Self-reported distress and problems after treatment for gynecological cancer - Correlation between a short screening tool and longer measures of anxiety/depression and health-related quality of life.

INTRODUCTION: The National Comprehensive Cancer Network (NCCN) distress thermometer and problem list (DTPL) is a brief self-report screening measure for use in follow-up cancer care. The aims of this study were to explore the correlations between scores on the DTPL and scores on longer measures of anxiety/depression and health-related quality of life among women treated for gynecological cancer, and to define a cutoff score on the DT representing high levels of psychological distress in this patient group. MATERIAL AND METHODS: During outpatient visits, 144 women filled in the DTPL, the Hospital Anxiety and Depression Scale (HADS) and the RAND-36-Item Short Form Health Survey (RAND-36) between October 2019 and March 2020. We assessed the agreement between the DT-scores and the HADS scores, explored variables associated with high levels of distress on the DT, and studied the associations between DTPL-scores and scores of health-related quality of life (HRQoL) from RAND-36. RESULTS: In receiver operating characteristic curve analysis between the distress score from the DT and a HADS total score ≥15 (defining high levels of anxiety/depression symptoms), the area under the curve was 0.81 (95% CI: 0.74-0.89). Using a cutoff of ≥5 on the DT (scale 0-10), we found a balanced level of sensitivity (81%) and specificity (71%) towards a HADS total score of ≥15. The scores of distress and problems reported on the DTPL correlated significantly with the majority of HRQoL function scales from RAND-36. CONCLUSIONS: The NCCN DTPL can be used as a screening measure for self-reported distress and problems after treatment for gynecological cancer. A score of ≥5 on DT may indicate high level of anxiety/depression as measured by HADS. The tool may help identify patients in need of referral to supportive care and rehabilitation facilities.

Health-Related Quality of Life, Fatigue, Level of Physical Activity, and Physical Capacity Before and After an Outpatient Rehabilitation Program for Women Within Working Age Treated for Breast Cancer.

The aims were to examine changes in patient-reported outcome measures (PROMs), level of physical activity (LPA), and physical capacity from before to after an outpatient rehabilitation program (ORP) for women with breast cancer (BC). Further aims were to explore the proportions of patients with clinically relevant improvements defined as ≥ 10% beneficial change in the scores of PROMs and variables associated with such improvements.A total of 270 women within working age (< 67 years) who recently (< 1.5 years) had completed primary therapy for BC with curative intent were included. The ORP consisted of seven weekly group sessions with patient education, group conversations, and PA. The patients completed questionnaires measuring health-related quality of life (HRQoL), fatigue and LPA before (T0), immediately after (T1), and 6 months after (T2) the program, and were physically tested at T0 and T1. The mean age of the patients was 50.4 years (SD 7.3) and the mean time since diagnosis was 10.6 months (SD 2.6). All patients had undergone surgery and 94% radiotherapy, and 96% had received chemotherapy and/or hormonal therapy.Physical-, role-, emotional-, cognitive-, and social function, global health, and fatigue significantly improved from T0 to T1. Physical-, role-, and cognitive function, and fatigue significantly improved from T1 to T2. LPA and physical capacity significantly improved from T0 to T1. More than 40% of the patients had a clinically relevant improvement in role-, social function, and fatigue symptoms, from T0 to T1. Low level of education was associated with an improvement in emotional function, and living alone was associated with an improvement in mental fatigue.HRQoL, fatigue, LPA, and physical capacity improved in women within working age recently treated for BC who participated in an ORP.

Distress, problems and unmet rehabilitation needs after treatment for gynecological cancer.

INTRODUCTION: The prevalence of distress, problems and need for rehabilitation among women treated for gynecological cancer is largely unknown. The aims of this study were to examine the prevalence of distress, problems and unmet rehabilitation needs in the first years after treatment for gynecological cancer. MATERIAL AND METHODS: Women treated for gynecological cancer within the last 2 years were invited. Participants responded to the National Comprehensive Cancer Network Distress Thermometer and Problem List measuring distress and problems. They also answered a questionnaire regarding physical endurance, muscle strength, and need for rehabilitation services. RESULTS: Of 114 eligible women, 92 (81%) agreed to participate. Mean time since last treatment was 7.6 months (range 0-24.5 months). A total of 57% of the participants reported distress. The four most common problems reported were fatigue (58%), tingling in hands/feet (54%), worry (53%), and problems with memory/concentration (50%). Problems associated with distress were: dealing with partner, all emotional problems (i.e. depression, fears, nervousness, sadness, worry, and loss of interest in usual activities), appearance, memory/concentration, pain, sex, sleep, and problems with physical endurance and muscle strength. Fifty-two percent reported unmet needs for rehabilitation services. Women with distress reported more unmet rehabilitation needs than those in the non-distressed group. CONCLUSIONS: The prevalence of distress in this population of women treated for gynecological cancer was high. Having a high number of problems and having unmet needs for rehabilitation services were both associated with distress. Hence, measurement of distress seems to be helpful when assessing the need for rehabilitation services.

