Distress and mental health care and medication use among survivors of multiple primary cancer diagnoses: Findings from the 2016 National Health Interview Survey.

OBJECTIVE: Over 1 million survivors of multiple primary cancer (MPC) diagnoses reside in the USA. Information regarding their physical and mental health status is limited. This study examined distress and mental health care use among MPC survivors relative to survivors of a single primary cancer (SPC) diagnosis. METHODS: Using the 2016 National Health Information Survey, MPC survivors (n = 265), SPC survivors (n = 2103), and no cancer controls (NCC; n = 28,320) were identified. The MPC group was compared to the SPC and NCC groups with regard to multiple distress indices and use of mental health care and anxiety and depression medication. RESULTS: Relative to the SPC group, the MPC group reported more Total Distress (M = 9.59 vs. 8.84; p < .001), and were more likely to report daily or weekly anxiety feelings (OR = 2.07; p < .001), meet criteria for serious psychological distress (OR = 1.49; p = .02) and have talked to a mental health professional (OR = 1.75; p = .01). Comparison of MPC and NweCC groups yielded similar results. The MPC group did not differ from the SPC or NCC groups in severity of anxiety or depression feelings, distress interference, or anxiety and depression medication use. CONCLUSIONS: MPC survivors reported greater distress relative to SPC survivors. The clinical significance of this greater distress is unclear, however. While MPC survivors were more likely to have talked to a mental health professional, uptake of mental health care appeared to be suboptimal. MPC and SPC survivors might be considered distinct subgroups and increased attention devoted to potentially unique mental and physical health needs of MPC survivors.

Ulipristal acetate on quality of life and sexual function of women with uterine fibromatosis.

To evaluate quality of life and sexual function of childbearing-age women, affected by uterine fibromatosis undergoing medical treatment with ulipristal acetate. The data obtained by filling the questionnaires European Quality of Life Five-Dimension Scale and modified Female Sexual Function Index, were analyzed to assess UPA usefulness in improving QoL and sexual activity. A total of 139 patients affected by uterine fibromatosis undergoing conservative ulipristal acetate treatment were enrolled in this prospective observational cohort study. Seventy-one women (average age 46.5 years) answered the questionnaires: QoL and sexuality were evaluated before and after ulipristal acetate treatment. 59 patients (83.1%) had an improvement of QoL and general health state, with a reduction of VAS score after ulipristal acetate treatment. EQ-5D-5L showed a statistically significant improvement of usual act impairment, mobility, discomfort, anxiety/depression (p < .0005). There was no difference in personal care management after therapy. Modified FSFI showed a statistically significant improvement (p < .0001) of sexual satisfaction and sexual life. A not statistically significant improvement in dyspareunia was also highlighted. This study provides a clear picture about QoL impact on women and confirms the effectiveness of the ulipristal acetate in improving different aspects of daily and sexual life of patients undergoing medical treatment.

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers.

OBJECTIVE: Survivors of multiple primary cancers (MPC) are at increased risk for poor health outcomes compared with survivors of single cancers. Using an adapted psychobehavioral stress-response model, the study purpose was to identify pathways and individual risk factors associated with poor health outcomes in adults with MPC. METHODS: Adult MPC survivors (N = 211) with first cancers (stages I-III) diagnosed within 1 to 10 years were recruited via tumor registry. Employing a cross-sectional design, established questionnaires were used to operationalize patient characteristics and theoretical constructs including perceived stress, psychological and behavioral responses, financial hardship, social role function, and physical health. Disease and treatment data were obtained via registry and medical records. Structural equation modeling (SEM) was performed to fit, test, and modify the hypothesized psychobehavioral model. RESULTS: Following measurement model refinement, an SEM linking self-management behaviors, distress, financial hardship, and functional health demonstrated a good fit: χ2 (200, N = 206) = 332.06, P < .01; Tucker-Lewis index (TLI) = .95, comparative fit index (CFI) = .96, standardized root mean residual (SRMR) = .06, root-mean-square error of approximation (RMSEA) = .06. Less use of self-management behaviors predicted higher distress which, in turn, predicted higher financial hardship; higher distress and financial hardship predicted poorer functional health. Several sociodemographic and personal factors predicted self-management behaviors and distress. CONCLUSIONS: The hypothesized stress-response model was partially supported. Data supported pathways among self-management behaviors, distress, financial hardship, and functional health. Self-management and distress may represent modifiable intervention targets for MPC survivors. High body mass index (BMI), less education, greater neuroticism, and lower social support were associated with less use of self-management behaviors and higher distress and should be further evaluated as potential markers of vulnerability.

Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: results from a large-scale observational study analysing effects of diagnoses and disease progression.

BACKGROUND: Non-melanoma skin cancer (NMSC) and actinic keratosis (AK) are very common among fair-skinned individuals. A disease continuum from AK to squamous cell carcinoma (SCC) has been frequently postulated. AK and NMSC may influence quality of life (QL) of patients, and it can be suspected that disease progression entails a QL reduction. The purpose of this study was to document QL in patients with NMSC and AK using the health-outcome questionnaire EQ-5D-5L. METHODS: The study was designed as a non-interventional, prospective, cross-sectional study. Patients with AK, SCC, basal cell carcinoma (BCC) or multiple diagnoses were enrolled in this study in 29 dermatological centres across Germany. Patients were asked to complete the EQ-5D-5L (compromising EQ Index and EQ VAS), and the dermatologists provided diagnosis, disease history and treatment data. RESULTS: A total of 1184 patients were enrolled and diagnosed as follows: 73% AK, 49% BCC and 17% SCC. 66% had a single diagnosis, 28% two different diagnoses and 6% three different diagnoses. QL was strongly associated with patients' diagnosis. Patients with a single AK diagnosis had significantly higher mean EQ VAS (78) than patients with BCC (74), SCC (72), and BCC plus SCC (69), P < 0.050. When the effects of disease progression were calculated, patients with AK plus SCC reported significantly less mean EQ VAS (71) than patients with a single AK diagnosis (78), P < 0.011. CONCLUSIONS: While rarely being imminently life-threatening, NMSC and AK have an impact on QL as quantified by the EQ-5D-5L. This impact is associated with diagnosis (AK vs. NMSC) and clinical progression (AK vs. AK plus SCC). Both lead to a clear decline in QL. This shows that disease progression is perceived and judged as detrimental by patients and that AK and NMSC should be diligently treated to preserve and restore QL.

Psychological Distress, Health Behaviors, and Benefit Finding in Survivors of Multiple Primary Cancers: Results From the 2010 Livestrong Survey.

PURPOSE/OBJECTIVES: To evaluate whether survivorship of multiple primary cancers (MPCs) is associated with psychological distress, positive health behaviors, and benefit finding.
. DESIGN: Secondary analysis of the 2010 Livestrong cross-sectional survey.
. SETTING: Online survey.
. SAMPLE: 238 MPC survivors and 3,295 single cancer survivors.
. METHODS: Chi-square and t tests for group comparisons were used. Multivariate linear regression, adjusted for covariates, was used to determine associations between variables.
. MAIN RESEARCH VARIABLES: MPC versus single cancer; psychological distress, health behavior (healthy lifestyle and positive healthcare utilization), and benefit-finding scores.
. FINDINGS: Survivors of MPCs (compared to single cancer survivors) were significantly older, less likely to have a spouse or partner, further out from original cancer diagnosis, and less likely to be employed full-time, and they differed by cancer diagnoses and survivorship stage. Having MPCs was associated with significantly higher psychological distress and healthcare utilization but not healthy lifestyle or benefit finding.
. CONCLUSIONS: Relative to those with single cancers, MPC survivors are at increased risk for psychological distress and are more likely to receive recommended cancer screenings. Additional research is needed to understand mechanisms surrounding psychological distress in MPC survivors.
. IMPLICATIONS FOR NURSING: Targeted distress screening in MPC survivors may allow for early identification and interventions to ameliorate distress and reduce negative downstream health effects.

Examining the relationship between multiple primary cancers and psychological distress: A review of current literature.

OBJECTIVE: The incidence of multiple primary cancers (MPCs) is increasing, but little is known about psychological distress in this population. The purpose of this study is to review and synthesize the literature regarding what is known about psychological distress in adults who have experienced MPC diagnoses. METHODS: All potentially eligible studies identified in PubMed and CINAHL were reviewed by 2 independent evaluators, and each relevant article was assessed for methodological quality. Data were extracted, organized, and recorded using a coding log, PRISMA flow diagram, and a standardized table of evidence. Effect size (ES) values were calculated using Cohen's d. RESULTS: Five of the 562 potentially relevant articles were selected for final analysis. MPC survivors, when compared with single cancer survivors, had lower global quality of life (d = 0.32-0.37), poorer emotional role function and stress (d = 0.08-0.20), greater and more frequent distress (d = 0.11-0.37), and greater subclinical anxiety (d = 0.15). Depressive symptoms were variable (d = 0.01-0.22), and no differences between MPC and single cancer groups were identified for sleep and suicidal ideation. CONCLUSION: There is a substantial lack of evidence focused on psychological distress among the growing MPC survivor population. ES noted in the 5 studies reflect small but potentially significant increases in psychological distress in survivors of MPC compared with survivors of a single cancer. Clinicians should be aware of this at-risk population when screening for distress in cancer survivors. Suggestions for future research are provided.

