Assessment of eligibility criteria in renal cell carcinoma trials evaluating systemic therapy.

OBJECTIVES: To characterise the restrictiveness of eligibility criteria in contemporary renal cell carcinoma (RCC) trials, using recommendations from the American Society of Clinical Oncology (ASCO)-Friends of Cancer Research (FCR) initiative. METHODS: vPhase I-III trials assessing systemic therapies in patients with RCC starting between 30 June 2012 and 30 June 2022 were identified. Eligibility criteria regarding brain metastases, prior or concurrent malignancies, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and human immunodeficiency virus (HIV) infection were identified and stratified into three groups: exclusion, conditional inclusion, and not reported. Descriptive statistics were used to determine the frequency of eligibility criteria. Fisher's exact test or chi-square test were used to calculate their associations with certain trial characteristics. RESULTS: A total of 423 RCC trials were initially identified of which 112 (26.5%) had sufficient accessible information. Exclusion of patients with HIV infection, HBV/HCV infection, brain metastases, and prior or concurrent malignancies were reported in 74.1%, 53.6%, 33.0%, and 8.0% of trials, respectively. In the context of HIV and HBV/HCV infection, patients were largely excluded from trials evaluating immunotherapy (94.4% and 77.8%, respectively). In addition, brain metastases were excluded in trials assessing targeted therapy (36.4%), combined therapy (33.3%), and immunotherapy (22.2%). Exclusion of patients with prior or concurrent malignancies was less frequently reported, accounting for 9.1%, 8.3%, and 5.6% targeted therapy, combined therapy and immunotherapy trials, respectively. CONCLUSION: A substantial proportion of RCC trials utilise restrictive eligibility criteria, excluding patients with fairly prevalent comorbidities. Implementing the ASCO-FCR recommendations will ensure resulting data are more inclusive and aligned with patient populations in the real-world.

Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions.

OBJECTIVE: Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs. METHOD: 217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs. RESULTS: : In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs. CONCLUSIONS: : Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.

Implementation and evaluation of a remote geriatric assessment and intervention program in Brazil.

BACKGROUND: This study sought to determine the feasibility and acceptability of a remote geriatric assessment (GA) and implementation (GAIN) program in Brazil. The authors also explored the effect of this program on health-related quality of life (HR-QOL) outcomes 3 months after initiating treatment. METHODS: This is a longitudinal study enrolling older adults (65+ years), diagnosed with any type of solid tumor, scheduled to initiate chemotherapy in a networked Brazilian cancer center. The GA was performed through telehealth. We assessed the feasibility of the remote GA, acceptability to patients, and changes in patient-centered outcomes (HR-QOL, mood, function) from baseline to month 3. Linear mixed model analysis was done, adjusting for age, gender, race, income, and disease stage. RESULTS: Fifty-six patients completed all intended assessments. Notably, the threshold of feasibility was 70% and there was 92% complete adherence. Average age was 76 years old (SD = 7.2). Most patients were female (57%), married (59%), and had a college degree (46%). The most common diagnoses were gastrointestinal (39%) and gynecological cancers (18%); most were diagnosed at an advance disease stage (77%). A total of 32 patients were referred to a remote appointment and 86% followed this recommendation(s). Significant improvement in Functional Assessment of Cancer Therapy - General FACT-G (mean difference, 6.04; p < .001), Geriatric Depression Scale (mean difference, -0.86; p = .008), and instrumental activities of daily living ratio (mean difference, 0.17; p < .001) were found. CONCLUSION: Remote GAIN is feasible and acceptable to older adults with cancer receiving treatment in Brazil. The authors also found significant improvement in HR-QOL outcomes over time. Notably, this GAIN program could guide early detection of chemotherapy toxicity and improving patient-reported outcomes in low-resource environments.

Patients' Perceptions Regarding the Relevance of Items Contained in the Functional Assessment of Cancer Therapy Kidney Symptom Index-19.

