively, with the highest correlation coefficient being for HADS-A. However, HADS-D was significantly more highly correlated than HADS-A to other QL dimensions, and depression was more highly correlated than anxiety with reduced QL. CONCLUSION The EF dimension of the EORTC QLQ-C30 predominantly assesses anxiety. Depression has a stronger impact on the global QL of patients than anxiety; therefore, the use of an additional instrument is recommended for the assessment of depression in outpatients with colorectal cancer.
Collapse
Affiliation(s)
- Akira Tsunoda
- Second Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
| | | | | | | | | | | |
Collapse
|
42
|
Shanmugham B, Karp J, Drayer R, Reynolds CF, Alexopoulos G. Evidence-based pharmacologic interventions for geriatric depression. Psychiatr Clin North Am 2005; 28:821-35, viii. [PMID: 16325731 DOI: 10.1016/j.psc.2005.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Bindu Shanmugham
- Weill-Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| | | | | | | | | |
Collapse
|
43
|
Patten SB, Beck CA, Kassam A, Williams JVA, Barbui C, Metz LM. Long-term medical conditions and major depression: strength of association for specific conditions in the general population. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:195-202. [PMID: 15898458 DOI: 10.1177/070674370505000402] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence of major depression (MD) in persons with nonpsychiatric medical conditions is an indicator of clinical need in those groups, an indicator of the feasibility of screening and case-finding efforts, and a source of etiologic hypotheses. This analysis explores the prevalence of MD in the general population in relation to various long-term medical conditions. METHODS We used a dataset from a large-scale Canadian national health survey, the Canadian Community Health Survey (CCHS). The sample consisted of 115 071 subjects aged 18 years and over, randomly sampled from the Canadian population. The survey interview recorded self-reported diagnoses of various long-term medical conditions and employed a brief predictive interview for MD, the Composite International Diagnostic Interview Short Form for Major Depression. Logistic regression was used to adjust estimates of association for age and sex. RESULTS The conditions most strongly associated with MD were chronic fatigue syndrome (adjusted odds ratio [AOR] 7.2) and fibromyalgia (AOR 3.4). The conditions least strongly associated were hypertension (AOR 1.2), diabetes, heart disease, and thyroid disease (AOR 1.4 in each case). We found associations with various gastrointestinal, neurologic, and respiratory conditions. CONCLUSIONS A diverse set of long-term medical conditions are associated with MD, although previous studies might have lacked power to detect some of these associations. The strength of association in prevalence data, however, varies across specific conditions.
Collapse
Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, University of Calgary, Alberta.
| | | | | | | | | | | |
Collapse
|
44
|
Ko CM, Malcarne VL, Varni JW, Roesch SC, Banthia R, Greenbergs HL, Sadler GR. Problem-solving and distress in prostate cancer patients and their spousal caregivers. Support Care Cancer 2005; 13:367-74. [PMID: 15657688 PMCID: PMC1599706 DOI: 10.1007/s00520-004-0748-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 11/02/2004] [Indexed: 10/25/2022]
Abstract
GOALS OF WORK Prostate cancer, the most common life-threatening cancer among American men, increases risk of psychosocial distress and negatively impacts quality of life for both patients and their spouses. To date, most studies have examined the relationship between patient coping and distress; however, it is also likely that what the spouse does to cope, and ultimately how the spouse adjusts, will affect the patient's adjustment and quality of life. The present study examined the relationships of spouse problem-solving coping, distress levels and patient distress in the context of prostate cancer. The following mediational model was tested: Spouses' problem-solving coping will be significantly inversely related to patients' levels of distress, but this relationship will be mediated by spouses' distress levels. PATIENTS AND METHODS One hundred seventy-one patients with prostate cancer and their spousal caregivers were assessed for mood; spouses were assessed for problem-solving coping skills. Structural equation modeling was used to test model fit. MAIN RESULTS The model tested was a good fit to the data. Dysfunctional spousal problem-solving was a significant predictor of spouse distress level but constructive problem-solving was not. Spouse distress was significantly related to patient distress. Spouse dysfunctional problem-solving predicted patient distress, but this relationship was mediated by spouse distress. The same mediational relationship did not hold true for constructive problem-solving. CONCLUSIONS Spouse distress mediates the relationship between spouse dysfunctional coping and patient distress. Problem-solving interventions and supportive care for spouses of men with prostate cancer may impact not only spouses but the patients as well.