Skin protection behaviour and sex differences in melanoma location in patients with multiple primary melanomas.

BACKGROUND/OBJECTIVES: Previous studies have shown that sunscreen usage, sun-protection measures and self-examination rates in patients with single primary melanomas (SPM) are similar to that in the general population. This study hypothesises that these rates would be different in a population with multiple primary melanomas (MPM). We further hypothesise that there would be a sex difference in melanoma location in patients with MPM. The objectives of this study were to determine skin protection measures, self-examinations and melanoma location in a cohort of patients with MPM. METHODS: A survey was conducted on 137 patients with MPM examining their sun-protection measures, skin self-examination rates and medical and phenotypic characteristics. These data were combined with a review of their medical records to examine the patients' skin cancer history. RESULTS: Patients with MPM had higher rates of skin self-evaluation (74% vs 22%), sunscreen usage (70% vs 45%) and other sun-protection measures (95% vs 46%) than has been published for patients with a history of a SPM. We have also shown that women have a higher risk of developing melanomas on their arms (p < 0.01) and lower legs (p < 0.05) than men. CONCLUSIONS: This report showed the rates of skin self-examination, sunscreen usage and other sun-protection methods in patients with MPM is higher than in studies of patients with SPM. It also highlighted sex differences in terms of melanoma location for patients with MPM. Further studies to examine the cause of the differences in these forms of protective behaviour could help improve the utilisation of these important preventative measures in all patients.

Meningiomatosis revealed by a major depressive syndrome.

Depressive symptoms may be the only expression of brain tumours. Thus, it is challenging to suspect a brain tumour when patients with depression have a normal neurological examination. We illustrate this by a case report regarding a meningiomatosis revealed by a treatment-resistant depressive syndrome that improved after surgery. This case highlights the importance of identifying signs of brain tumour in patients with depression. Although there is no consensus about whether brain imaging is indicated for depressive syndromes, it should be performed, particularly in late onset of depressive syndrome (after 50 years of age), treatment-resistant depression or in apathy with a reduced emotional response or without dysphoric manifestations.

Preliminary data on the lived experience of having multiple primary cancer diagnoses.

Approximately one in two Canadians will develop some form of cancer, and some will live long enough to be diagnosed with multiple primary cancers. There is some indication that multiple primary cancer diagnoses negatively impact survivors' mental and physical status, and quality of life. Existing research studies do not fully capture the complexity of what it is like to have multiple primary cancer diagnoses. Accordingly, a qualitative study was conducted to elicit detailed descriptions of the lived experiences of having multiple primary cancer diagnoses. Participants included 10 individuals from Atlantic Canada with a history of two or more cancer diagnoses. Data were captured through semi-structured interviews and participant-generated photographs. Interviews were transcribed and reviewed for common meanings. Preliminary data analyses suggest that the essential meaning of having cancer multiple times is that cancer is "unwanted encore". This study yields findings that can provide empirically-based guidance to healthcare providers to help support cancer survivors in a more holistic way throughout the extended continuum of care and ultimately improve the health of individuals who have had multiple primary cancers.

[Is it quality of life that patients really want? Assessment from a general practitioner's perspective]. / Ist Lebensqualität das, was Patienten wirklich wollen? Einschätzungen aus einer hausärztlichen Perspektive.

The multidimensional, complex construct of 'quality of life' as a patient-reported outcome is used in medicine as a measurable indicator of health and illness. But do we know what we do when we measure 'quality of life'? Can we grasp how the patient with his individual concept of disease really feels when we use instruments that were designed, administered and analysed by professionals? Do we know the meaning of what we have measured? Is it not shortsighted to focus on health-related quality of life? And is it really quality of life that patients actually want? From a general practitioner's perspective, these questions will be asked of three patients.

[Radiotherapy after testicular-sparing surgery for bilateral or monorchide testicular tumours: an innovative approach]. / Radiothérapie testiculaire après chirurgie conservatrice des tumeurs germinales bilatérales ou sur testicule unique: une stratégie innovante.