BACKGROUND: There is a lack of consensus regarding the optimal method of assessing health-related quality of life (HR-QOL) among patients with metastatic renal cell carcinoma (mRCC). This study explored the perceived relevance of items that make up the Functional Assessment of Cancer Therapy Kidney Symptom Index-19 (FKSI-19), as judged by patients with mRCC. METHODS: This was a multinational cross-sectional survey. Eligible patients responded to a questionnaire composed of 18 items that assessed the perceived relevance of each item in the FKSI-19 questionnaire. Open-ended questions assessed additional issues deemed relevant by patients. Responses were grouped as relevant (scores 2-5) or nonrelevant (score 1). Descriptive statistics were collated, and open-ended questions were analyzed and categorized into descriptive categories. Spearman correlation statistics were used to test the association between relevance and clinical characteristics. RESULTS: A total of 151 patients were included (gender: 78.1 M, 21.9F; median age: 64; treatment: 38.4 immunotherapy, 29.8 targeted therapy, 13.9 immuno-TKI combination therapy) in the study. The most relevant questions evaluated fatigue (77.5), lack of energy (72.2), and worry that their condition will get worse (71.5). Most patients rated blood in urine (15.2), fevers (16.6), and lack of appetite (23.2) as least relevant. Qualitative analysis of open-ended questions revealed several themes, including emotional and physical symptoms, ability to live independently, effectiveness of treatment, family, spirituality, and financial toxicity. CONCLUSION: There is a need to refine widely used HR-QOL measures that are employed among patients diagnosed with mRCC treated with contemporary therapies. Guidance was provided for the inclusion of more relevant items to patients' cancer journey.

Anxiety, Depression, and Coping Strategies during Chemotherapy Treatment: A Comparison of Older and Younger Adults with Advanced Cancer in Brazil.

We sought to examine differences in anxiety, depression and coping strategies among younger (<64-year old) and older (≥65-year old) patients. Patients were assessed at baseline (T1), mid-point (T2) and on the last day of treatment (T3) using the Hospital Anxiety and Depression Scale and the Ways of Coping. A linear mixed modeling approach was used. The study included 200 patients (gender: 70% women; diagnosis: 30% breast, 22% hematological, 18% gastrointestinal; disease stage: 60% advanced). Older patients who used an emotion-focused coping strategy had a greater decrease in anxiety at T3 compared to those that used problem-focused coping (p = .002).

Perceptions of COVID-19 Vaccination in Patients with Genitourinary Cancers: A Survey Study.

Since the approval of the COVID-19 vaccines, their safety and efficacy has been widely demonstrated in patients with cancer. However, there remain patients with reservations regarding vaccination. We aimed to assess genitourinary cancer patients' perceptions of the vaccines as well as barriers and influencers of decision-making through the completion of a questionnaire. While vaccine-associated concerns were observed, most patients with genitourinary cancers were willing to receive the vaccine. Moving forward, differing strategies could be considered to enhance patient education on the utility of vaccination in the setting of cancer and beyond.

mHealth program for patients with advanced cancer receiving treatment in a public health hospital in Brazil.

OBJECTIVE: Previous studies have suggested the benefit of routine screening for biopsychosocial symptoms among patients with cancer. In recognition of the lack of data from low- and middle-income countries, this study sought to test and determine the effect of a mHealth program to screen biopsychological symptoms among patients with advanced breast or gynecological cancer. METHODS: This was a quasi-experimental pre-post study conducted in a public hospital located in central western Brazil. Patients diagnosed with advanced breast of gynecological cancer who were about to initiate chemotherapy treatment at this institution and had access to Internet by smartphone, computer or tablet were invited to participate. Patients received training on using the app Comfort, a program developed to rate their physical and emotional symptoms during the 6-month of the proposed study. Patients were also asked to complete the EuroQOL 5D (EQ-5D-3L) every month. Mann-Whitney U test was used to determine differences among groups of patients (engaged and non-engaged). RM-ANOVA was used to determine the effect of time on mean visual analog scale (VAS) score. RESULTS: A total of 125 patients were recruited (median age = 46.6 years old, 41.6% married). Mostly, patients possessed lower levels of education and had relatively low monthly incomes. Notably, 67.2% of patients engaged with the Comfort program, and few patients (4%) withdrew due to lack of engagement with the program or issues with internet connection. In general, patients who engaged with the program reported improvement in physical and emotional symptoms (p < 0.01), as well as in their overall quality of life (VAS; p = 0.009), compared with patients who did not engage with the program. CONCLUSIONS: This is the first mHealth program developed in Brazil for patients in a low resource setting. Our findings suggest that Comfort could be an effective resource to assist patients and health care providers track symptoms and improve patients' quality of life.

Racial and ethnic differences in perceptions of germline or somatic DNA sequencing among patients with advanced prostate, urothelial, or kidney cancer.