Collapse
Affiliation(s)
- Celine M Ko
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA.
| | | | | | | | | | | | | |
Collapse
|
45
|
Lloyd-Williams M, Dennis M, Taylor F. A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 2004; 18:558-63. [PMID: 15453627 DOI: 10.1191/0269216304pm923oa] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Depression is a common symptom in patients with advanced cancer and patients who are depressed may also have physical symptoms which are difficult to palliate and which improve as their depression is appropriately treated. This study was carried out to determine if there was an association between depression and physical symptoms in patients with advanced cancer and to establish whether a seven-item verbal rating scale asking patients to verbally rate the severity of physical symptoms together with low mood could be used to screen for depression. The scale was validated against a semi-structured clinical interview according to DSM IV criteria. Seventy-four patients participated with an age range of 28-92 years. All patients had an ECOG performance status of two or three. The prevalence of major depression in this study was found to be 27% (95% C.I. 17-37%). The mean score on the verbal rating scale was 28.77 (median score 29.5) (95% C.I., 26.23 - 31.31; range 0-65). A cut-off of > or = 30 gave a sensitivity of 65% and specificity of 59%, with positive and negative predictive values of 37% and 82% respectively. The verbal mood item alone had an optimal cut-off point of 3, with a sensitivity of 80% and specificity of 43%. Patients diagnosed as being depressed according to psychiatric interview rated each symptom higher than nondepressed patients. The verbal mood item and total verbal rating score correlated with a high significance (rs = 0.607, P < 0.01), implying a relationship between a patient's subjective mood state and other symptoms. Both using the verbal scale and asking patients to verbally rate their mood alone had poor efficacy as a screening tool. However, there is a close association between physical symptoms and the presence of depression in palliative care patients.
Collapse
Affiliation(s)
- Mari Lloyd-Williams
- Department of Primary Care, University of Liverpool Medical School, Liverpool, UK.
| | | | | |
Collapse
|
46
|
|
47
|
Carney CP, Jones L, Woolson RF, Noyes R, Doebbeling BN. Relationship between depression and pancreatic cancer in the general population. Psychosom Med 2003; 65:884-8. [PMID: 14508036 DOI: 10.1097/01.psy.0000088588.23348.d5] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Prior research suggesting a relationship between pancreatic cancer and depression conducted on clinical populations has been subject to recall bias. We reexamined this association using longitudinal population-based data. METHODS This was a retrospective cohort study using longitudinal insurance claims data. RESULTS Men with mental disorders were more likely to develop pancreatic cancer than those without psychiatric claims (odds ratio 2.4, confidence interval 1.15-4.78). Depression more commonly preceded pancreatic cancer than it did other gastrointestinal malignancies (odds ratio 4.6, confidence interval 1.07-19.4) or all other cancers (odds ratio 4.1, confidence interval 1.05-16.0). CONCLUSIONS Depression and pancreatic cancer are associated in the general population.
Collapse
Affiliation(s)
- Caroline P Carney
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa 52242, USA.
| | | | | | | | | |
Collapse
|
48
|
Chen KM, Snyder M, Krichbaum K. Translation and equivalence: the Profile of Mood States Short Form in English and Chinese. Int J Nurs Stud 2002; 39:619-24. [PMID: 12100873 DOI: 10.1016/s0020-7489(01)00068-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As international research collaborations increase, health care professionals are becoming more aware of the advantages of using common measures to compare outcomes of assessments across cultures. Measuring mood states across diverse cultures is important for understanding the universal aspects of mood and measuring outcomes of nursing interventions. The purpose of this article is to describe the process used to translate the Profile of Mood States Short Form from English to Chinese and to assess the equivalence of this instrument in the two languages. The translated Chinese version of the instrument was found to be as reliable as the original English version and is appropriate for use with Chinese elders who speak either Mandarin or Taiwanese.
