Psychosocial care for cancer survivors: A global review of national cancer control plans.

OBJECTIVE: National Cancer Control Plans (NCCPs) are high-level policy documents that prioritise actions to be taken to improve cancer control activities. As the number of cancer survivors grows globally, there is an urgent need to assess whether and how psychosocial care across the cancer care continuum is included in NCCPs. This review aimed to ascertain the extent to which NCCPs referenced psycho-oncology care for cancer survivors in the post-treatment phase. METHODS: NCCPs were obtained from the International Cancer Control Partnership (ICCP) portal (in November 2021) and reviewed in two phases. In Phase 1, all available NCCPs were screened to determine whether they mentioned psycho-oncology or survivorship. In Phase 2, reviewers extracted data from the NCCPs identified in Phase 1 on the degree that each plan articulated objectives/goals to improve psychosocial care in the post-treatment survivorship phase. RESULTS: We screened 237 NCCPs. Of these, initial potential reference to psycho-oncology and survivorship content were identified in 97 plans (41%). In Phase 1, 57/97 (59%) had reference to psycho-oncology or survivorship content within defined criteria. In Phase 2, 27/97 (28%) had little mention of psycho-oncology specifically in survivorship, 47/97 (48%) had some (general or brief) mention, and the remaining 23/97 (24%) had substantial content/specific sections and clearly articulated goals and/or objectives. Common goals for improving psychosocial care in the post-treatment period included building capacity of healthcare professionals, implementing rehabilitation models, and increasing the utilisation of community services. CONCLUSIONS: Most NCCPs did not reference psycho-oncology and only one-quarter contained clear objectives specifically in the post-treatment survivorship phase.

European Groundshot-addressing Europe's cancer research challenges: a Lancet Oncology Commission.

Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.

Normative values for the distress thermometer (DT) and the emotion thermometers (ET), derived from a German general population sample.

PURPOSE: The distress thermometer (DT) and the emotion thermometers (ET) are short screening instruments for use in oncological practice. The aim of this study was to provide normative values and to analyze the correlational structure of the ET. METHODS: A representative sample of the adult German general population (N = 2437) completed the ET, the PHQ-4, the FACIT-fatigue scale, and the demoralization scale. RESULTS: The percentages of people above the cutoff (≥ 4) and the mean scores of the five ET scales were as follows: distress: 39.0%, M = 3.15 ± 2.62, anxiety: 12.3%, M = 1.36 ± 1.93, depression: 16.1%, M = 1.65 ± 2.11, anger: 24.5%, M = 2.33 ± 2.16, and need for help: 10.7%, M = 1.18 ± 1.90. Women reported significantly higher levels of burden than men, with effect sizes between 0.07 (anger) and 0.36 (anxiety). All ET dimensions were interrelated (r between 0.44 and 0.69) and significantly correlated with the other scales (r between 0.36 and 0.68). CONCLUSIONS: The normative scores can help qualify assessments of groups of patients. The new four dimensions of the ET provide relevant additional information that is not already covered by the DT.

Are male cancer patients more affected by losing their jobs than female patients? Gender as a moderator of the relationship between losing the job and well-being in a sample of Romanian cancer patients.

PURPOSE: Research indicates the heightened need of cancer patients to return to work, which would be beneficial for their emotional/mental health and well-being. The major aim of this study was to identify the overall effect of losing the job upon different dimensions of well-being, and possible gender differences related to this influence. METHODS: A sample of 800 Romanian cancer patients was screened in 2014 (461 female and 338 male). RESULTS: Our results indicate that losing one's job after being diagnosed with cancer affects male more than female patients on the physical, emotional, and functional dimensions of well-being. Furthermore, male patients perceive a higher level of interference between illness/treatment and paid work than female patients, and perceive themselves less able to work than female cancer patients. Also the fulfillment derived from work perceived by male patients is lower than that of female cancer patients. CONCLUSION: Counselors and therapists should focus on enlarging the patients' pool of alternative sources of meaning, thus enhancing their well-being and implicitly their clinical recovery.

Does knowledge of diagnosis really affect rates of depression in cancer patients?

Significant levels of distress usually accompany the entire cancer experience, affecting the patients' general functioning and adaptation to illness. OBJECTIVE: The major objective of the present study was to investigate potential demographic and intrapersonal moderators of the relationship between knowing the cancer diagnosis and the level of depression experienced. METHOD: The present research has a transversal comparative repeated cross-sectional design (2006-2014), sampling following the proportional quota method. Research was conducted in the four major oncological institutes in Romania, obtaining a national sample of cancer patients, maintaining gender and ethnic rates, and permitting the investigation of the stability of the results from one assessment to the other. RESULTS: Results indicate that in the Romanian context, knowing the diagnosis is associated with a lower level of depression than not knowing the diagnosis, the results being similar in both assessments (2006-2014). Furthermore, from the explored demographic factors (gender, residence, age, and education), only age has a main effect upon depression (depression increasing with age), while education is the only factor from those analyzed, which has a moderator effect. Regarding the analyzed intra-individual variables, only dysfunctional attitudes, emotion-focused coping, and lack of emotional support from the family (loneliness) have main effects upon the level of depression (i.e., higher levels of dysfunctional attitudes, emotion-focused coping, and loneliness are associated with higher levels of depression), while neither of them has a moderator effect on the relationship between knowing the diagnosis and depression. CONCLUSION: These results are important in the improvement of the doctor-patient relationship, the management of cancer-related distress, and implicitly for the course of illness. Copyright © 2016 John Wiley & Sons, Ltd.

