Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab.

BACKGROUND: Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown. METHODS: Fifty BC patients underwent TTE assessment before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of < 0.05 was considered significant. RESULTS: TTE revealed reduced left atrial conduit strain in the cardiotoxicity group. Mean heart rate increased during all maneuvers at follow-up, with no differences in HRV indexes between patients with or without cardiotoxicity. However, a lower Δ in supine-controlled breathing of several HRV indexes predicted early cardiotoxicity identified by echocardiography (e.g. SDNN ≤ -8.44 ms: Sensitivity = 75%, Specificity = 69%). CONCLUSIONS: BC patients treated with chemotherapy maintain cardiac autonomic responses to physiological stimuli after 3 months of chemotherapy. However, a lower Δ during active standing and controlled breathing before chemotherapy may predict early cardiotoxicity.

Detection of psychosocial distress in cancer patients: A survey of Mexican oncologists.

Purpose: Identification of patients' distress is relevant for an on-time referral to psychosocial treatment. The objective was to assess the implementation of the guidelines for distress managing in Mexican oncologists based on the NCCN guidelines.Design: The study was non-experimental and cross-sectional.Sample: Two hundred thirty-one oncologists participated with an average age of 38 ± 11 years.Methods: The likelihood of distress assessment was quantitatively evaluated.Findings: A high percentage of oncologists knew and used procedures to assess psychosocial discomfort. However, a smaller percentage used a valid and reliable instrument. Factors associated with performing distress identification procedures were knowing the distress guidelines and lack of time. Factors for questionnaire usage are the availability of brief instruments and the percentage of patients suffering from stress.Implications for Psychosocial Providers: Psychosocial providers should develop strategies to educate and ensure that oncologists are familiar with guidelines on distress in oncology. More dissemination of screening procedures and referral to psychosocial programs in oncology is required. Integrating a distress screening program involving psychosocial providers and oncologists should be approached as a routine in high-quality cancer care, to reduce the stigma associated with mental health services.

Validation of the Patient Dignity Inventory in Mexican Cancer Patients.

Introduction: The Patient Dignity Inventory (PDI) is a reliable screening instrument for a variety of problems (physical, existential, and social) that affect the dignity of patients during their end of life. The PDI has been translated into several different languages and has been validated in different settings. As such, it is important to validate the instrument in patients with cancer in Mexico to assess dignity in this population. The aim of this study was to translate and validate the Spanish version of the PDI in Mexican patients with cancer. Methods: This is a cross-sectional study that included patients with cancer, both those enrolled and not enrolled in palliative care, at the Instituto Nacional de Cancerología in Mexico City from September 2018 to August 2019. A translation and back translation were performed to obtain the Mexican version of the PDI (PDI-Mx) instrument. Patients completed the PDI-Mx, the Hospital Anxiety and Depression Scale (HADS), and functional scales (Eastern Cooperative Oncology Group [ECOG] and Karnofsky). Psychometric properties were evaluated by determining internal consistency, exploratory and confirmatory factor analysis (CFA), and concurrent validity with the HADS. Results: We included 290 participants with cancer (145 in palliative care and 145 not enrolled in palliative care). The Cronbach's alpha of the PDI-Mx was 0.95. There was a significant correlation with the HADS (rs = 0.757, p < 0.0001). The factor analysis showed four factors that explain 64.7% of the model. The CFA presented adequate indicators, which show the adjustment of the structure that indicates a balanced and parsimonious model. Conclusions: The Mexican version of the PDI shows adequate psychometric properties in patients with cancer. We suggest the use of PDI-Mx in clinical care and research. The study was approved by the Institutional Review Board and Ethics Committee with numbers (016/063/CPI) and (CEI/1115/16) respectively.

Validation of an instrument to assess health care quality (FACIT-TS-PS) in cancer patients.

INTRODUCTION: Cancer patient satisfaction with the healthcare team is of great relevance for assessing the quality of the care provided by the health system. In Mexico, no valid and reliable tool is available to assess this construct. OBJECTIVE: To validate the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction (FACIT-TS-PS) instrument, version 4, in cancer patients. METHOD: Cross-sectional design, non-probability convenience sampling. The sample consisted of 200 cancer-diagnosed patients, with mean age of 45.86 ± 15.01 years. Exploratory and confirmatory factor analyses were conducted. RESULTS: The exploratory factor analysis identified four factors, with a Cronbach alpha of 0.945, and an explained variance of 68.15 %. The confirmatory factor analysis indicated that the proposed theoretical model adjusts to the data with an error close to zero and, in addition, it is balanced and carefully measures overall patient satisfaction with the treatment. CONCLUSION: FACIT-TS-PS was shown to be a valid and reliable instrument for use in clinical care and research in Mexican cancer patients. Its use is recommended in the evaluation of oncology multidisciplinary healthcare teams in Mexico.

