Cancer worry at higher-risk sample of hereditary cancer in Spain.

BACKGROUND: Few studies have examined the prevalence of cancer worry in the general and at-risk population. The objective of this study was to describe the prevalence of cancer worry in a sample of individuals at increased risk of developing hereditary cancer, determine differences in cancer worry by socio-demographic characteristics and assess the relationship between cancer worry and psychological distress. METHODS: A cross-sectional study was designed with 895 patients. The Cancer Worry Scale (CWS), Hospital Anxiety and Depression Scale (HADS) for psychological distress and sociodemographic characteristics were examined. The multiple linear regression model was developed to explore what variables were predicted for cancer worry. To identify variables associated with higher cancer worry scores, a logistic model was fitted. RESULTS: In the at-higher-risk sample of hereditary cancer, the mean of CWS was 10.20 (SD: 3.70). The significant predictors for cancer worry were gender, age, previous psychiatric treatment, patients affected by cancer and having children. In the sample, 38% of patients had higher scores on cancer worry, the variables associated were patients affected by cancer compared, women, widow/divorced participants, less than secondary school, patients with previous psychiatric treatment and patients less than 55 years old. Using the HADS cutoff score 29% of the sample showed significant psychological distress, more anxiety (35%) than depressive (22%) symptomatology. Psychological distress showed a higher variability (36%) on cancer worry. CONCLUSION: Findings highlighted distinctive profiles in socio-demographic characteristics according to the degree of cancer worry; therefore, genetic counseling should continue to be provided to address cancer worry and relieve psychological distress.

Comparison of the accuracy of the 7-item HADS Depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis.

The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of ≥7 for the HADS-D (sensitivity 0.79 [0.75, 0.83], specificity 0.78 [0.75, 0.80]) and ≥15 for the HADS-T (sensitivity 0.79 [0.76, 0.82], specificity 0.81 [0.78, 0.83]) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from -0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparison of psychological distress for breast, ovarian and colorectal cancer predisposition in a Spanish sample at high risk of hereditary cancer.

OBJECTIVES: Although future treatments may speciically target the tumour phenotype, other factors should be included to confirm the efficacy of treatment and prevention strategies. The objective of this study was to compare sociodemographic characteristics and psychological distress for breast, ovarian and colorectal cancer predisposition syndrome in a sample at high risk of hereditary cancer. METHODS: A cross-sectional study was designed with 799 patients. The nonparametric test, with Kruskal-Wallis test, was used to compare three genetic cancer syndromes, with significant differences in sample size. RESULTS: There were no differences in cancer hereditary syndromes related to sociodemographic characteristics except sex, as breast/ovarian cancer mainly affects women. No group differences were observed for cancer worry (P = 0.17). Breast/ovarian cancer syndrome showed significantly higher scores in cognitive distress compared to colorectal cancer (P = 0.01). CONCLUSION: The differences in the distribution of sociodemographic characteristics in these hereditary cancer syndromes can help to better plan resources for patient care in genetic counselling units.

Psychiatric symptoms in a Spanish sample with hereditary cancer risk.

OBJECTIVE: An integral part of the genetic counselling process is the assessment of psychiatric morbidity. The objectives of this study were first to assess psychometric properties of the General Health Questionnaire (GHQ-28items) in a Spanish sample at increased risk of hereditary cancer, and second evaluated the prevalence of psychiatric morbidity and the contribution of socio-demographic and clinical characteristics to predict distress. METHODS: A cross-sectional study was designed with 766 patients. Psychometric analysis with exploratory factor analysis was performed. The influences of socio-demographic characteristics were investigated by multiple linear regression analyses. RESULTS: Factor analysis supported the four-factor solution of the original GHQ-28; Depression and Social dysfunction scales were more stable than Anxiety and Somatic symptom scales. Psychiatric morbidity was detected in 212 (27.9%) patients. The variables predicting psychiatric morbidity were gender, age, patient affected by cancer, previous psychiatric treatment, and patients with relatives affected by cancer. The higher prevalence of psychiatric symptoms was in the age group from 41 to 59 years (16.73%), women (24.37%), patients affected by cancer (19.89%), patients without previous psychiatric treatment (20.82%), and patients with relatives affected by cancer (21.74%). CONCLUSION: Screening psychological distress should consider socio-demographic and clinical characteristics with reference to improve the quality of care. TRIAL REGISTRATION: Clinical trials identifier: NCT04428710.

