Rural-urban disparities in psychosocial functioning in epithelial ovarian cancer patients.

OBJECTIVE: Although rural residence has been related to health disparities in cancer patients, little is known about how rural residence impacts mental health and quality of life (QOL) in ovarian cancer patients over time. This prospective longitudinal study investigated mental health and QOL of ovarian cancer patients in the first-year post-diagnosis. METHOD: Women with suspected ovarian cancer completed psychosocial surveys pre-surgery, at 6 months and one-year; clinical data were obtained from medical records. Histologically confirmed high grade epithelial ovarian cancer patients were eligible. Rural/urban residence was categorized from patient counties using the USDA Rural-Urban Continuum Codes. Linear mixed effects models examined differences in psychosocial measures over time, adjusting for covariates. RESULTS: Although disparities were not observed at study entry for any psychosocial variable (all p-values >0.22), urban patients showed greater improvement in total distress over the year following diagnosis than rural patients (p = 0.025) and were significantly less distressed at one year (p = 0.03). Urban patients had a more consistent QOL improvement than their rural counterparts (p = 0.006). There were no differences in the course of depressive symptoms over the year (p = 0.17). Social support of urban patients at 12 months was significantly higher than that of rural patients (p = 0.04). CONCLUSION: Rural patients reported less improvement in psychological functioning in the year following diagnosis than their urban counterparts. Clinicians should be aware of rurality as a potential risk factor for ongoing distress. Future studies should examine causes of these health disparities and potential long-term inequities and develop interventions to address these issues.

Emotional distress and future healthcare utilization in oncology populations: A systematic review.

OBJECTIVE: Emotional distress has been correlated with greater healthcare utilization and economic costs in cancer; however, the prospective relationship between positive distress screens and future healthcare utilization is less clear. Taken together, there is a critical need to synthesize studies examining the prospective relationship between emotional distress and future healthcare use to inform distress management protocols and motivate institutional resource allocation to distress management. The aim of the systematic review is to explore the relationship between emotional distress, measured via validated emotional distress questionnaires, and subsequent healthcare utilization in patients diagnosed with cancer. METHODS: A systematic search of seven databases was conducted on 29 March 2022 and updated 3 August 2023. Eligibility criteria were: (1) peer-reviewed, (2) quantitative or mixed methods, (3) adults (≥18 years) diagnosed with cancer, (4) cancer distress questionnaire(s) completed prior to healthcare utilization, and (5) written in English. Exclusion criteria included: (1) non-emotional aspects of distress (i.e., spiritual or physical distress), (2) healthcare utilization characterized via economic or monetary variables, and (3) caregiver or non-cancer populations. RESULTS: Nineteen peer-reviewed articles were included in the review. There was significant heterogeneity in emotional distress instruments and type of healthcare utilization used. Most studies examining general distress or anxiety found that increased distress was predictive of greater future healthcare utilization. CONCLUSION: The results suggest that individuals with higher levels of general distress and anxiety are at increased risk for future healthcare utilization.

Prospective Association of Psychological Distress and Sexual Quality of Life Among Hematopoietic Stem Cell Transplant Survivors.

Sexual health concerns are one of the most common late effects facing hematopoietic stem cell transplant (HSCT) survivors. The current study tested whether self-reported depression and anxiety symptoms before transplant were associated with embedded items assessing two specific areas of sexual health-sexual interest and sexual satisfaction-one year post-HSCT. Of the 158 study participants, 41% were diagnosed with a plasma cell disorder (n = 60) and most received autologous transplantation (n = 128; 81%). At post-HSCT, 21% of participants reported they were not at all satisfied with their sex life, and 22% were not at all interested in sex. Greater pre-HSCT depressive symptomology was significantly predictive of lower sexual interest (ß = -.27, p < .001) and satisfaction (ß = -.39, p < .001) at post-HSCT. Similarly, greater pre-HSCT trait anxiety was significantly predictive of lower sexual interest (ß = -.19, p = .02) whereas higher levels of state and trait anxiety were both predictive of lower satisfaction (ß = -.22, p = .02 and ß = -.29, p = .001, respectively). Participant sex significantly moderated the relationship between state anxiety and sexual satisfaction (b = -.05, t = -2.03, p = .04). Additional research examining the factors that contribute to sexual health post-HCST is needed to inform and implement clinical interventions to address these commonly overlooked survivorship concerns.

