Feasibility of a video-based cognitive behavioral therapy for insomnia in French adult cancer outpatients: results from the Sleep-4-All-1 study.

BACKGROUND: Insomnia affects up to 63% of patients with cancer. Cognitive behavioral therapy for insomnia (CBT-I) is considered to be the non-pharmacological gold standard treatment, but it remains underutilized in France. Self-administered interventions offer new ways to overcome some of the barriers that restrict access to efficacious supportive care. OBJECTIVE: To assess the feasibility, among French adult cancer outpatients, of a validated Quebec video-based, self-administered, cognitive behavioral therapy for insomnia (VCBT-I). METHODS: A pre-post design with quantitative measures (Insomnia Severity Index, Edmonton Symptom Assessment System, Treatment Perception Questionnaire) and qualitative measures (semi-structured interviews) was used. RESULTS: One hundred and seventy-three cancer outpatients were self-screened for insomnia, and 57% (n=99) reported significant symptoms. Among them, 80% (n=79) agreed to participate in the VCBT-I. The download rate of the VCBT-I was 78% (n=62/79). Several technical and contextual barriers to the delivery and the applicability of the VCBT-I emerged. However, participants reported a high level of satisfaction, and some valuable benefits at post-immediate intervention (increased knowledge about sleep, better quality of sleep, and higher acceptance of the burden of insomnia), regardless of whether or not they still had insomnia. DISCUSSION: This study confirms that there is a demand for a VCBT-I, which was perceived as appropriate by a sample of French cancer outpatients with insomnia, but it also highlights some limitations in terms of implementation and practicality. Remote professional support appears to be a core need in order to address these issues and personalize the guidance process.

Prospective memory and brain metastases: a relevant target for rehabilitation in post-operative patients?

PURPOSE: The study investigated the prospective memory (PM) functioning among patients with brain metastases (BM), eligible for neurosurgy/radiosurgery, and its relationships with depression and quality of life (QoL). METHODS: This case-healthy-control, cross-sectional study, comprised 160 participants, including 49 patients with BM from various cancers treated with neurosurgery or radiosurgery. They were compared with 111 matched controls on a set of neuropsychological tests, including the MoCA global cognitive test and an experimental PM task 'PROMESSE'. Participants also completed a depression scale (BDI-II), a generic (SF-12) and a specific (QLQ-C30) QoL instrument for cancer patients. Multivariate analyses were conducted on various PM outcomes, in particular on event-based (EBPM) and time-based (TBPM) PM performances. RESULTS: After adjusting for age and socio-cultural level, patients with BM performed worse than the control on the PM task (p < .0001) [OR 1.05; 95%CI (1.01-1.08)], whatever the location of BM (frontal versus temporal lobe). Patients with infratentorial BM exhibited better TBPM performances than patients with supratentorial BM (p = .02). The global PM performance was positively correlated with the MoCA (r = .45) and the SF-12 global score (r = .34), and negatively with the BDI-II score (r = - .20), the number of BM (r = - .34) and the volumetric of the BM (r = - 29). The TBPM performance was linked to the global QoL (r = .40) in patients. CONCLUSION: The study showed a significant PM deficit in patients with BM eligible for a neurosurgy/radiosurgery, which is linked to damaged QoL and which likely maintains some depressive affects. Prospective memory rehabilitation program should especially focus on TBPM for post-operative patients with BM.

Relationships between metacognitive beliefs, social evaluative threat and worry.

A worry state is assumed to emerge from the interaction between metacognitive beliefs, and the appraisal of environmental demands (Wells & Matthews, 1994). The aim of this study was to show that metacognitive beliefs moderate the effect of sources of social evaluative threat on worry. Our sample (N = 174) completed a working memory task in two contexts (threatful vs. neutral), while both pre- and post-task measures subjective stress states were recorded. Our results confirmed significant effects of sources of social evaluative threat and metacognitive beliefs on worry. The interaction metacognition * threat context effect on worry was not significant. Our findings support the hypothesis that worry is a form of subjective stress explained by a combination of outcome uncontrollability and social evaluative threat. Social evaluative threat and metacognitive beliefs appeared as two, independent predictors of a worry state. Our results are discussed in reference to the Self Regulative model of stress.