Testicular-sparing surgery may avoid definitive testosterone supplementation and preserve fertility in selected cases of men presenting with bilateral testicular tumours or in case of monorchidia. Testicular-sparing surgery may enable the conservation of both endocrine function and spermatogenesis in selected young men in order to preserve natural fatherhood, avoid definitive androgen replacement therapy and probably improve quality of life by reducing psychosexual consequences of anorchia. The tumorectomy must be followed by an external irradiation of the remaining testicle to eradicate testicular intratubular neoplasia revealed in 82% of cases after per-surgery biopsy. This approach concerns some rare indications. Dose level and technical consideration are still debated.

Tactile drawings, ethics, and a sanctuary: metaphoric devices invented by a blind woman.

Until the last two decades, indications that blind people would understand and create pictures were sparse. EW, a totally blind adult, who began making raised-line drawings in her thirties, created a portfolio of several hundred sketches in nine years. She selects her own topics and invents her treatments of the subjects. What is of special interest here is that two of her drawings, shown in the present paper, depict places but also use devices to indicate one is a sanctuary and the other concerns a tragic era, using metaphor. Lightness of line in a forest drawing indicates it is out of reality, enchanted, and a sanctuary. A tilted grid in a drawing of a Holocaust memorial shows the events at issue were twisted and crooked. The devices are metaphoric and novel. The drawings deal with an ontological category--values--for which metaphorical devices in raised-line depictions have not previously been considered.

[Chronic musculoskeletal pain syndrome in primary hyperparathyroidism]. / Chronisches muskuloskelettales Schmerzsyndrom bei primärem Hyperparathyreoidismus.

Chronic somatic pain disorders with somatic and mental factors (ICD-10: F45.41) are common among psychosomatic patients. In the present case, due to the close temporal association with a trauma and the subsequent development of symptoms including depressive symptoms, a chronic pain disorder with a relevant somatoform component was suspected. However, after a period of several months without significant somatic findings, targeted diagnostic approaches resulted in the diagnoses of primary hyperparathyroidism and a papillary thyroid carcinoma. Surgical therapy resulted in an almost complete decline of symptoms within a short period of time.

Reversible delirium in an advanced cancer patient.

Delirium is still one of the most common and distressing symptoms in palliative care patients. Causes and pathophysiology of this neuropsychiatric dysfunction are multifactorial. Recent studies indicate that the interaction of special triggers facilitates development of delirium. Some of them are reversible. This case report presents a reversible delirium in an advanced cancer patient and offers a list of possible delirogen medications. This list might be useful to prevent delirium, particularly in older people.

[Correlation between sonographic findings and level of knowledge/self-report of symptoms in women with uterine leiomyomata]. / Korrelation von sonografischem Untersuchungsbefund mit Informiertheit und Symptom-Selbsteinschätzung bei Frauen mit Uterus myomatosus.

PURPOSE: Is there any correlation between the pre-therapeutic level of knowledge concerning the number/size of leiomyomata or self-reported symptoms and confirmation by sonography? How does the assumption of the number/size of leiomyomata influence the self-perception of symptoms? MATERIALS AND METHODS: In an anonymous questionnaire 498 patients were asked about the number, size and symptoms induced by leiomyomata using a visual chart from 0 - 10. The data were correlated with findings from transvaginal and abdominal ultrasound. RESULTS: The self-reported number of leiomyomata corresponded with the sonographic findings in 80 % of patients with 1 leiomyoma and in 54 % of patients with 2 or 3 leiomyomata, while the self-reported size only corresponded with the sonographic findings in 20 % to 70 % of patients. There was no correlation between the number of leiomymata confirmed by sonography and self-reported symptoms. There are significant correlations between the sonography-defined size and self-reported level of dysmenorrhea (p = 0.003) and self-reported pressure in the abdomen (p = 0.02), as well as submucosal leiomyomata and hypermenorrhea (p = 0.01). Patients who assumed multiple or large leiomyomata ≥ 10 cm reported strong pressure on the bladder or pressure in the abdomen significantly more frequently than patients who assumed 1 leiomyoma (p = 0.03) or a leiomyoma less than 10 cm (p = 0.018). CONCLUSION: There is a discrepancy between the relatively good knowledge about the number of leiomyomata and the lack of knowledge about their size. Subjective incorrect presumptions concerning the number or size of leiomymata can result in different disorders. Therefore, they should not be the exclusive indication for further operative interventions.

A novel mutation in the SDHD gene responsible for familial paraganglioma. Medical and psychological implications.