Genetic variants associated with post-traumatic stress symptoms in patients with gynecologic cancer.

OBJECTIVE: Patients with cancer experience symptoms of post-traumatic stress disorder (PTSD) more commonly than the general population. The objective of this study was to identify single nucleotide polymorphisms (SNPs) associated with increased risk of post-traumatic stress disorder (PTSD) in patients with gynecologic cancer. METHODS: A prospective cohort study recruited 181 gynecologic cancer survivors receiving care at the University of Minnesota between 2017 and 2020 who completed PTSD DSM-V surveys to self-report their symptoms of PTSD and provided saliva samples. DNA samples were genotyped for 11 SNPs in 9 genes involved in dopaminergic, serotonergic, and opioidergic systems previously associated with risk of PTSD in populations without cancer. RESULTS: Most participants had either ovarian (42.5%) or endometrial (46.4%) cancer; fewer had cervical (7.7%) or vaginal/vulvar (3.3%) cancer. Two SNPS were identified as statistically significantly associated with higher PTSD scores: rs622337 in HTR2A and rs510769 in OPRM1. CONCLUSIONS: Genetic variation likely plays a role in development of PTSD. HTR2A is involved in the serotonin pathway, and OPRM1 is involved in the opioid receptor pathway. This information can be used by oncologic providers to identify patients at greater risk of developing PTSD and may facilitate referral to appropriate consultants and resources early in their treatment.

"You start feeling comfortable, you just start sharing:" A qualitative study of patient distress screening in Black and White patients with endometrial cancer.

OBJECTIVES: Black patients with endometrial cancer are less likely to express distress and receive referrals for support services compared to White patients. We aim to characterize patient perceptions of the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), a common distress screening tool, among Black and White patients with endometrial cancer and determine strategies to improve equity in referral to appropriate support services. METHODS: We conducted semi-structured interviews with 15 Black and 15 White patients with endometrial cancer who reported varying levels of distress on the NCCN DT & PL. Interviews were audio-recorded, transcribed, evaluated through staged content analysis, and salient themes were compared by patient race. RESULTS: The NCCN DT & PL was generally considered understandable, however the word "distress" could be alienating to participants who considered their stress to be less "drastic." Black participants mentioned fewer negative emotions such as worry and sadness in describing distress and spoke more often of a positive outlook. Additionally, Black participants emphasized the importance of relationship-building with clinicians for open communication on the NCCN DT & PL and clinical encounter. Finally, participants were divided on whether they would alter the way they completed the NCCN DT & PL given more information on cut off scores for referrals, but generally expressed a desire for more direct offers of support services. CONCLUSIONS: Relationship-building, open communication around emotion, and longitudinal direct offers of support emerged as avenues to reduce inequities in referral to supportive services for patients with endometrial cancer.

Real-World Implementation of Best-Evidence Cancer Distress Management: Truly Comprehensive Cancer Care.