Demographic Characteristics, Motivation and Perception of Change as Determinants of Memory Compensation Self-Reports After Acquired Brain Injury.

INTRODUCTION: Individuals with brain injuries experience cognitive and emotional changes that have long-lasting impacts on everyday life. In the context of rehabilitation, surveys have stressed the importance of compensating for memory disturbances to ease the impact of disorders on day-to-day autonomy. Despite extensive research on the nature of neurocognitive impairments following brain injury, few studies have looked at patients' perceptions of these day-to-day compensations. This study examines these perceptions; in particular, what brain-injured people believe they do to compensate for memory deficiencies in everyday life. It also investigates the determinants of reported compensation strategies (age, gender, perceived stress, change awareness and motivation to succeed). METHODS: Eighty patients and 80 controls completed the French Memory Compensation Questionnaire, a self-report measure of everyday memory compensation. Five forms of compensation were investigated: External and Internal strategies, Reliance on social help, and investments in Time and Effort, along with two general factors: the degree of importance attached to Success (motivation) and perceptions of Change. Participants also completed measures of demographic and emotional aspects that may affect everyday compensation perceptions. RESULTS: The brain-injured group reported significantly more frequent use of memory compensation strategies than controls, with the exception of External aids. Large effects were observed for Reliance and Effort. Demographic, motivation and perception of change determinants were found to have different effects depending on the compensation strategy, and mediated the direct effect of brain injury on reported compensation. CONCLUSION: Clinical and rehabilitation neuropsychologists often seek to have a better sense of how their patients perceive their compensatory behaviors. In practice, such an understanding is needed to help select appropriate methods and improve the long-term impact of rehabilitation programs: memory rehabilitation will fail if neuropsychologists do not deal, first and foremost, with the emotional and metacognitive issues surrounding traumatic brain injury (TBI), rather than focusing on cognitive efficiency.

Impact of perceived stress on cognitive performance: Moderating effect of mild cognitive impairment and Alzheimer's disease.

INTRODUCTION: Stress is a well-known determinant of cognitive performance in both younger and older adults. However, the moderating effect of pathological aging on this relationship remains insufficiently documented. We hypothesize that mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients will report higher perceived stress than control older adults, when asked to complete an effortful cognitive task. We also hypothesize that the deleterious effect of perceived stress on cognitive performance is more evident in MCI and AD patients. METHOD: The 131 participants consisted of: 25 functional older adults, 35 nonamnestic-MCI patients, 35 amnestic-MCI patients, and 36 AD patients. They were asked to complete the Victoria Stroop test and report their level of perceived stress at four times: before the test (i.e., baseline) and after each part of the test (three, increasingly effortful levels of cognitive requirement). RESULTS: Overall, perceived stress increased in the most effortful condition-except for AD patients, who reported a decline. A positive main effect of perceived stress on response latency was confirmed. However, this effect became negative in all participants when the model accounted for the difficulty of the task. DISCUSSION: The results suggest that the ability to perceive the stress levels generated by an effortful cognitive task may be altered in AD. They also suggest that the Stroop task may generate a form of perceived stress favoring engagement, and AD patients may not benefit from its positive effects on performance. They put into questions the usual clinical interpretations.

Validity of the French Prospective and Retrospective Memory Questionnaire (PRMQ) in healthy controls and in patients with no cognitive impairment, mild cognitive impairment and Alzheimer disease.