Perfil de personalidad en pacientes con trasplante renal: el modelo alternativo de los cinco factores / Personality profile of kidney transplant patients: the alternative five factor model

Resumen Introducción: la investigación sobre rasgos de personalidad en pacientes con trasplante renal es limitada. El objetivo de este estudio fue describir el perfil de personalidad de pacientes con trasplante renal, utilizando el modelo alternativo de cinco factores (AFFM), y compararlo con población estándar española. Material y métodos: la personalidad fue evaluada mediante el Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Una muestra de 207 pacientes con trasplante renal se emparejó por edad y género con 207controles de la población estándar. El análisis de regresión logística permitió estudiar la aportación de cada dimensión del ZKPQ al perfil distintivo de los pacientes trasplantados. Resultados: aparecieron diferencias significativas en las dimensiones de Neuroticismo-Ansiedad (p=.001), Agresión-Hostilidad (p=.009) y Actividad (p=.001), con puntuaciones bajas en pacientes trasplantados en comparación con la población estándar. La sociabilidad (p=.024) fue significativamente mayor en pacientes trasplantados. En el análisis de regresión, las bajas puntuaciones en Neuroticismo-Ansiedad (p=.005) y Actividad (p=.001) fueron predictores significativos para caracterizar los rasgos de personalidad de pacientes trasplantados. Conclusiones: desde el AFFM, los pacientes con trasplante renal muestran un perfil diferente de personalidad comparado con la población estándar, con bajas puntuaciones en las dimensiones de Neuroticismo-Ansiedad y Actividad.

Abstract Background: There is limited research on personality traits that characterized kidney transplant patients. The aim of this study was to describe personality profile of kidney transplant patients using the Alternative Five Factor Model (AFFM), and compared it with the Spanish standard population. Method: Personality was assessed using the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). A sample of 207 kidney transplant patients was matched by age and gender with 207 standard range controls. A logistic regression analyses was utilized to study the contribution of each ZKPQ dimension to describe the distinctive transplant patient's profile. Results: Significant differences were showed in Neuroticism-Anxiety (p=.001), Aggression-Hostility (p=.009), and Activity (p=.001) dimensions, with lower scores on transplant patients compared with standard population. But Sociability (p=.024) was significantly higher on kidney transplant patients. In logistic regression analysis low scores on Neuroticism-Anxiety (p=.005) and Activity (p=.001) were the significant predictors to characterize personality traits of kidney transplant patients. Conclusions: Kidney transplant patients had a differential profile under the AFFM compared to standard range sample, with lower scores on Neuroticism-Anxiety and Activity dimensions.

Caregiver burden in end-of-life care: advanced cancer and final stage of dementia.

OBJECTIVE: Considering two advanced illnesses, cancer and end-stage dementia, the aim of this study was to describe the symptoms of caregiver psychological distress and burden. METHOD: In this cross-sectional study, regression analyses were calculated to explain the influence of psychological distress in caregiver burden. A t test was employed to compare differences between the symptoms of caregiver burden. RESULTS: The percentage of psychological distress was similar between caregivers of cancer patients (77.6%) and caregivers of dementia patients (72.4%). In the regression analysis, cancer caregiver distress accounted for 27.9% of the variance in symptoms of burden, while dementia caregiver distress accounted for 24.4% of the variance in symptoms of burden. No significant differences were revealed when comparing caregiver burden symptoms between caregivers of the two advanced illnesses (t = 0.06; p = 0.94). SIGNIFICANCE OF RESULTS: In end-of-life care for patients with dementia, due to significant levels of caregiver distress and burden symptoms, there is a need to support caregivers in the same way as is done for caregivers of cancer patients.

The influence of coping response and health-related quality of life on perceived social support during cancer treatment.

OBJECTIVE: In the biopsychosocial approach, perceived social support has served as a protective factor for psychological adjustment to cancer. This study aimed to determine the influence of different coping responses and health-related quality of life (HRQoL) domains on perceived social support during cancer treatment. METHOD: A cross-sectional analysis was carried out in a sample of 757 cancer outpatients. The Medical Outcomes Study Social Support Survey (MOS-SSS) was employed to assess perceived social support. The Mental Adjustment to Cancer (MAC) Scale measured coping response, and HRQoL was tested with the Medical Outcomes Study Short Form-36 (SF-36). Multivariate analyses were carried out to examine the extent to which coping and HRQoL were associated with perceived social support. RESULTS: Coping response explained only 2% of the variance in perceived social support, but Hopelessness had a significant influence on perceived social support (p ≤ 0.01). HRQoL, physical, and mental domains made a significant contribution toward perceived social support, accounting for around 10% of total variance. More than coping response, HRQoL's physical and mental domains had an important influence on perceived social support during cancer treatment. SIGNIFICANCE OF RESULTS: The findings of the current study report the importance of HRQoL domains in predicting perceived social support during cancer treatment, emphasizing the holistic and multidisciplinary approach to facilitate adjustment to cancer.

Perceived social support in Spanish cancer outpatients with psychiatric disorder.