BACKGROUND: Cancer distress management is an evidence-based component of comprehensive cancer care. Group-delivered cognitive behavioral therapy for cancer distress (CBT-C) is the first distress treatment associated with replicated survival advantages in randomized clinical trials. Despite research supporting patient satisfaction, improved outcomes, and reduced costs, CBT-C has not been tested sufficiently within billable clinical settings, profoundly reducing patient access to best-evidence care. This study aimed to adapt and implement manualized CBT-C as a billable clinical service. PATIENTS AND METHODS: A stakeholder-engaged, mixed-methods, hybrid implementation study design was used, and the study was conducted in 3 phases: (1) stakeholder engagement and adaptation of CBT-C delivery, (2) patient and therapist user testing and adaptation of CBT-C content, and (3) implementation of practice-adapted CBT-C as a billable clinical service focused on evaluation of reach, acceptability, and feasibility across stakeholder perspectives. RESULTS: A total of 40 individuals and 7 interdisciplinary group stakeholders collectively identified 7 primary barriers (eg, number of sessions, workflow concerns, patient geographic distance from center) and 9 facilitators (eg, favorable financial model, emergence of oncology champions). CBT-C adaptations made before implementation included expanding eligibility criteria beyond breast cancer, reducing number of sessions to 5 (10 total hours), eliminating and adding content, and revising language and images. During implementation, 252 patients were eligible; 100 (40%) enrolled in CBT-C (99% covered by insurance). The primary reason for declining enrollment was geographic distance. Of enrollees, 60 (60%) consented to research participation (75% women; 92% white). All research participants completed at least 60% of content (6 of 10 hours), with 98% reporting they would recommend CBT-C to family and friends. CONCLUSIONS: CBT-C implementation as a billable clinical service was acceptable and feasible across cancer care stakeholder measures. Future research is needed to replicate acceptability and feasibility results in more diverse patient groups, test effectiveness in clinical settings, and reduce barriers to access via remote delivery platforms.

Distress screening in endometrial cancer leads to disparity in referral to support services.

OBJECTIVES: Racial disparities in survival from endometrial cancer (EC) are well known. Cancer distress has also been associated with worse clinical outcomes. We characterized the association between race/ethnicity, patient distress reported on the National Comprehensive Cancer Network Distress Thermometer and Problem List (NCCN DT & PL), referral to support services, time to surgery, and acceptance of adjuvant therapy in patients with EC. METHODS: We included patients presenting at an academic gynecologic oncology practice from 1/2013-6/2020 who had not received prior EC-directed treatment. Demographics, NCCN DT scores, and treatment details were abstracted from the electronic medical record. Difference in initial DT scores by race/ethnicity and treatment type was tested using general linear modeling. The significance of interaction effects was tested using linear mixed models and logistic regression. RESULTS: 393 non-Hispanic White (NHW) and 134 non-Hispanic Black (NHB) patients were included. Median distress scores were higher in NHW patients compared to NHB patients (4 vs. 2, p < 0.001); 51% of NHW patients qualified for referral to support services compared to 40% of NHB patients (p = 0.03). Distress scores were highest at initial appointment and declined over time in NHW patients regardless of treatment, but were initially low and remained low over time in NHB patients. There was no association of initial distress score with time to surgery or acceptance of adjuvant treatment (p-values >0.25). CONCLUSIONS: An observed difference in NCCN DT leads to racial disparities in referral to support services. The NCCN DT may not adequately measure distress in NHB women with EC.

Parents' acceptance and regret about end of life care for children who died due to malignancy.

PURPOSE: To analyse the preference of end of life care place in paediatric oncology patients, and to understand the end of life care needs and regrets among the care givers. METHOD: This was an observational qualitative study. Parents of in-curable paediatric malignancy patients who died during the years 2016-2018 were interviewed using a pre-formed open-ended questionnaire. Fears during the last phase of child's life, most disturbing symptoms, choice of end of life care plan, regret of care givers and reasons for such choices were noted and analysed. RESULT: Twenty six families were interviewed. A median of 3 months of discordance was noted between declaration of in-curability and acceptance of the same by the family. During terminal months, pain (84.62%) was described as the most bothersome symptom followed by respiratory distress (73.08%). Eighteen families (69%) opted for home-based terminal care, 8 (31%) for hospital-based terminal care. Regret of choice was noted in 62.5% families of the hospital-based care group (separation from home environment being the main reason) and 38.89% of the home-based care group (lack of access to health care personnel and pain medication being the main reasons). CONCLUSION: Home-based care is the preferred option for end of life care by the care givers. Lack of community-based terminal care support system and availability of analgesics are the main areas to work on in India.

Recover your smile: Effects of a beauty care intervention on depressive symptoms, quality of life, and self-esteem in patients with early breast cancer.