Introduction: The Prospective and Retrospective Memory Questionnaire (PRMQ) is one of the most commonly used scales to assess both retrospective memory (RM) and prospective memory (PM) complaints. This study aimed to: 1/replicate the previous results concerning the PRMQ latent structure in a French version and 2/provide its psychometric properties in a normal and clinical population. Method: This observational study included 488 participants divided into five subgroups. A sample of 168 healthy participants (no memory consultation sought), served as controls. Patients were recruited in a memory clinic: 98 "functional" patients (subjective memory complaints but no memory impairment), 83 amnestic-Mild Cognitive Impairment (a-MCI), 82 non-amnestic-MCI (na-MCI) and 57 Alzheimer Disease (AD) patients. Structure, validity, consistency, reliabilitiy and reproducibility of the PRMQ were calculated. Novelty, Area Under the Receiver-Operating Characteristics (AUROC) curve, was used to determine the optimal cut-off, to distinguish "functional" patients from control participants. Results: The optimal fit model of the French PMRQ was not a tri but a bi-partite model, with a RM and a PM subscale. The convergent validity showed significant correlation with cognitive difficulties (r = .82 and .78, respectively), anxiety (r = .44 and .48, respectively) and depression (r = .23) scales. Cronbach's alpha was good (α = .79 and .88), as well as the reproducibility (r = .71 and .80). The interaction [Subgroups of participants x PMRQ Subscales] was significant [F(4, 483) = 11.46; p < .001]. The power discrimination was adequate (AUROC = .71 and .74) for detecting "functional" patients compared with controls, in particular for the PM subscale (sensitivity 66.6%, specificity 77.4%). Conclusions: The PMRQ, with minor changes, was validated in its French form with satisfactory psychometric qualities. This self-rating tool appears useful for identifying significant memory complaints in a normal population and may also be helpful in discriminating between functional/na-MCI and a-MCI/AD patients.

Complementary and Alternative Medicine in Patients With Breast Cancer: Exploratory Study of Social Network Forum Data.

BACKGROUND: Patients and health care professionals are becoming increasingly preoccupied in complementary and alternative medicine (CAM) that can also be called nonpharmacological interventions (NPIs). In just a few years, this supportive care has gone from solutions aimed at improving the quality of life to solutions intended to reduce symptoms, supplement oncological treatments, and prevent recurrences. Digital social networks are a major vector for disseminating these practices that are not always disclosed to doctors by patients. An exploration of the content of exchanges on social networks by patients suffering from breast cancer can help to better identify the extent and diversity of these practices. OBJECTIVE: This study aimed to explore the interest of patients with breast cancer in CAM from posts published in health forums and French-language social media groups. METHODS: The retrospective study was based on a French database of 2 forums and 4 Facebook groups between June 3, 2006, and November 17, 2015. The extracted, anonymized, and compiled data (264,249 posts) were analyzed according to the occurrences associated with the NPI categories and NPI subcategories, their synonyms, and their related terms. RESULTS: The results showed that patients with breast cancer use mainly physical (37.6%) and nutritional (31.3%) interventions. Herbal medicine is a subcategory that was cited frequently. However, the patients did not mention digital interventions. CONCLUSIONS: This exploratory study of the main French forums and discussion groups indicates a significant interest in CAM during and after treatments for breast cancer, with primarily physical and nutritional interventions complementing approved treatments. This study highlights the importance of accurate information (vs fake medicine), prescription and monitoring of these interventions, and the mediating role that health professionals must play in this regard.

Assessing dietary intake in accordance with guidelines: Useful correlations with an ingesta-Verbal/Visual Analogue Scale in medical oncology patients.