Familial paragangliomas/pheochromocytomas are dominantly inherited disorders characterized by the development of highly vascularized tumors of the head and neck, derived from non-chromaffin cells of the extra-adrenal paraganglia, and tumors with endocrine activity, derived from chromaffin cells, usually located in the adrenal medulla and pre- and para-vertebral thoracoabdominal regions. Germline inactivating heterozygous mutations in one of the genes encoding for succinate dehydrogenase subunits B, C or D (SDHB, SDHC or SDHD) are responsible for hereditary paragangliomas (PGLs), accounting for nearly 70% of familial cases. Particularly in the SDHD gene, different types of mutations have been found, nevertheless, alterations other than point mutations and deletion leading to missense/nonsense/splicing mutations are extremely rare. Here we report a family with multiple cases of PGL which co-segregates with a novel SDHD gene mutation predictable to give rise to an abnormal gene product (CybS). The identification of the molecular event responsible for PGL in our family made genetic counseling particularly useful for younger first degree relatives at risk to develop this late-onset disease.

Quality of life in survivors of multiple primary cancers compared with cancer survivor controls.

BACKGROUND: Cancer survivors may develop additional cancers after their first diagnosis, but to the authors' knowledge the quality of life (QOL) consequences of a second cancer are not known. The current study assessed QOL and its correlates after a second cancer diagnosis. METHODS: QOL was compared between 487 survivors of second-order and higher-order primary cancer diagnoses, and a matched group of 589 survivors of a single cancer diagnosis. Outcome measures included standardized questionnaires that assessed depressive symptoms, perceived stress, vitality, post-traumatic growth, existential well-being, sexual adjustment, and global QOL. RESULTS: Survivors of multiple primary cancer diagnoses had significantly lower global QOL (t (792) = 5.42; P < .001), vitality (Student t test [t] (794) = 2.41; P < .01), and existential well-being (t (775) = 2.78; P < .01), and higher intrusive stress symptoms (t (775) = -1.93; P < .05). Controlling for demographic, medical, and trait-like psychosocial characteristics (eg, optimism and resilience), having multiple primary cancer diagnoses explained small, although significant, variances in global QOL (coefficient of determination [R(2)] = .04; P < .001), vitality (R(2) = .01; P < .05), and existential well-being (R(2) = .01; P < .05), with patients in the multiple primary cancer group faring worse on all of these measures. CONCLUSIONS: The results of the current study suggest that the typical survivor of multiple primary cancers experiences modest but lasting QOL deficits.

Comparison of four common stressors across the breast cancer trajectory.

OBJECTIVE: Studies of cancer stressors have typically assessed a limited number of factors using cross-sectional designs. There is little information about aspects of cancer that patients consider most stressful at different points along the disease trajectory. METHODS: Seventy-two breast cancer patients rated the degrees to which they experienced each of four common cancer concerns as stressful during the preceding month at 3, 7, 11, and 15 months, and at 6 years after diagnosis. Stressors included fear of the future; physical limitations; pain; and problems with family or friends due to cancer. RESULTS: Overall, the cancer concerns were rated as not especially stressful, with the exception of fear of the future which was the most stressful of the four concerns on all measurement occasions. Although fear of the future decreased from 3 to 7 months following diagnosis, it remained elevated at all of other time points. Physical limitations and pain were reported to induce equivalent levels of stress and their intensities decreased over time. However, there was a resurgence of the stressfulness of physical limitations and pain at the 6-year follow-up point when women experienced a second cancer during the long-term follow-up period. At all measurement occasions, breast cancer survivors reported very low levels of concern in relation to family and friends. CONCLUSION: Breast cancer can be stressful for years after diagnosis for some women and especially for those who experience a second cancer. Fear of the future is the most pressing target for psychosocial interventions.

[Challenging conversation with a patient about the change in treatment strategy from a curative to a palliative setting]. / Aufklärungsgespräch mit einer Patientin über den Wechsel des Behandlungsansatzes vom kurativen zum palliativen Setting.

Palliative care is fortunately gaining importance in the treatment of endstage oncological patients. Patient information regarding therapeutic strategies, especially when treatments are suggested to alleviate symptoms and are not curing the disease can be the most challenging part. Our case of a 49 year old female presenting with a colorectal adenocarcinoma and vertebral body metastasis required spinal stabilization surgery to prevent paralysis. However, she did not consent to the necessary treatment, completely refusing to recognize the seriousness of her disease. In spite of many attempts to enlighten her, the disease was allowed to progress, and it was only when thrombosis caused massive edema of the right leg that the patient finally started to ask about prognosis and potential treatment. An interdisciplinary approach to provide medical and psychosocial help could be established. This case shows the typical problems of a physician-patient relationship in an oncologic clinic and emphasizes the importance of integrating medical with psychosocial care.