OBJECTIVE: Medical cancer treatment is often accompanied by appearance-related side effects such as hair loss, skin irritation, and paleness, which can subsequently lead to psychosocial distress. Initial evidence suggests that beauty care interventions may reduce distress and improve quality of life (QoL), body image, and self-esteem immediately. METHODS: We investigated the effects of a brief beauty care intervention on self-reported symptoms of depression, quality of life, body image, and self-esteem in 39 female primary breast cancer patients with appearance-related treatment side effects. Patients were randomly assigned either to an immediate intervention group (IG) or to a wait-list control (WL). The intervention consisted of a single-session group makeup workshop, a photo shooting, and of receiving professionally edited portrait and upper-body photos. RESULTS: While groups did not differ regarding any measure at the pretreatment baseline assessment, IG patients reported less symptoms of depression, higher QoL, and higher self-esteem compared with baseline and compared with WL. Follow-up at 8 weeks indicated moderate stability of these improvements. CONCLUSIONS: In contrast to previous research, results indicate beneficial short-term and midterm effects of beauty care on psychological outcomes in patients with early breast cancer. These results emphasize the utility of this type of brief, low-cost intervention in women undergoing medical cancer treatment in order to improve their well-being.

Cancer and treatment distress psychometric evaluation over time: A BMT CTN 0902 secondary analysis.

BACKGROUND: Routine monitoring of cancer-related distress is recognized as essential to quality care and mandated by a major accrediting organization. However, to the authors' knowledge, few cancer-specific measures have been developed to date to assess the multiple cancer-related factors contributing to this distress. In the current study, the authors examined the psychometric properties of the Cancer and Treatment Distress (CTXD) measure over time in hematopoietic cell transplantation (HCT) recipients. METHODS: As a secondary analysis of a multicenter randomized controlled clinical trial, adult patients undergoing autologous or allogeneic HCT completed patient-reported outcomes including the CTXD and the Medical Outcomes Study Short Form-36 (SF-36) before transplantation and 100 days and 180 days after HCT. RESULTS: Across 21 transplantation centers, a total of 701 patients consented, underwent transplantation, and were included in the current analyses, 645 of whom were alive at 100 days and 618 of whom were alive at 180 days. Internal consistency reliability was found to be strong for the overall CTXD at the 3 time points: Cronbach alphas (α) were .94, .95, and .95, respectively. Subscale reliability met hypothesized levels of an α>.70 across time, with the lowest reliability noted for the Identity subscale at 180 days (α = .77). Correlations with the SF-36 Mental Health subscale were higher than with the Physical Functioning subscale at each time point, thereby supporting convergent and discriminant validity. Strong correlations of the pretransplantation CTXD with the posttransplantation CTXD and SF-36 Mental Health subscale supported predictive validity. CONCLUSIONS: The CTXD is reliable and valid as a measure of cancer distress both before and after HCT. It may be a useful tool for measuring dimensions of distress and for defining those patients requiring treatment for distress during and after transplantation. Cancer 2017;123:1416-1423. © 2016 American Cancer Society.

Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer.

BACKGROUND: Clinically significant levels of fear of cancer recurrence (FCR) affect up to 49% of cancer survivors and are more prevalent among women. FCR is associated with psychological distress, lower quality of life, and increased use of medical resources. Despite its prevalence, FCR is poorly addressed in clinical care. To address this problem, we first developed, and pilot tested a 6-week, 2 h, Cognitive-existential group intervention therapy that targeted FCR in survivors of breast or gynecological cancer. Following the positive outcome of the pilot, we are now testing this approach in a randomized clinical trial (RCT). Goal and hypotheses: This multicenter, prospective RCT aims to test the efficacy of the intervention. The study hypotheses are that, compared to a control group, cancer survivors participating in the intervention (1) will have less FCR, (2) will show more favorable outcomes on the following measures: cancer-specific distress, quality of life, illness uncertainty, intolerance of uncertainty, perceived risk of cancer recurrence, and coping skills. We further postulate that the between-group differences will persist three and 6 months post-intervention. METHODS: Sixteen groups of seven to nine women are being allocated to the intervention or the control group. The control group receives a 6-week, 2 h, structurally equivalent support group. We are recruiting 144 cancer survivors from four hospital sites in three Canadian cities. The sample size was based on the moderate pre/post-test changes found in our pilot study and adjusted to the drop-out rates. MEASUREMENTS: The primary outcome, FCR, is measured by the Fear of Cancer Recurrence Inventory. Secondary outcomes measured include cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, coping, and quality of life. We use reliable and recognized valid scales. Participants are to complete the questionnaire package at four times: before the first group session (baseline), immediately after the sixth session, and 3 and 6 months post-intervention. ANALYSIS: In the descriptive analysis, comparison of group equivalent baseline variables, identification of confounding/intermediate variables and univariate analysis are planned. Each participant's trajectory is calculated using Generalized Estimating Equation models to determine the time and group effects, after considering the correlation structures of the groups. An intent-to-treat analysis approach may be adopted. DISCUSSION: Our Fear of Recurrence Therapy (FORT) intervention has direct implications for clinical service development to improve the quality of life for patients with breast (BC) and gynecological cancer (GC). Based on our pilot data, we are confident that the FORT intervention can guide the development of effective psychosocial cancer survivorship interventions to reduce FCR and improve psychological functioning among women with BC or GC. TRIAL REGISTRATION: Dr. Christine Maheu registered the trial with ISRCTN registry (Registration number: ISRCTN83539618, date assigned 03/09/2014).

