Screening for distress, the 6th vital sign: common problems in cancer outpatients over one year in usual care: associations with marital status, sex, and age.

BACKGROUND: Very few studies examine the longitudinal prevalence of problems and the awareness or use of clinical programs by patients who report these problems. Of the studies that examine age, gender and marital status as predictors of a range of patient outcomes, none examines the interactions between these demographic variables. This study examined the typical trajectory of common practical and psychosocial problems endorsed over 12 months in a usual-care sample of cancer outpatients. Specifically, we examined whether marital status, sex, age, and their interactions predicted these trajectories. We did not actively triage or refer patients in this study in order to examine the natural course of problem reports. METHODS: Patients completed baseline screening (N = 1196 of 1707 approached) and the sample included more men (N = 696) than women (N = 498), average age 61.1 years. The most common diagnoses were gastrointestinal (27.1%), prostate (19.2%), skin (11.1%) and gynecological (9.2%). Among other measures, patients completed a Common Problem Checklist and Psychosocial Resources Use questions at baseline, 3, 6, and 12 months using paper and pencil surveys. RESULTS: Results indicated that patients reported psychosocial problems more often than practical and both decreased significantly over time. Younger single patients reported more practical problems than those in committed relationships. Younger patients and women of all ages reported more psychosocial problems. Among a number of interesting interactions, for practical problems, single older patients improved more; whereas among married people, younger patients improved more. For psychosocial problems we found that older female patients improved more than younger females, but among males, it was younger patients who improved more. Young single men and women reported the most past-and future-use of services. CONCLUSIONS: Younger women are particularly vulnerable to experiencing practical and psychosocial problems when diagnosed with cancer, but being married protects these younger women. Marriage appeared to buffer reports of both practical and psychosocial problems, and led to less awareness and use of services. Unexpectedly, young men reported the highest use of psychosocial services. This study informs clinical program development with information on these risk groups.

Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis.

PURPOSE: Numerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival. METHODS: In a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies-Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival. RESULTS: Median survival time was 53.6 months for women with decreasing CES-D scores over 1 year and 25.1 months for women with increasing CES-D scores. There was a significant effect of change in CES-D over the first year on survival out to 14 years (P = .007) but no significant interaction between treatment condition and CES-D change on survival. Neither demographic nor medical variables explained this association. CONCLUSION: Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample. Further research is necessary to confirm this hypothesis in other samples, and causation cannot be assumed based on this analysis.

Evaluation of fine needle capillary sampling in superficial and deep-seated lesions. An analysis of 670 cases.

OBJECTIVE: To study the efficacy and merits of a simplified cytologic technique of fine needle capillary (FNC) sampling in 670 cases. STUDY DESIGN: FNC sampling was tested on a consecutive series of 600 superficial palpable masses and 70 deep-seated lesions during the period January 1993-September 1993. Among superficial masses, sampling was done on 380 lymph nodes, 88 breast lesions, 56 thyroids, 12 salivary glands and 64 miscellaneous sites. Fifty-five lung lesions were sampled using 8 computed tomography, while 15 abdominal masses were sampled using ultrasonography. Cell samples were assessed as diagnostically adequate or inadequate. RESULTS: The diagnostic adequacy in lymph node, breast and thyroid lesions was 95%, 91.07% and 90.09%, respectively. The diagnostic adequacy for deep-seated lesions was 91.42%. CONCLUSION: The procedure gives a better perception of tumor consistency and control of the hand. FNC resulted in a high yield of good-quality material with retention of cellular architecture. It is recommended that the operator become familiar with the macroscopic slide appearance of a cellular smear. Doubts persist with respect to fibrotic and cystic lesions.