We sought to determine racial and ethnic differences in perceptions (quality of communication, expectations, and concerns) of germline or somatic DNA sequencing (genomic profiling). Patients with prostate, urothelial, or kidney cancer were surveyed using a questionnaire that assessed previous experience, beliefs, expectations, and concerns regarding genomic profiling. Descriptive statistics and chi-square tests were used to identify factors associated with patients' perceptions of genomic profiling. A total of 150 consecutive patients were enrolled. The majority were male (74%) with a mean age of 68 years old. Most patients underwent somatic testing (54%), 24% undertook germline testing, and 21% undertook both tests. Significant differences were found across racial and/or ethnicity concerning factors that could have influenced patients' decision to pursue genomic profiling, including ability to guide the type of treatment (White: 54.1% vs. other ethnic groups: 43.9%, p = 0.04) and potential to improve treatment response (White: 10.1% vs. other ethnic groups: 22.0%, p = 0.04). Other ethnic group of patients were more concerned about learning that the cancer was less treatable or aggressive (43.8% vs. 27.7%, p = 0.01) and anxious about what would be learnt from genomic profiling (34.4% vs. 21.3, p = 0.01) as compared to White patients. Our findings reinforce the importance of developing culturally tailored education to help patients participate actively in decisions about genomic profiling.

Discerning critical stressors and resources in the lives of cancer patients: A multivariate analysis of targets of intervention for enhancing cancer care and quality of life.

OBJECTIVE: This study examined the relationship between a broad variety of stressors, resources, and outcomes to identify targets of intervention to enhance the quality of life of cancer patients and contribute to a comprehensive model of cancer care. METHODS: Five hundred and sixty persons with a diagnosis of cancer completed measures of stressors (past negative life events, current problems, current symptoms, comorbidities), resources (coping self-efficacy, social support, satisfaction with care) and outcomes (emotional and functional well-being). RESULTS: Multivariate canonical correlations between pairs of canonical variates (stressors-outcomes, Rc  = 0.56; stressors-resources, Rc  = 0.42, resources-outcomes Rc  = 0.66) were significant (all ps < 0.0001), which confirmed the relationship between those components and supported proceeding to more granular levels of analysis. More refined analyses revealed that the most critical variables in relation to outcomes (i.e., emotional and functional well-being), were current problems and symptoms among the stressors and coping self-efficacy, social support and patient satisfaction among the resources. CONCLUSIONS: This study provided an approach to the discernment of the most critical aspects of interventions that may improve supportive care and quality of life outcomes. Thus, efforts to address current problems (e.g., financial, home life, work), as well as effective management of symptoms (e.g., pain, fatigue, sleep), using the coordinated integration of medical care, support services and psycho-social interventions would provide the greatest impact on quality-of-life outcomes. Interventions that focus on problem solving and reinforce patient agency and activation may be most effective in sustaining quality of life outcomes into survivorship.

Psycho-Oncology and the Relevance of a Biopsychosocial Screening Program.

A 40-year-old unmarried Brazilian woman, Ms A, received a diagnosis of papillary renal cell carcinoma (RCC) in February 2020; she underwent nephrectomy the following month. In August, she began to experience generalized pain with subsequent scans revealing metastatic disease to the supraclavicular lymph node, liver, and vagina. In October 2020, Ms A started first-line systemic combination treatment with nivolumab (Opdivo; 3 mg/kg) plus ipilimumab (Yervoy; 1 mg/kg) every 3 weeks for 4 doses, followed by nivolumab (3 mg/kg) every 2 weeks, to be taken for 2 years. In April 2021, follow-up testing revealed a partial response to therapy, and a complete response was evident in August 2021. Ms A was first screened for biopsychosocial distress by the supportive care team in October 2020, and she completed the Edmonton Symptom Assessment System (ESAS) evaluation.During her fourth cycle of treatment in October 2020, the patient was assessed with the ESAS. During her medical visits, Ms A also expressed concern regarding her physical symptoms and admitted frequent self-monitoring for signs of recurrence or progression. Her oncologist prescribed tramadol for pain and the supportive care team recommended increased engagement in physical activity. Upon further assessment, the patient reported a belief that her psychosocial symptoms, worry about recurrence or progression, and time spent self-monitoring were a normal part of her cancer experience.

Discrepancies between genitourinary cancer patients' and clinicians' characterization of the Eastern Cooperative Oncology Group performance status.