In search of the sixth vital sign: cancer care in Romania.

PURPOSE: Romania still has to adapt and develop psychosocial assessment protocols which would allow standardized screening for the sixth vital sign in cancer patients, namely distress and quality of life. The present study screens for the psychosocial and communication needs of cancer outpatients in palliative care and in rehabilitation. These data are also compared with those obtained from a sample of cancer inpatients. METHODS: Subjects for this study were recruited from cancer care services from the Transylvania region in Romania. A total of 203 persons with cancer were included in the screening. Of this number, 68 were in the hospitalized group, 71 were from the rehabilitation group, and 64 were palliative care cases. FACT-G 4.0 and BDI screening instruments were used in these clinical samples. Statistical analysis performed was: associational and comparative statistics, one-way analysis of variance. RESULTS: Statistically and clinically significant results were found in relation to symptoms of depression, physical and functional well-being, and overall quality of life. However, with regard to psychosocial well-being, there were no clinically relevant or significant differences among cancer patients under hospital treatment, or in rehabilitation and palliative care programs. More than 40 % of the cancer patients included in our pilot screening were not open to talk about their illness and their related needs. CONCLUSIONS: Cancer is an unmet psychosocial challenge to patients and to the specialized services, regardless of care type. The urgency of psychosocial screening in the Romanian cancer care system is revealed. Based on these findings, there is a need for psychosocial screening and related supportive care services that need to be integrated into Romania's cancer care programs. A recommendation is to pilot psychosocial and supportive care model within the four regional cancer care institutions.

A review of drug prevention system development in Romania and its impact on youth drug consumption trends, 1995-2005.

ISSUES: A tremendous growth occurred in the reported drug use and abuse in Romania from 1995 to 1999. Lack of concern by government and little policy attention contributed to the surprising delay of drug policy and drug prevention system development. General public stigmatize drug users and drug consumption is considered a matter of personal fault and responsibility. There is some but not sufficient research and evaluation on drug use, abuse problem. APPROACH: Drug use, abuse and prevention are discussed from research-based, user-focused and prevention system development perspectives. Prevalence and trends of drug use, abuse in the past decade (1995-2005) are summarized. Prevention issues are discussed based on research data from adolescents, parents and teachers. The Romanian primary drug prevention system has been evaluated based on our experiences in drug use prevention activities carried out in schools and recreational environments. KEY FINDINGS: Public and scientific perspectives on drug consumption in Romania, between 1995 and 1999, were dominated by an idealistic, non-realistic perception. Since 1995, drug use among adolescents increased almost four times in less than 4 years. The first law against drug traffic and consumption was issued only in 2000. Now primary drug prevention strategies are in action, but in general they are lacking standard evaluation procedures. IMPLICATIONS/CONCLUSION: Conclusions are drafted for new perspectives in prevention activities. More long-term, user-focused, demand-centred prevention activities should be carried out in more and more diversified settings and evaluation should be thoroughly considered.

Non-disclosure of cancer diagnosis: an examination of personal, medical, and psychosocial factors.

OBJECTIVES: In recent psycho-oncological literature, few studies are concerned with the consequences of cancer diagnosis non-disclosure. The aims of this study were to analyze factors that may explain the non-disclosure of cancer diagnosis to patients by physicians and to compare personal characteristics of cancer patients, on the basis of cancer diagnosis disclosure versus non-disclosure. METHODS: A total of 420 hospitalized cancer patients were included in our study; 342 with malignant and 78 with benign tumors. Two hundred thirty-eight women and 185 men completed a self-report questionnaire that included standardized measures of depressive symptoms (BDI), hopelessness, ways of coping, negative life events and anomie. Data were controlled for demographic, medical, and psychosocial factors. RESULTS: Malignant cancer (OR:11.88), severe and moderate depression (OR:10.57 and OR:4.81), lack of chemotherapy (OR:4.20) and low anomie (OR:2.77) after overall adjustment predicted cancer diagnosis non-disclosure to patients. CONCLUSION: Our results underline the persistent need for delivering patient-focused health services in oncological care based on respect for the patients' right to autonomy.

[Analysis of the effectiveness of psychologic interventions in oncology regarding the quality of life and survival of cancer patients]. / Onkopszichológiai beavatkozások hatékonyságvizsgálata a daganatos betegek életminösége és túlélési esélye szempontjából.

Psychotherapy and psycho-social interventions in oncological rehabilitation, based on confirmed results of several controlled studies designed and conducted in a bio-psycho-social research framework, have been proved to reduce the psycho-social vulnerability of cancer patients and to enhance health related quality of life in this patient population. It is also supposed that psychological intervention increases survival outcomes of cancer patients through immune-modulation. Findings of psycho-neuro-immunological research have underlined that the human neurological and immunological system, mainly the NK, CD4 and CD8 cell activity and cytotoxicity, are mediators and modulators in the progress of malignant tumors. Positive outcomes of psycho-social rehabilitation in oncology reinforce not only its effectiveness in reducing stress and anxiety, strengthening active coping mechanisms and immune functions, and improving quality of life but also its cost-effectiveness in view of relatively low investment and the high, multiplied health related benefits.