INTRODUCCIÓN: La satisfacción del paciente oncológico con el equipo de salud es de relevancia para evaluar la calidad de la atención del sistema de salud. En México no se dispone de una herramienta válida y confiable para evaluar este constructo. OBJETIVO: Validar el Instrumento de Evaluación de Funcionalidad en el Tratamiento para Enfermedades Crónicas-Satisfacción con el Tratamiento-Satisfacción del Paciente (FACIT-TS-PS) versión 4, en pacientes mexicanos con cáncer. MÉTODO: Diseño transversal, muestreo no probabilístico, por disponibilidad. La muestra consistió en 200 pacientes diagnosticados con cáncer, con edad promedio de 45.86 ± 15.01 años. Se realizó un análisis factorial exploratorio y confirmatorio. RESULTADOS: Se identificaron cuatro factores con un alfa de Cronbach de 0.945 y una varianza explicada de 68.15 %. El análisis factorial confirmatorio indicó que el modelo teórico propuesto se ajusta a los datos con error próximo a cero y que, además, es equilibrado y mide cuidadosamente la satisfacción global del paciente con el tratamiento. CONCLUSIÓN: FACIT-TS-PS mostró ser un instrumento válido y confiable para su uso en la atención clínica e investigación dirigida a pacientes mexicanos con cáncer. Se recomienda su utilización en la evaluación de equipos de salud multidisciplinarios en oncología en México.

Propiedades psicométricas de la Escala de Evaluación Funcional para el Tratamiento del Cáncer, versión próstata (FACT-P), en pacientes mexicanos.

BACKGROUND: Prostate cancer is the most frequent neoplasm in Mexican men, the research literature contains few studies that address prostate cancer patients and quality of life in Mexico. OBJECTIVE: To validate the Functional Assessment Cancer therapy (FACT-P) scale. METHOD: 201 males 49 to 90 years of age, at any clinical stage of prostate cancer, under treatment or follow-up participated. It's a non-experimental cross-sectional study. Patients were evaluated through the FACT-P jointly with the European Organization for Research and Treatment of Cancer Quality of Life and Hospital Anxiety and Depression Scale. Exploratory analysis examined the factorial structure, and confirmatory analysis to evaluate the adjustment of the exploratory model to the data. RESULTS: A four-factor model that explained 64.65% of the variance, Cronbach's alpha 0.79, and correlations were statistically significant, Pearson's r of 0.146-0.716, p < 0.01 and p < 0.05. Analyses also distinguished metastatic patients from non-metastatic ones. The main indices of the confirmatory model were satisfactory for the adjustment of data and showed an estimate error close to zero. CONCLUSIONS: This Mexican version of FACT-P showed reliability and validity comparable to the original one.

ANTECEDENTES: El cáncer de próstata es la neoplasia más frecuente en los varones mexicanos, pero pocos estudios han abordado la calidad de vida en los pacientes con cáncer de próstata en México. OBJETIVO: Validar la Escala de Evaluación Funcional para el Tratamiento del Cáncer, versión próstata (FACT-P). MÉTODO: 201 pacientes de 49 a 90 años en cualquier etapa clínica, en tratamiento o seguimiento. Diseño de estudio: transversal no experimental. Se usaron el FACT-P, el Inventario de la Organización Europea para la Investigación y Tratamiento del cáncer y Calidad de Vida, y la Escala de Ansiedad y Depresión Hospitalaria. Se realizaron análisis factorial exploratorio y análisis factorial confirmatorio para evaluar el ajuste del modelo de los datos, mediante el método de máxima verosimilitud. RESULTADOS: Se obtuvo un modelo de dos factores y dos indicadores que explicaron el 64.65% de la varianza, alfa de Cronbach 0.79, correlaciones estadísticamente significativas, r de Pearson de 0.146-0.716, p < 0.01 y p < 0.05. La escala discrimina los pacientes sin y con metástasis. Los principales índices del modelo confirmatorio sugieren un modelo estable y parsimonioso, con error próximo a cero, que se ajusta aceptablemente a los datos analizados. CONCLUSIONES: La versión mexicana del FACT-P posee una confiabilidad y una validez adecuadas, similares a las de la original.