BACKGROUND: Patient-reported outcomes have been used to assess treatment effectiveness and actively engage patients in their disease management. This study was designed to describe the patient-reported performance status (PS) and the provider-reported PS. METHODS: Patients with metastatic genitourinary cancers were recruited from a single cancer center before the initiation of a new line of treatment. PS (Eastern Cooperative Oncology Group [ECOG]), quality of life (Functional Assessment of Chronic Illness Therapy-General), and distress (Patient-Reported Outcomes Measurement Information System Anxiety and Depression) were self-reported by patients. Clinical data (eg, age, sex, diagnosis, and physician-reported ECOG PS) were extracted from medical records. Multivariate analysis was used to determine the association between PS, quality of life, and psychological symptoms. RESULTS: One hundred forty-five patients were enrolled (76.6% male, 70.3% White, 81.4% married, and 76.6% well educated). The median age was 67 years; 66.9% were diagnosed with renal cell carcinoma, 20.0% were diagnosed with urothelial carcinoma, and 13.1% were diagnosed with prostate cancer. Clinicians more frequently classified patients' ECOG PS as 0 in comparison with the patients themselves (92.4% vs 64.1%; P = .001). Higher clinician-reported ECOG PS was associated with poorer physical and functional well-being and higher rates of depression (P < .01), whereas higher patient-reported ECOG PS was associated with worse psychosocial outcomes (P < .01). CONCLUSIONS: Discrepancies were noted between the patient- and provider-reported ECOG PS, with clinicians overestimating the ECOG PS in comparison with the patients themselves. This study's findings suggest that patients incorporate their social and emotional well-being into their PS score in addition to their physical well-being. This information is not immediately accessible to most clinicians from just a standard patient interview and likely accounts for the overestimation of the patients' ECOG PS by the clinicians.

Emotional problem-related distress screening and its prevalence by cancer type: Assessment by patients' characteristics and level of assistance requested.

OBJECTIVE: Emotional problem-related distress is a common issue faced by patients with cancer. However, patients suffering with this emotional burden do not typically seek assistance. This study sought to determine the prevalence of emotional problem-related distress by cancer type, and identify factors correlated with the level of assistance requested. METHODS: Using the SupportScreen®, patients were screened for emotional problem-related distress at their first or second visit to an NCI designated Comprehensive Cancer Center. General Linear Model was used to test the association between emotional problem-related distress and type of cancer, and the relationship between level of assistance requested and patients' characteristics. RESULTS: A total of 2,421 patients were included in this analysis. Patients were mostly female (62%), diagnosed with breast (24%), gynecological (16%) or gastrointestinal (15%) cancers. Highest levels of emotional problem-related distress were reported by patients diagnosed with lung, gynecological, breast and gastrointestinal cancers. Level of assistance requested were significantly associated with problem-related distress scores (p < 0.001), which were higher among patients with lower household incomes (p < 0.001) and Spanish as primary language (p = 0.001). CONCLUSION: Our study found an association between Level of assistance requested and emotional problem-related distress, which were heightened by lower income and Spanish-speaking. Intervention strategies should be considered to increase access to psychosocial support services.

Association between hospital anxiety and depression scale and problem-related distress in patients with cancer in a Brazilian private institution.

OBJECTIVE: Emotional symptoms are frequently reported among patients with cancer. We evaluated the association between emotional symptoms and problem-related distress in a sample of patients with cancer about to initiate chemotherapy within a private hospital in Brazil. METHODS: Patients were assessed before initiating chemotherapy, treatment mid-point, and on the last day of treatment for anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) and for problem-related distress (Distress Thermometer Problem List). Problem-related distress variable was computed as the sum of practical, physical, spiritual and familial problems. Mixed-model analysis was applied to determine the association between HADS and problem-related distress, adjusting for age and gender. RESULTS: A total of 655 consecutive patients were enrolled. There was a significant main effect of time (F = 8.99, p = 0.0001), showing that emotional symptoms improve over time. A significant main effect was observed for problem-related distress (F = 371.56, p < 0.0001) revealing that patients with elevated problem-related distress at baseline tend to have higher HADS across the three time points, compared to patients with lower problem-related distress. There was an interaction effect between problem-related distress and time (F = 85.22, p < 0.0001), suggesting that HADS scores decreased differently over time, depending on patients' initial level of problem-related distress. CONCLUSION: Overall, emotional symptoms, while decreasing over time, remained associated with problem-related distress after chemotherapy in Brazil. The potential benefit of implementing a psychosocial intervention remains high throughout cancer treatment.

Comorbidity, Functional Impairment, and Emotional Distress: A Coping Mediation Model for Persons With Cancer.