Changes in psychological adjustment over the course of treatment for breast cancer: the predictive role of social sharing and social support.

BACKGROUND: Although research on social sharing suggests it could be an important factor in subsequent adjustment, it has rarely been examined in combination with the nature of the support received by patients. The goal of this study was to determine whether and to what extent social sharing concerning the disease and perceived social support after breast surgery explain psychological adjustment at the end of the treatment. METHODS: One hundred two participants were recruited consecutively at a large cancer care center (Gustave Roussy, France). After surgery (T1) and at the end of the adjuvant treatment (T2), patients responded to self-report questionnaires assessing psychological adjustment (depressive symptoms and cancer-related distress), social sharing concerning the illness, and perceived social support (generic and cancer specific). RESULTS: When the initial levels of adjustment were controlled for, hierarchical multiple regression models showed that greater instrumental support at T1 accounted for favorable changes in depressive symptoms at T2. In contrast, the perception of aversive attitudes in the environment and the avoidance of social sharing explained an increase in intrusive cancer-related thoughts. CONCLUSION: The results suggest a negative impact of aversive attitudes from the environment on adjustment during treatment. It also confirms the importance of practical aspects of social support after surgery. In line with Lepore theory, sharing about the illness in a supportive environment may be of primary importance in the cognitive processing of cancer and thus may promote adjustment. These results have original implications for the counseling of patients and their relatives.

Performance of Distress Thermometer: A Study among Cancer Patients.

BACKGROUND: The Distress Thermometer accompanied with Problems List is a commonly used screening tool for psychosocial distress. However, it's cut-off score, performance and risk factors for psychosocial distress varies among studies. This is the first study conducted in Nepal to investigate the Distress Thermometer's screening properties, its optimal cut-off score and evaluating the prevalence of psychosocial distress and its risk factors. METHODS: This cross-sectional study enrolled 162 heterogeneous cancer patients. The English form of the Distress Thermometer was translated to Nepali using a forward and backward translation method. Questionnaires including socio-demographic, clinical characteristics, the Hospital Anxiety and Depression Scale and Distress Thermometer accompanied with Problems List were filled. Receiver Operating Characteristic analysis of distress thermometer scores was evaluated against Hospital Anxiety and Depression Scale-Total (≥15). An Area Under the Curve, sensitivity, specificity, positive predictive value and negative predictive value were calculated at each Distress Thermometer cut-off score. RESULTS: Receiver Operating Characteristic analysis showed an excellent discriminating performance (Area Under the Curve =87.4%). A cut-off score of 4 on Distress Thermometer was established and it yielded sensitivity (88.9%), specificity (71.1%), positive predictive value (75.4%) and negative predictive value (86.5%) respectively. Furthermore, 55.6% of participants were distressed and emotional problems (odd ratio = 28.00), practical problems (odd ratio = 12.152) and physical problems (odd ratio = 2.397) were found to be significant risk factors for PD. CONCLUSIONS: PD is a global burden in cancer patients. The DT with a cut-off score of 4 accompanied with PL is valid instrument for screening PD in Nepali cancer patients. PL identified the problems that causes of PD.