Gender differences in health status and benefits of a one-week educational programme for caregivers of cancer patients.

OBJECTIVE: The aims of this study were to investigate differences between female and male caregivers' health status before and 3 months after a one-week educational programme, self-reported needs for support and changes in health status over time. METHODS: Caregivers were partners of cancer patients aged ≥18 years who participated in the programme. Questionnaires were completed at baseline and 3 months after the programme. RESULTS: At baseline, 167 caregivers completed the questionnaire, 55% were females and the mean age 60.2 years (range 31-79). Female caregivers reported poorer vitality (p = 0.016) and more chronic fatigue compared to male caregivers (28% vs. 13%, p = 0.036). Females more frequently reported need for support: psychological counselling (21% vs. 3%, p = 0.001), group conversations (51% vs. 28%, p = 0.003), nutritional counselling (39% vs. 17%, p = 0.002) and recreational stay (46% vs. 24%, p = 0.004). Significant benefits within-group changes were observed among female caregivers in role physical, general health, vitality, social functioning, mental and total fatigue, whereas no significant within-group changes were observed for males. However, in adjusted analyses no significantly between-group gender differences in mean changes were observed. CONCLUSION: More studies are needed to better understand the differences and possible effects of programmes among female and male caregivers in order to develop relevant support.

Is psychological distress in men recently diagnosed with testicular cancer associated with their neuropsychological test performance?

OBJECTIVE: To study the level of cancer-related distress (CRD) and variables associated with CRD in recently diagnosed testicular cancer patients (TCPs), and to explore associations between distress levels and neuropsychological test performance at the same time-point. METHODS: As part of a prospective study of their psychological and cognitive functioning, 135 TCPs completed the Impact of Event Scale (IES) as a measure of CRD at a median of 37 days after diagnosis. They also completed the Hospital Anxiety and Depression Scale (HADS) and the Positive and Negative Affect Schedule (PANAS). Among 135 TCPs, 131 were interviewed and 129 were also tested with a neuropsychological battery. All investigations were done after orchidectomy but before any additional treatment. The associations between neuropsychological test-scores and IES, HADS and PANAS were examined. RESULTS: Twenty-four percent (95%CI 17%-31%) of the TCPs reported clinically significant CRD (IES-total score>26). No demographic or cancer-related variables were associated with the CRD-level. In univariate analyses, previous mental problems, sleeping problems, a higher level of neuroticism, daily smoking and hazardous alcohol-use were significantly associated with the CRD-level. In multivariate analysis neuroticism, smoking and alcohol-use remained significantly associated with CRD. Four out of 18 neuropsychological test-scores were significantly associated with at least one distress-measure. Increasing distress-levels were associated with decreasing test performance on some measures of attention, working memory and executive functions. CONCLUSIONS: In newly diagnosed TCPs, the scores on neuropsychological tests should be considered in relation to co-existing mental distress. Future studies should consider adjustment for this on relevant tests.

Fear of recurrence in long-term testicular cancer survivors.

OBJECTIVE: To explore fear of recurrence (FoR) in long-term testicular cancer survivors (TCSs) since FoR hardly has been examined in TCSs. METHODS: In a cross-sectional questionnaire study, 1336 TCSs at a mean of 11.4 years (SD 4.2) after diagnosis gave information about their medical and social situation, and completed measures on mental distress, fatigue, quality of life, coping, self-esteem and neuroticism. FoR during the last week was explored with one question, with the response categories rated on a 4-point Likert scale. Nine percent of the TCSs had a structured psychiatric interview. RESULTS: Twenty-four percent of the TCSs reported 'quite a bit' FoR and 7% reported 'very much' FoR during the last week. The FoR question showed moderate correlations (0.22-0.51) with established psychological measures. The level of FoR was significantly positively correlated with mental distress, fatigue and neuroticism and significantly negatively correlated with quality of life, self-esteem and coping. In univariate analyses, neurotoxic side effects and somatic symptoms, but not treatment modality, were significantly associated with level of FoR. In a multivariate analysis, a medium educational level, increasing levels of traumatic cancer-related stress symptoms and of neuroticism were significantly associated with rising FoR. Among those who had a psychiatric interview, the presence of at least one current mental disorder was significantly associated with FoR. CONCLUSIONS: High levels of FoR in long-term TCSs are not uncommon. Levels of mental and somatic problems are associated with the levels of FoR. Clinical consequences of these findings for TCSs are discussed.