BACKGROUND: Comorbid disease in cancer patients can substantially impact medical care, emotional distress, and mortality. However, there is a paucity of research on how coping may affect the relationship between comorbidity and emotional distress. PURPOSE: The current study investigated whether the relations between comorbidity and emotional distress and between functional impairment and emotional distress were mediated by three types of coping: action planning (AP), support/advice seeking (SAS), and disengagement (DD). METHODS: Four hundred and eighty-three persons with cancer completed a measure of functional impairment (Sickness Impact Profile), the Checklist of Comorbid Conditions, the Brief COPE, the Hospital Anxiety and Depression Scale, the Quality of Life Assessment for Cancer Survivors (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were used to form a latent construct representing the outcome, emotional distress. RESULTS: Model comparison analysis indicated that the model with DD as a mediator had a better fit than models containing AP and SAS. DD mediated the relationship between functional impairment and emotional distress, so that engaging in DD was associated with greater distress. In addition, comorbidity and functional impairment were directly and positively related to emotional distress, but the relation between comorbidity and distress was not mediated by coping type. CONCLUSIONS: Both comorbidity and functional impairment may be associated with distress, but disengagement coping only mediated the relation involving functional impairment and was positively associated with distress. Future studies can investigate whether teaching active coping or adaptive coping (e.g., through mindfulness exercises) can decrease distress in cancer patients, despite functional impairments.

Emotional Distress During the COVID-19 Pandemic: Psycho-Oncology Perspective.

Patients with cancer represent a vulnerable population and are at greater risk of developing serious complications as a result of a COVID-19 infection. In response, oncology societies around the world have proposed changes to their standards of care. These changes have helped guide health care providers in prioritizing clinical management of patients with cancer: identifying situations in which urgent intervention is needed and those that can be triaged until the risk of infection has lessened.

Obesity and psychosocial well-being among cancer patients and survivors.

OBJECTIVE: As the association between obesity and cancer receives increasing attention, studies have begun to examine the potential impact of excess weight on psychosocial domains during treatment and survivorship. The current study will examine the effect of weight status on psychosocial outcomes among patients diagnosed with breast cancer, prostate cancer, and colon cancer. METHODS: This retrospective study included 4159 patients over the age of 55 who were diagnosed with postmenopausal breast (52.2%), prostate (38.7%), or colon cancer (9.1%). Prior to treatment, patients were screened for problem-related distress using a 33-item touch screen-based instrument. Descriptive statistics were generated for each cancer type and one-way analysis of covariance (ANCOVA) used to determine significant differences in distress by weight (nonobese: <30 kg/m2 vs obese: ≥30 kg/m2 ). RESULTS: A higher prevalence of biopsychosocial problem-related distress was reported by patients with breast cancer (M = 4.3) compared with prostate (M = 2.8) and colon cancer (M = 3.8). Obese breast and prostate cancer patients reported higher levels of problem-related distress compared with nonobese patients (P < .05), whereas an opposite trend was noted for patients with colon cancer. CONCLUSION: The current study found notable obesity-related differences among patients diagnosed with postmenopausal breast cancer or prostate cancer, with excess weight consistently associated with poorer psychosocial outcomes. These findings among a large cohort of patients provide insight into the impact of obesity during the cancer care trajectory and can provide guidance in the development and implementation of supportive care services for this "at-risk" population.

Social relationship coping efficacy: A new construct in understanding social support and close personal relationships in persons with cancer.

OBJECTIVE: Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL). METHOD: A mixed diagnosis sample (N = 151) of cancer patients completed a variety of measures: physical debilitation, received emotional and instrumental support, SRCE, and QOL. RESULTS: The SRCE scale is a 10-item, one-factor, internally reliable (α = 0.965) measure with strong concurrent validity in relation to measures of social support. SRCE fully mediated the relationship between physical debilitation and both instrumental and emotional received support. SRCE also was directly related to both social/family well-being and psychological distress, and this relationship was also partially mediated by social support. CONCLUSIONS: The results corroborated that SRCE might account for changes in both instrumental and emotional support. Also, the direct and indirect relationship (mediated by social support) of SRCE with both social/family well-being and distress indicated that interventions to increase SRCE with those at risk for social support loss may bolster social support in personal relationships as well as enhance emotional well-being and quality of life.

Interventions to enhance self-efficacy in cancer patients: A meta-analysis of randomized controlled trials.