Organizing Psycho-Oncological Care for Cancer Patients: The Patient's Perspective.

BACKGROUND: Cancer patients often suffer from psychological distress during or after cancer treatment, but the use of psycho-oncological care among cancer patients is limited. One of the reasons might be that the way psycho-oncological care is organized, does not fit patients' preferences. This study aimed to obtain detailed insight into cancer patients' preferences regarding the organization of psycho-oncological care. METHODS: 18 semi-structured interviews were conducted among cancer patients. Patients completed psycho-oncological treatment between 2015 and 2020 at the psychology department in a general hospital or a center specialized in psychological cancer care in the Netherlands. The interview comprised questions related to preferences regarding the institute where to receive treatment, the psychologist who provides treatment, and the type of treatment, as well as questions related to experienced barriers and facilitators to receive psycho-oncological care. Interviews were digitally recorded and transcribed verbatim. Data were analyzed individually by two coders into key issues and themes. RESULTS: Regarding the institute, easy accessibility and prompt availability of psychol-oncological care were considered important. Regarding the psychologist, most participants had a strong preference to be treated by a psychologist specialized in cancer or other somatic diseases. Individual face-to-face therapy was preferred above other types of treatment. Several barriers were mentioned to receive psycho-oncological treatment, among which poor accessibility to psycho-oncological care, lack of knowledge on the possibilities for psycho-oncological treatment, and stigma. Most frequently mentioned facilitators were being assertive to ask for help, having a good relationship with the healthcare professional, and the integration of psycho-oncological support within medical cancer care. CONCLUSION: From the patient's perspective, the organization of psycho-oncological care for cancer patients should focus on easy accessibility and availability, delivered by specialized psychologists, and integration in medical cancer care. Online and group therapy are acceptable, but individual face-to-face therapy is preferred. It is warranted to increase awareness on psycho-oncological care targeting both patients and healthcare providers.

Psychosocial and Functional Distress of Cancer Patients in A Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Global burden of cancer is witnessing an exponential increase. Nepal is no exception. In the recent years, cancer care has seen a focus shift towards holistic healing. This includes screening and assessing for psychosocial distress, allowing health care providers to deliver timely psychological interventions. The goal of this study was to find the prevalence of psychosocial and functional impact of cancer diagnoses in Nepal. METHODS: A descriptive cross-sectional study was carried out on 169 cancer patients attending out-patient department, day-care and in-patient department at B.P. Koirala Memorial Cancer Hospital, Nepal. National Comprehensive Cancer Network Distress Thermometer was used to evaluate spiritual/religious concerns, practical, family, emotional and physical issues and the distress score of these patients. RESULTS: One-hundred and thirty eight (81.7%) of respondents had a Distress Thermometer score of ≥4. Distress Thermometer score of 7 was reported by the largest number of patients. Highest average Distress Thermometer scores were found in patients with hepatobiliary, head & neck and lung cancers. More than 50% of the patients reported to experience spiritual or religious concerns, fatigue, pain, worry and insurance or financial related concerns. Pain, sadness, worry and spiritual/religious concerns were significantly associated with distress levels. Sixty-two (36.7%) of respondents were in stage IV of cancer. Average Distress Thermometer score for patients in stage IV cancer was 5.69, the highest among all cancer stages. Ninety-six (56.8%) of the respondents were females, 73 (43.2%) were males. Gynaecological, haematological, gastrointestinal, head & neck and breast cancers were the top 5 cancer types. CONCLUSIONS: Cancer patients in Nepal have clinically significant psychosocial issues that directly impact on their distress.

Psychosocial interventions in breast cancer survivorship care.