A prospective study of cognitive complaints in patients with testicular cancer.

UNLABELLED: Self-reported memory and concentration problems (cognitive complaints) among testicular cancer patients treated with chemotherapy or radiotherapy during the 1990-ies were prospectively explored. The chemotherapy group had significantly higher prevalence of cognitive complaints compared to the radiotherapy group at 3-months follow-up, while at 12-months no significant group difference was found. Treatment modality (chemotherapy vs. radiotherapy) was not significantly associated with the presence of cognitive complaints at any time point after adjustment for relevant QoL variables. INTRODUCTION: Cognitive complaints are frequent among patients with cancer. Oncologists and patients have become concerned that systemic chemotherapy may have cognitive side effects. After this concern became public there was a risk of expectation bias in studies of cognitive complaints. We prospectively explored cognitive complaints in patients with testicular cancer treated with chemotherapy or radiotherapy during the 1990s, before today's increased awareness of this possible side effect. PATIENTS AND METHODS: The European Organisation for Research and Treatment of Cancer (EORTC) quality of life (QoL) questionnaire (QLQ-C30) and a testicular cancer module (TC module) were completed before treatment (baseline), at 3 months, and at 12 months by 276 chemotherapy and 71 radiotherapy patients enrolled in 3 EORTC studies. Cognitive complaints were based on the cognitive function (CF) items (concentration and memory) of the QLQ-C30. Other QLQ-C30 functions and symptoms represented adjustment variables. RESULTS: The chemotherapy group (CHEMO) showed a significant increase in prevalence of cognitive complaints from baseline to 3 months. At 12 months these rates were back at baseline levels. The radiotherapy group (RAD) showed no significant change in the prevalence of cognitive complaints over time. Significant differences between the 2 treatment groups were observed only at the 3-month follow-up. In multivariate analyses, treatment modality did not show significant association with cognitive complaints at any time point, whereas current fatigue showed significant associations at all time points. CONCLUSION: In patients with testicular cancer with no information or expectation bias, an increased rate of cognitive complaints was observed shortly after chemotherapy, with return to baseline levels at 12 months. Treatment modality (chemotherapy vs. radiotherapy) was not associated with cognitive complaints at any time point after adjustment for relevant QoL variables.

Self-reported cognitive problems in testicular cancer patients: relation to neuropsychological performance, fatigue, and psychological distress.

OBJECTIVE: There is a concern about negative cognitive effects of systemic chemotherapy. We prospectively explored self-reported cognitive problems in testicular cancer patients (TCPs) treated with and without chemotherapy. METHODS: One hundred and twenty-two TCPs were interviewed about concentration and memory problems shortly after orchidectomy but before any additional treatment (baseline), and then at a median of 1 year after end of treatment (follow-up). Symptoms of psychological distress, fatigue, and peripheral neurotoxicity were assessed by questionnaires, and patients also underwent neuropsychological testing. Self-reported cognitive problems were compared between three treatments groups: no chemotherapy, one cycle of chemotherapy, and multiple cycles of chemotherapy. Variables associated with an increase of self-reported cognitive problems from baseline to follow-up were explored. RESULTS: Significantly larger proportions of TCPs in the two chemotherapy groups had an increase of self-reported cognitive problems from baseline to follow-up compared to the no-chemotherapy group. Increase of self-reported cognitive problems was significantly associated with psychological distress, fatigue, lower level of education, and Raynaud-like symptoms, but not with a decline in neuropsychological test performance. CONCLUSION: In this explorative study of TCPs, an increase of self-reported cognitive problems from baseline to 1-year follow-up was associated with chemotherapy and with symptoms of fatigue and psychological distress at follow-up, while no significant association was found with a decline in neuropsychological test performance.

Venlafaxine and asthma.

A 54-year-old man of Asian origin with major depression developed an asthma-like reaction during venlafaxine treatment. Two weeks after therapy was initiated, he experienced gradually worsening dry cough at night and periodically dyspnea during the daytime. After 5 weeks, clinical examination revealed marked signs of pulmonary obstruction and the forced expiratory volume (FEV1) was assessed to only 32% of the expected value. The venlafaxine medication was gradually decreased and eventually discontinued 9 weeks after its initiation, resulting in a successive improvement of the patient's respiratory complaints.