BACKGROUND & AIMS: Energy intake and food ingesta are central in nutritional screening and assessment. Cancer patients are at nutritional risk of losing weight, and clinicians need quick and easy tools to identify patients for nutritional support. This study aimed to evaluate the feasibility and the accuracy of a Visual/Verbal Analogue Scale of food ingesta (ingesta-VVAS) to assess energy food intake and nutritional risk in medical oncology patients. METHODS: Dieticians administered prospectively the ingesta-VVAS in 1762 medical oncology patients. The external validity of the ingesta-VVAS was determined against daily energy intake based on a 24-h dietary recall. Patients had to estimate how they currently ate on a scale from 0 "nothing at all" to 10 "as usual". Area Under the Receiver-Operating Characteristics (ROC) curve served as determine the optimal cut-off and provide the discriminative power of the tool to detect patients who ingested less or more than 25 kcal kg-1 day-1. RESULTS: The feasibility of the ingesta-VVAS was 97.7%. The scores were significantly correlated with energy intake (ρ = .67, p < .05), whatever the specific situation (i.e. malnutrition or not). With a cut-off of ≤7, the ingesta-VVAS exhibited a good power discrimination (AUC = .804) to detect patients who ingested less or more than 25 kcal kg-1 day-1, with a sensitivity of 80.8%, a positive predictive value of 83.6%, a specificity of 67.5%, and a negative predictive value of 63.3%. Patients with a score ≤7 on the ingesta-VVAS score were at 12-fold higher probability of nutritional risk [OR 12.3; 95% CI (8.7-17.4); p < .001]. Sensitivity to detect patients with a significant weight loss was 71%, and a positive predictive value of 75.9%. CONCLUSIONS: This easy-to-use ingesta-VVAS is well-correlated with energy intake and may be useful in clinical practice. An ingesta-VVAS score is ≤ 7 could be used to detect patients with nutritional risk of weight loss in medical oncology.

French Version of the Hayling Sentence Completion Test, Part I: Normative Data and Guidelines for Error Scoring.

OBJECTIVE: The Hayling Sentence Completion Test (HSCT) measures prepotent response inhibition, useful to assess inhibition deficit in a variety of clinical conditions. Despite its extensive use by numerous clinical and research groups in France, normative data for the HSCT are not yet available for French speakers. METHOD: A French version of the HCST was administered to a sample of 426 healthy community-dwelling French speaking adults (20-87 years of age). Normative data were calculated using a regression-based approach. RESULTS: Regression analyses indicated that both age and education were associated with response latency and number of errors in the inhibition condition. Equations to calculate Z scores are provided for clinical use. In addition, we provided a clear guideline for the error scoring of the inhibition condition by establishing a corpus of errors adjusted for the linguistic and cultural realities of the French population. Using this guideline, a good inter-rater reliability was observed. Because of the restricted ranges of response latency and number of errors in the automatic condition, the relationship between these scores and demographic factors was not explored. By consequence, no norms were proposed for this condition. CONCLUSIONS: We provide normative data of a French version of the HSCT for adults and elderly patients. These normative data obtained will be extremely useful for clinical practice and research purposes.

Meal context and food preferences in cancer patients: results from a French self-report survey.

PURPOSE: The present study examined patient self-reports of descriptions, experiences and consequences of meal disturbances and food preferences within a cultural context (i.e., French meal traditions) in various treated cancer patients along their disease trajectory. METHODS: Over 800 questionnaires were sent to 20 cancer treatment centres in France. During a 9-month period, 255 questionnaires were received from five centres. Inclusion criteria included those French patients over 18 years of age, could read and understand French, had an Eastern Cooperative Oncology Group score between 0 and 2, experienced treatment-induced nutrition changes and/or had decreased oral intake. Dietetic staff assessed clinical characteristics while patients completed a 17-item questionnaire. RESULTS: The majority of patients were diagnosed with breast, gastro-intestinal (GI) tract and head and neck cancers (62 %). Half of the patients (49 %) experienced weight loss >5 %. The main treatment-induced side effects were fatigue, nausea, dry mouth, hypersensitivity to odors and GI tract transit disorders. These discomforts affected eating and drinking in 83 % of patients, inducing appetite loss and selected food aversion. Food preference appeared heterogeneous. Food taste, odor and finally appearance stimulated appetite. Finally, dietary behaviors and satisfaction were driven by the extent to which food was enjoyed. CONCLUSIONS: During oncologic treatments, eating and drinking were affected in more than three-quarters of patients. As recommended by practice guidelines, nutritional assessment and follow-up are required. Personalized nutritional counseling should include the role of the family, patient's meal traditions, and food habits.