This study examines differences in perceived social support during oncology treatment of cancer patients, whilst taking into account the presence of psychiatric disorder. Of particular interest were cancer patients who received psychopharmacology treatment compared with those who did not. A total of 760 cancer outpatients were recruited from one hospital in Spain. Multivariate analysis of variance with the general linear model procedure was used. The Medical Outcomes Study Social Support Survey was used to assess social support perceived. The Diagnostic Interview Schedule using DSM-III-R criteria was utilized for the diagnosis of psychiatric disorders. There were significant differences between the patients diagnosed with a psychiatric disorder and those not diagnosed with psychiatric disorders in terms of perceived Emotional/Informational Support (F = 19.11, p < 0.01), Affectionate Support (F = 12.30, p < 0.01) and the Overall Support Index (F = 16.73, p < 0.01). In patients requiring psychopharmacology treatment, significant differences were presented with Structural Support (F = 4.32, p < 0.05), Emotional/Informational Support perceived (F = 7.87, p < 0.01), Instrumental Support (F = 4.17, p < 0.05) and Overall Support Index (F = 7.84, p < 0.01). Psychopharmacology treatment helped to increase the perception of social support received by the patient. Healthcare professionals could provide support that would normalize cancer patients' distress, taking into account the importance of perceived social support for the psychological well-being of patients.

Longitudinal assessment of distress and quality of life in the early stages of breast cancer treatment.

BACKGROUND: During breast cancer treatment, a decline in quality of life and the patient's psychological well-being is observed. The purpose of this study was to assess levels of quality of life and psychological distress during breast cancer treatment. METHODS: Utilizing a longitudinal design, patients with breast cancer were assessed at three time-points during treatment. The within-subject analysis of variance was conducted to compare subscales of quality of life. Linear regression analyses were utilized to determine the contribution of psychological distress to the quality of life at each time assessment. RESULTS: Significant differences between the assessment times on the physical subscale (p < 0.001), socio-family (p < 0.01) and emotional well-being (p < 0.001) were showed. Specific domain-related breast cancer and psychological distress (p < 0.05) were significant during the assessment period. No difference was found on the total quality of life score within the three points of reference for treatment. The regression analysis revealed that after treatment, psychological distress showed a higher percentage of variance of the quality of life (62.6%) compared to other treatment time-points. CONCLUSIONS: Significant changes to the quality of life and psychological distress subscales are seen during breast cancer treatment. The degree to which psychological distress affected quality of life varied over the illness continuum. Health professionals should pay attention to the variability of the emotional support and care needs of patients with cancer at different times of treatment.

Caregivers' morbidity in palliative care unit: predicting by gender, age, burden and self-esteem.

PURPOSE: This study assesses psychological distress suffered by caregivers of patients with a disease at an advanced and terminal state admitted at a palliative care unit. Specifically, these areas were examined in how distress was perceived: the contribution of caregiving burden, caregivers' self-esteem, caregivers' age and gender. METHODS: The sample constituted of 159 caregivers. Measurements included the Hospital Anxiety and Depression Scale (HADS) to assess distress, the shortened version of the Zarit Burden Inventory and Rosenberg self-esteem scale. RESULTS: Approximately 77% of the caregivers reported probable significant distress (HADS ≥ 12), with a similar proportion with anxiety (76.1%) and depression (77.4%) within the caregivers' symptomatology. Multiple regression analysis revealed that the caregivers' self-esteem (p < 0.01) and caregivers' burden (p < 0.01) were stronger predictors of caregivers' distress than the socio-demographic characteristics, age or gender (p < 0.05). CONCLUSIONS: A high prevalence of morbidity was noticed in caregivers of patients admitted at the palliative care unit. The early provision of psychological support to caregivers by healthcare staff may indeed help to decrease comorbidity symptoms.

Cognitive processing variables in breast cancer: worry and distress at the end of treatment.

This study assessed the influence of cognitive processing variables on cancer worries and distress after breast cancer treatment. In multivariate analyses, while independent variables were intolerance of uncertainty and intrusive thoughts, constructs' variables were anxiety and depression symptoms and cancer-related worries. The intolerance to uncertainty had a tendency to influence on distress and concerns about cancer after the end of treatment (Wilks' λ = 0.687, p = 0.074). Whereas, thought intrusion had a significant influence on distress and cancer related worries (Wilks' λ = 0.228, p = 0.000). Cognitive variables could be addressed by the oncology nurse when considering the patients' concerns related to cancer and psychological distress.

Posttraumatic stress disorder symptoms in cancer: psychometric analysis of the Spanish Posttraumatic Stress Disorder Checklist-Civilian version.