Collapse
Affiliation(s)
- Kuei-Min Chen
- Department of Nursing, Fooyin Institute of Technology, 151 Chin-Hsueh Road, Taliao Hsiang, Kaohsiung 831, Taiwan.
| | | | | |
Collapse
|
49
|
Heffernan N, Cella D, Webster K, Odom L, Martone M, Passik S, Bookbinder M, Fong Y, Jarnagin W, Blumgart L. Measuring health-related quality of life in patients with hepatobiliary cancers: the functional assessment of cancer therapy-hepatobiliary questionnaire. J Clin Oncol 2002; 20:2229-39. [PMID: 11980994 DOI: 10.1200/jco.2002.07.093] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This is the first report on the development and initial validation of the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire, a 45-item self-report instrument designed to measure health-related quality of life (HRQL) in patients with hepatobiliary cancers. The FACT-Hep consists of the 27-item FACT-G, which assesses generic HRQL concerns, and the newly validated 18-item Hepatobiliary Subscale (HS), which assesses disease-specific issues. PATIENTS AND METHODS The development of the HS followed a four-phase process of item generation, item reduction, scale construction, and reliability/validity testing. Two independent samples were studied: item generation (sample 1; n = 30) and reliability/validity testing (sample 2; n = 51). RESULTS In sample 2, all subscales and aggregated scores showed high internal consistency at initial assessment (Cronbach's alpha range, 0.72 to 0.94) and retesting (Cronbach's alpha range, 0.81 to 0.94). Measurement stability over a 3- to 7-day period was also high for all aggregated scales (test-retest correlation range, 0.84 to 0.91; intraclass correlation coefficient range, 0.82 to 0.90). Convergent and divergent validity were demonstrated by examining relationships between FACT subscales and mood, social support, and social desirability. Finally, when performance status and treatment status were used to divide sample 2, the HS differentiated groups to a degree comparable to the Physical and Functional Well-Being subscales of the FACT-G, thereby contributing favorably to a 32-item Trial Outcome Index. In addition to the 18 validated, scored items in the HS, seven treatment-related items may be appended, if clinically indicated, as a separate subscale. CONCLUSION The 45-item FACT-Hep can be used independently as a brief measure of disease-related symptoms and functioning. Alone or paired with the FACT-G, the HS has promise for use in assessing the disease-specific HRQL of patients with hepatobiliary cancers.
Collapse
Affiliation(s)
- Nancy Heffernan
- Hepatobiliary Disease Management Program, Memorial Sloan-Kettering Cancer Center, and Beth Israel Medical Center, New York, NY 10021, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Pereira J, Bruera E. Depression with psychomotor retardation: diagnostic challenges and the use of psychostimulants. J Palliat Med 2001; 4:15-21. [PMID: 11291390 DOI: 10.1089/109662101300051906] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A patient with advanced pancreatic cancer is presented to demonstrate the clinical challenge of diagnosing depression in palliative care. The conundrum related to the relative roles of somatic and psychological symptoms in screening or diagnosing depression in these patients is illustrated and discussed. There is no clear consensus on how to apply diagnostic criteria for diagnosing depression in these patients. Although an approach that focuses on the psychological symptoms is often suggested, it appears that somatic criteria cannot be entirely excluded. The case also highlights the use of methylphenidate to treat palliative care patients. As compared to traditional antidepressants that may take as long as 6-8 weeks to have a full effect, they offer the advantage of onset of action within a few days. This is especially helpful in patients with limited life expectancies. They appear to be particularly advantageous where psychomotor retardation is a main feature of the depression. The patient discussed demonstrated an observed and self-reported improvement of mood and psychomotor retardation following the initiation of psychostimulant treatment. Larger, controlled trials, using specified criteria to diagnose depression, are warranted to elucidate the role of psychostimulants in treating depression in palliative care patients.
Collapse
Affiliation(s)
- J Pereira
- Palliative Care Program, Grey Nuns Community Hospital & Health Centre, Edmonton, Canada.
| | | |
Collapse
|