OBJECTIVE: Self-efficacy expectations are associated with improvements in problematic outcomes widely considered clinically significant (ie, emotional distress, fatigue, and pain), related to positive health behaviors, and as a type of personal agency, inherently valuable. Self-efficacy expectancies, estimates of confidence to execute behaviors, are important in that changes in self-efficacy expectations are positively related to future behaviors that promote health and well-being. The current meta-analysis investigated the impact of psychological interventions on self-efficacy expectations for a variety of health behaviors among cancer patients. METHODS: Ovid Medline, PsycINFO, CINAHL, EMBASE, Cochrane Library, and Web of Science were searched with specific search terms for identifying randomized controlled trials (RCTs) that focused on psychologically based interventions. Included studies had (a) an adult cancer sample, (b) a self-efficacy expectation measure of specific behaviors, and (c) an RCT design. Standard screening and reliability procedures were used for selecting and coding studies. Coding included theoretically informed moderator variables. RESULTS: Across 79 RCTs, 223 effect sizes, and 8678 participants, the weighted average effect of self-efficacy expectations was estimated as g = 0.274 (P < .001). Consistent with the self-efficacy theory, the average effect for in-person intervention delivery (g = 0.329) was significantly greater than for all other formats (g = 0.154, P = .023; eg, audiovisual, print, telephone, and Web/internet). CONCLUSIONS: The results establish the impact of psychological interventions on self-efficacy expectations as comparable in effect size with commonly reported outcomes (distress, fatigue, pain). Additionally, the result that in-person interventions achieved the largest effect is supported by the social learning theory and could inform research related to the development and evaluation of interventions.

Breast and gynecological cancer patients' risk factors associated with biopsychosocial problem-related distress.

OBJECTIVES: Inequalities exist between breast and gynecological cancer patients' experiences, leading to high levels of distress throughout the cancer journey. The present study aims to identify differences in source of biopsychosocial problem-related distress between women diagnosed with breast or gynecological cancers. METHODS: From 2009 to 2016, women with breast (n = 2111) and gynecological (n = 641) cancers were screened using the core items of the instrument You, Your Family, and City of Hope are a Team. This is a touch screen-based instrument that assess problem-related distress due to physical, practical, functional, emotional, and other problems and identifies types of assistance requested. Data were analyzed using the linear regression model. RESULTS: A significant difference in overall biopsychosocial problems rated as high distress was found between breast (M = 5.0) and gynecological (M = 6.2) cancer patients (P < .001). Gynecological cancer patients endorsed a greater number of problems to talk with a member of the team (alone or with written information), while both cancer groups requested written information equally. Gynecological cancer was associated with higher physical, functional, emotional, and total distress. Younger patients, non-Asian, and those with lower education and lower household income also reported greater distress. CONCLUSIONS: Gynecological cancer patients represent a high-risk group, reporting greater problem-related distress and higher levels of requested assistance. Age, education, race/ethnicity, and income were found to be potential risk factors. Findings highlight the importance of considering characteristics and special needs related to specific types of cancer to assist in the effective treatment of distress throughout the continuum of care.

Assessment of distress and quality of life in rare cancers.

OBJECTIVE: Rare cancers are a heterogeneous group of conditions that can be associated with emotional and physical impairments. In view of the dearth of research in this area, we investigated the quality of life and prevalence of distress in a cohort of patients diagnosed with a rare cancer, classified by the RARECARE definition. METHODS: A cohort of rare cancer patients, treated in a Brazilian public cancer center, was assessed for distress (Distress Thermometer), anxiety/depression (Hospital Anxiety and Depression Scale), and quality of life (Functional Assessment of Cancer Therapy-General Version). Descriptive statistics were generated, and multivariate analyses were used to identify factors associated with distress, anxiety/depression, and quality of life. RESULTS: A total of 137 patients (52.6% male, mean age of 50 years; range 18-90) were identified. Nearly half (49.6%) of patients reported high levels of distress, with 19.7% endorsing anxiety and 15.3% depression. In multivariate analysis, demographic and clinical variables associated with worse psychosocial outcomes included younger age (P < 0.05), female gender (P < 0.01), advanced disease stage (P < 0.01), and engagement in active therapy (P < 0.05). CONCLUSIONS: Patients diagnosed with rare cancer reported poorer psychosocial outcomes and impaired quality of life when compared to the general population of cancer patients. Certain demographic groups (eg, women and younger patients) may benefit from targeted psychosocial interventions.