OBJECTIVE: The PTSD Checklist-Civilian version (PCL-C) was used as a screening tool to assess the presence of PTSD symptoms. The aim of this study was to explore the factorial structure of the Spanish version of the PCL-C and calculate the correlation of PTSD symptoms with distress and health-related quality of life. METHOD: The sample included 494 cancer outpatients. In order to validate the PCL-C, a principal component analysis was applied. The association between variable was measured by Pearson correlation. RESULTS: Findings evidenced three symptoms clusters on the PCL-C version, defined as Hyperarousal/Re-experiencing, Numbing and Avoidance. About 10% of the total sample met clinical PTSD symptoms. In addition, PTSD symptoms were related negatively to health-related quality of life and positively related with distress. CONCLUSION: The conceptualization of PTSD symptoms for cancer patients is supported by the specific symptom clusters identified on PCL-C.

Quality of life in the chemotherapy treatment of Spanish cancer patients: a comparison of general population norms.

OBJECTIVE: The SF-36 Health Survey (SF-36) is a general instrument used to assess health-related quality of life (HRQL). The purpose of this study is to describe self-reported information on health and the quality of life among cancer outpatients during chemotherapy treatment and to compare it with the baseline sample drawn from the general Spanish population. METHODS: A randomised sample of 583 cancer outpatients completed the questionnaire. Using a cross-sectional analysis of the SF-36 data, standardised scores were used to compare patients with comparative Spanish baseline data. Other health-related concerns (gender, age, site of cancer) were also analysed. RESULTS: The patients showed acceptable levels on HRQL and no significant differences were found between the oncology patients compared with the general population for any of the SF-36 domains. The older patients had scores significantly lower in physical functioning (p<0.01) and physical role (p<0.05). The results identified lower HRQL ratings among women compared with men on all the scales except general health. In relation to the location of the cancer, patients with genitourinary tumours scored statistically lower (p<0.05) on bodily pain in the SF-36 domain compared with patients with gastrointestinal tumours. CONCLUSIONS: Although more studies are needed, the SF-36 allows us to describe the HRQL of cancer outpatients during chemotherapy treatment compared with the general population.

The Mental Adjustment to Cancer scale: a psychometric analysis in Spanish cancer patients.

OBJECTIVE: The Mental Adjustment to Cancer (MAC) scale was used to assess the cognitive responses to a cancer diagnosis. The aim of this study was to replicate the factorial structure of the Spanish version of the scale and ascertain the correlations between dimensions of the MAC and socio-demographic characteristics or medical variables. MATERIAL AND METHODS: The sample included 693 cancer outpatients. In order to validate the MAC questionnaire was applied a principal component analysis. The dimensions of the questionnaire were compared and correlated with socio-demographic characteristics (age and gender), medical variables (cancer site, time since diagnosis) and distress. RESULTS: After the MAC factorial analysis, 28 items were included in five factors: Hopeless, Anxiety, Resignation/Fatalism, Illness Acceptance and Self-Safety Behaviour. In relation to the variables, the women cope with cancer with more Illness Acceptance and Resignation subscales than men. More mature ages were related with Hopeless, Resignation and Self-Safety Behaviour, also correlated negatively with Anxiety. The cancer site showed significant differences on the Hopeless and a tendency on Resignation subscale. Time since diagnosis did not correlate significantly with any subscales in the Spanish version of the MAC. Distress was reflected in the Anxiety and Hopeless subscales, and moreover it was related negatively with Self-Safety Behaviour. CONCLUSIONS: The MAC scale was a valid and acceptable tool for Spanish cancer patients, however, these findings provide a factorial structure different from the original MAC scale.

[Validity of the questionnaire MOS-SSS of social support in neoplastic patients]. / Validación del cuestionario MOS-SSS de apoyo social en pacientes con cáncer.

BACKGROUND AND OBJECTIVE: Previous studies have pointed out how the perception of social support benefits the wellbeing of patients. The main objective in this study is to adapt and validate the MOS-SSS (Medical Outcomes Study-Social Support Survey) questionnaire to measure social support. PATIENTS AND METHOD: In a sample of 400 oncology out-patients, in order to validate the MOS-SSS questionnaire, we have applied a exploratory factorial analysis. The factors were extracted by principal components and varimax rotation. Then, we compared the dimensions of the questionnaire with other variables as size of social network, sex and age. RESULTS: We have observed a high reliability of the MOS-SSS questionnaire, with the alpha coefficient around 0.94 . By a factorial analysis, we have extracted 3 factors: emotional/informational support, affective support and instrumental support. The fourth dimension included in the original questionnaire, positive social interaction, was included in the emotional/informational support dimension. Comparing the mean scores of the 3 dimensions with other variables (number of members in the family and friends, sex and age), we have observed that a high number of relatives and friends were related with a higher perception of social support. However, the men received more instrumental and emotional/informational support than women; and the age was not related with the perception of social support in patients with cancer. CONCLUSIONS: The MOS-SSS questionnaire is a valid instrument to assess the multidimensionality of the perception of social support in Spanish cancer patients.