Validación de FACIT-TS-PS en una muestra de pacientes mexicanos con cáncer / Validation of an instrument to assess health care quality (FACIT-TS-PS) in cancer patients

Resumen Introducción: La satisfacción del paciente oncológico con el equipo de salud es de relevancia para evaluar la calidad de la atención del sistema de salud. En México no se dispone de una herramienta válida y confiable para evaluar este constructo. Objetivo: Validar el Instrumento de Evaluación de Funcionalidad en el Tratamiento para Enfermedades Crónicas-Satisfacción con el Tratamiento-Satisfacción del Paciente (FACIT-TS-PS) versión 4, en pacientes mexicanos con cáncer. Método: Diseño transversal, muestreo no probabilístico, por disponibilidad. La muestra consistió en 200 pacientes diagnosticados con cáncer, con edad promedio de 45.86 ± 15.01 años. Se realizó un análisis factorial exploratorio y confirmatorio. Resultados: Se identificaron cuatro factores con un alfa de Cronbach de 0.945 y una varianza explicada de 68.15 %. El análisis factorial confirmatorio indicó que el modelo teórico propuesto se ajusta a los datos con error próximo a cero y que, además, es equilibrado y mide cuidadosamente la satisfacción global del paciente con el tratamiento. Conclusión: FACIT-TS-PS mostró ser un instrumento válido y confiable para su uso en la atención clínica e investigación dirigida a pacientes mexicanos con cáncer. Se recomienda su utilización en la evaluación de equipos de salud multidisciplinarios en oncología en México.

Abstract Introduction: Cancer patient satisfaction with the healthcare team is of great relevance for assessing the quality of the care provided by the health system. In Mexico, no valid and reliable tool is available to assess this construct. Objective: To validate the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction (FACIT-TS-PS) instrument, version 4, in cancer patients. Method: Cross-sectional design, non-probability convenience sampling. The sample consisted of 200 cancer-diagnosed patients, with mean age of 45.86 ± 15.01 years. Exploratory and confirmatory factor analyses were conducted. Results: The exploratory factor analysis identified four factors, with a Cronbach alpha of 0.945, and an explained variance of 68.15 %. The confirmatory factor analysis indicated that the proposed theoretical model adjusts to the data with an error close to zero and, in addition, it is balanced and carefully measures overall patient satisfaction with the treatment. Conclusion: FACIT-TS-PS was shown to be a valid and reliable instrument for use in clinical care and research in Mexican cancer patients. Its use is recommended in the evaluation of oncology multidisciplinary healthcare teams in Mexico.

Psychometric properties of the resilience scale in Mexican patients with chronic hemodialysis / Propiedades psicométricas de la escala de medición de resiliencia en pacientes mexicanos con hemodiálisis crónica

Abstract Introduction Resilience consists of a series personalized skills to cope with adverse situations and overcome them, and even emerge strengthened. Resilience in patients with chronic renal insufficiency (CRI) treated with hemodialysis (HD) has been evaluated with general questionnaires that are not specific for this population. Objective To evaluate the psychometric properties of a resilience questionnaire in patients treated with chronic HD. Method The study included 280 patients with CRI (aged 18 to 85, 44% women) treated with HD for at least two months in six hemodialysis units in Mexico, who completed Beck's depression and anxiety inventories, an inventory of cognitive distortions, and the Mexican Resilience Measurement Scale (RESI-M). Results Owing to the duplication of more than one factor, two of the 43 items were eliminated in the exploratory factor analysis. We confirmed five factors that explained 63.4% of the total variance, with a Cronbach's alpha of .96 (the alpha ranges in the five factors from .85 to .95). The confirmatory analysis showed a theoretical structural model that fits the empirical data in an acceptable, balanced, and parsimonious way. The five factors correlate positively with each other and negatively with anxiety and depression symptoms and distorted thoughts. Discussion and conclusion The RESI-M scale is valid and reliable for assessing resilience in patients treated with chronic HD. Resilience factors evaluated with RESI-M are a potential therapeutic target to reduce depression and anxiety symptoms in these patients.