Cancer distress screening and subsequent referral for psychosocial intervention has been mandated for continued cancer center accreditation. Increasing emphasis is being placed on the referral component of this mandate, ensuring that patient distress is not only identified but also effectively treated. Many evidence-based interventions exist for cancer distress. Specific interventions can effectively target biopsychosocial impacts of stress and promote adaptive coping, focusing on problem-solving, social support utilization, assertive communication, sexual health and intimacy, adherence to medical and supportive care recommendations, health behavior change, and emotional processing and expression. In randomized clinical trials, specific interventions have also been associated with biological improvements, including neuroendocrine and immune functioning, decreased rates of breast cancer recurrence, and improved survival rates. As cancer treatments advance and patients live longer, it is pertinent to treat the impacts of breast cancer with evidence-based interventions.

Scan-associated distress in lung cancer: Quantifying the impact of "scanxiety".

OBJECTIVES: Diagnostic imaging may be a major source of cancer-related distress, a condition known as "scanxiety". Scant scholarly work has been performed to evaluate scan-associated distress in cancer. We sought to characterize risk factors for scan-associated distress among patients with Non-Small Cell Lung Cancer (NSCLC), and to evaluate the impact of scan-associated distress on quality of life. MATERIALS AND METHODS: We conducted a cross-sectional survey study of patients with recurrent/metastatic NSCLC treated at an academic medical center. Clinical and demographic variables were obtained through chart abstraction and patient self-report. We used a modified version of the Impact of Event Scale 6 (IES-6) to specifically assess distress associated with scans, and quality of life was measured using the Functional Assessment of Cancer Therapy - Lung (FACT-L). RESULTS: Among 103 participants (survey response rate 76.3%), median age was 67, 61.2% were women, and 82.5% were white. At the study visit, 72.8% of subjects discussed a recent scan, and 83% reported some scan-associated distress. Scan-associated distress was not associated with whether the patient had a recent scan, progressive disease or time from diagnosis. Scan-associated distress was associated with impaired quality of life (p=0.004); each unit increase in IES-6 corresponded to an approximately one-unit decrease in FACT-L score. CONCLUSION: Scan-associated distress is a common problem among patients with NSCLC, and is associated with impaired quality of life. Scan-associated distress severity was not associated with time since diagnosis or whether a recent scan was discussed at the study visit, which implies scan-associated distress may be a persistent problem.

Distress e enfrentamento: da teoria à prática em psico-oncologia / Distress and coping: from theory to practice in psychoonchology

Ante o diagnóstico de câncer, o equilíbrio psicológico de muitos pacientes passa a ser ameaçado pelo medo da morte e pelas dificuldades que a doença e seus tratamentos podem desencadear. Aqueles que têmhabilidades adaptativas de enfrentamento poderão alcançar melhor ajustamento psicológico. Por outro lado, pacientes que avaliam as demandas do contexto de adoecimento como elevadas e ou que seusrecursos de enfrentamento são limitados, tendem a experimentar nível elevado de distress e apresentar respostas desadaptativas que contribuem para a deterioração do ajustamento psicológico. No presenteartigo, as autoras discorrem sobre os conceitos de distress e de enfrentamento no contexto da oncologia e apresentam intervenções psicossociais utilizadas para auxiliar no processo de adaptação ao adoecimento.

The psychological balance of many patients who are diagnosed with cancer is jeopardized by the fear of death and the difficulties that the disease and its treatments can impose. Those who have adaptive coping skills may achieve better psychological adjustment. On the other hand, patients who consider the demands of the illness high and/or their coping resources limited tend to experience a high level of distress and presentmaladaptive responses, which may contribute to the deterioration of their psychological adjustment. In this paper the authors discuss the concepts of distress and coping in the context of oncology and present psychosocial interventions used to assist these patients in the process of adaptation to the illness.

Seguimento das diretrizes terapêuticas e adesão à farmacoterapia no tratamento da asma / Compliance with guidelines and adherence to pharmacotherapy in the treatment of asthma

Verificar o seguimento das diretrizes terapêuticas e a adesão Farmacoterapêutica em ambulatório de hospital público terciário do DistritoFederal, Brasil.

To investigate compliance with therapeutic guidelines and adherence to pharmacotherapy in an outpatient unit of a tertiary public hospital in theFederal District of Brazil.