Resumen Introducción La resiliencia consiste en una serie de habilidades personalizadas que sirven para afrontar situaciones adversas y superarlas, e incluso salir fortalecido. La resiliencia en pacientes con insuficiencia renal crónica (IRC) tratados con hemodiálisis (HD) se ha evaluado con cuestionarios generales, no específicos para esta población. Objetivo Evaluar las propiedades psicométricas de un cuestionario de resiliencia en pacientes tratados con HD crónica. Método Se incluyeron 280 pacientes con IRC (edad 18 a 85 años, 44% mujeres) tratados con HD al menos dos meses en seis unidades de hemodiálisis en México, que respondieron los inventarios de depresión y ansiedad de Beck, un inventario de distorsiones cognitivas y la escala de medición de resiliencia con mexicanos (RESI-M). Resultados Por duplicidad en más de un factor, se eliminaron dos de 43 reactivos en el análisis factorial exploratorio. Se confirmaron cinco factores que explicaron 63.4% de la varianza total, con alfa de Cronbach de .96 (el alfa en los cinco factores va de .85 a .95). El análisis confirmatorio mostró un modelo estructural teórico que se ajusta aceptable, equilibrada y parsimoniosamente a los datos empíricos. Los cinco factores se correlacionan positivamente entre ellos y negativamente con los síntomas de ansiedad, depresión y los pensamientos distorsionados. Discusión y conclusión La escala RESI-M es válida y confiable para evaluar resiliencia en pacientes tratados con HD crónica. Los factores de resiliencia evaluados con la RESI-M son un blanco terapéutico potencial para disminuir los síntomas depresivos y ansiosos en estos pacientes.

Desarrollo y validación de un instrumento para la evaluación de distorsiones cognitivas en pacientes con insuficiencia renal crónica terminal / Development and validation of a questionnaire for the assessment of cognitive distortions among Mexican patients with end-stage renal disease

Background Psychological disturbances are common in patients with chronic renal failure (CRF). From the cognitive-behavioral theoretical perspective, they may be due largely to specific cognitive distortions (CD) that are likely to be modified by brief interventions. The aim of this study was to develop and validate an instrument for evaluation of specific CD among patients with CRF. Method A questionnaire with an encouraging phrase for each of five categories of CD (catastrophizing, dichotomous thinking, outside self-worth, negative self-labeling, and perfectionism) was developed. This was applied to 21 patients with CRF (11 women and 10 men). Based on the technique of natural semantic networks, a set of responses (defining words) with greater semantic weight to each sentence stimulus (core network) were identified and a pilot instrument was developed. This one was applied along with Beck's inventories of anxiety and depression among 255 patients with CRF (118 women, 137 men) attended in four different hospitals. Results The pilot questionnaire was composed of 46 items with greater semantic weight between 343 original defining words. Sixteen items were discarded for lack of ability to discriminate (1), low internal reliability (8) and duplicated in more than one factor (7). The final instrument of 30 items had an internal consistency of 0.93 for the total scale and more than 0.75 in all subscales. The five factors correlated positively and significantly with each other and with symptoms of anxiety and depression. Conclusions The instrument that is presented is a valid and reliable measure to assess five CD associated with depression and anxiety in Mexican patients with CRF. It is suggested as a useful tool for the design and evaluation of cognitive behavioral interventions for depression and anxiety among patients with CRF.

Antecedentes Las alteraciones psicológicas son frecuentes en los pacientes con insuficiencia renal crónica terminal (IRC). Desde la perspectiva teórica cognitivo-conductual, éstas pueden deberse en gran medida a distorsiones cognitivas específicas (DC), que son susceptibles de ser modificadas mediante intervenciones breves. El objetivo del presente estudio fue desarrollar y validar un instrumento de evaluación de las DC de pacientes con IRC. Método Se integró un cuestionario con una frase estímulo para cada una de cinco categorías de DC: catastrofismo, pensamiento dicotómico, autovalorización externa, autoetiquetización negativa y perfeccionismo. Éste se aplicó a 21 pacientes con IRC (11 mujeres y 10 hombres). Con base en la técnica de redes semánticas naturales, se identificó el conjunto de respuestas (palabras definidoras) con mayor peso semántico para cada frase estímulo (núcleo de la red), con las que se construyó el instrumento piloto. Éste se aplicó junto con los Inventarios de Ansiedad y Depresión de Beck a 255 pacientes con IRC (118 mujeres, 137 hombres) de cuatro centros hospitalarios. Resultados El cuestionario piloto se integró con 46 reactivos con mayor peso semántico de entre 343 palabras definidoras originales. Se descartaron 16 reactivos por falta de capacidad de discriminación (1), baja confiabilidad interna (8) y duplicidad en más de un factor (7). El instrumento final de 30 reactivos tuvo una consistencia interna de 0.93 para el total y mayor a 0.75 en todas las subescalas. Los cinco factores se correlacionaron positiva y significativamente entre sí y con los síntomas de ansiedad y depresión. Conclusiones El instrumento que se presenta es una medida válida y confiable para evaluar cinco DC asociadas con depresión y ansiedad en pacientes mexicanos con IRC. La medida se sugiere útil para el diseño y valoración de intervenciones cognitivo-conductuales para la depresión y ansiedad de los pacientes con IRC.