Ajuste y adaptación psicosocial de adultos jóvenes supervivientes de un cáncer en etapa pediátrica: Revisión sistemática / Psychosocial adjustment and adaptation in young adults surviving pediatric cancer: A systematic review

Introducción: Los efectos a largo plazo de tumores en la infancia pueden alterar la trayectoria de adaptación y ajuste psicosocial de los supervivientes en etapas de vida posteriores. Objetivo: Esta revisión sistemática se centra en analizar las experiencias de crecimiento postraumático, estrés postraumático, malestar emocional y dificultades psicosociales sufridas por jóvenes adultos supervivientes a un cáncer en etapa pediátrica. Resultados: Los resultados sugieren una trayectoria mayoritaria que podría definirse como adaptativa, en la que se observa tanto crecimiento postraumático (prevalencia superior al 60%), como síntomas de estrés postraumático (prevalencia inferior al 30%). No obstante, en comparación con población control no oncológica, estos supervivientes tienen mayor riesgo de padecer síntomas de ansiedad y depresión, de alcanzar menores logros educativos y profesionales, y de permanecer solteros o vivir solos, lo que se hipotetiza que podría estar relacionado con las secuelas de cada tipo de tumor y tratamiento, y no únicamente con la vivencia de la enfermedad. Conclusiones: La atención a jóvenes adultos supervivientes a un cáncer pediátrico debería centrarse en proporcionar mayor apoyo médico y psicosocial a largo plazo, a través del abordaje interdisciplinar y la atención centrada en la persona, como aproximación que favorezca una trayectoria de ajuste adaptativa.(AU)

Introduction: Long-term effects of childhood tumors can alter the trajectory of adjustment and psychosocial adjustment of survivors later in life. Purpose: This systematic review focuses on analyzing the experiences of posttraumatic growth, posttraumatic stress, emotional distress, and psychosocial difficulties experienced by young adult survivors of pediatric cancer. Results: The results suggest a more prevalent trajectory that could be conceptualize as adaptive, in which both post-traumatic growth (prevalence greater than 50%) and post-traumatic stress symptoms (prevalence less than 30%) are observed. However, compared to the non-oncology control population, these survivors are at higher risk for anxiety and depressive symptoms, lower educational and occupational attainment, and remaining single or living alone, which is hypothesized to be related to the sequelae of each tumor type and treatment, and not just the disease experience. Conclusions: Care for young adult survivors of pediatric cancer should focus on providing enhanced long-term medical and psychosocial support through an interdisciplinary approach and person-centered care as an approach that supports a trajectory of adaptive adjustment.(AU)

Sobrecarga, afrontamiento y soporte social en progenitores de niños con cáncer / Caregiver burden, coping and social support in parents of children with cancer

Objetivo: Analizar la relación entre las estrategias de afrontamiento, el soporte social, las características de padres cuidadores migrantes y sus niños con cáncer en la sobrecarga del cuidador de dichos padres. Método: Participaron 82 cuidadores (67 madres y 15 padres) en condición de bajo recursos que residían en albergues para niños con cáncer y sus cuidadores, quienes migraron a la ciudad para recibir el tratamiento. Se utilizó la Escala de Sobrecarga de Zarit (Zarit et al., 1980), el Inventario de Afrontamiento COPE (Carver et al., 1989) y el Cuestionario MOS de apoyo social (Sherbourne y Stewart, 1991). Resultado: Se realizaron dos modelos de regresión para evaluar el impacto de las variables demográficas y psicológicas en la carga del cuidador, el primer modelo involucra la escala global de apoyo social (R2 ajustado=,43, F=9,73, p<,001) y el segundo las escalas específicas (R2 ajustado=,45, F=8,23, p<,001). Los resultados evidencian el rol predictivo de las estrategias de afrontamiento como la aceptación, la reinterpretación positiva y enfocar y liberar emociones; el soporte social global y de tipo afectivo; y características sociodemográficas como el nivel de instrucción del progenitor y la edad del hijo en la sobrecarga del cuidador. La mayoría de estas variables tienen una relación inversa con la sobrecarga. Conclusiones: Los resultados del estudio subrayan la importancia de investigar la sobrecarga del cuidador en situación de vulnerabilidad. Además, el estudio destaca la relevancia de factores como las estrategias de afrontamiento y el apoyo social, que desempeñan un papel clave en la sobrecarga del cuidador.(AU)

Aim: To analyze the relationship between coping strategies, social support, characteristics of migrant parent caregivers and their children with cancer on caregiver overload of such parents. Zarit Burden Interview (Zarit et al., 1980), the COPE Inventory (Carver et al., 1989) and the MOS Social Support Questionnaire (Sherbourne y Stewart, 1991) were used. Method: Eighty-two caregivers (67 mothers and 15 fathers) residing in shelters for children with cancer and their caregivers, who migrated to the city to receive treatment, participated in this study. Results: Two regression models were performed to evaluate the impact of demographic and psychological variables on caregiver burden, the first model involves the global social support scale (R2 adjusted=.43, F=9.73, p<.001) and the second the specific scales (R2 adjusted=.45, F=8.23, p<.001). Results: There is evidence the predictive role of coping strategies such as acceptance, positive reinterpretation and growth, focus and venting of emotions; global and affective social support; and sociodemographic characteristics such as parental level of education and child age in caregiver burden. Most of these variables have an inverse relationship with caregiver burden. Conclusions: The results of the study underline the crucial importance of investigating caregiver burden in the context of vulnerability. In addition, the study highlights the importance of factors such as coping strategies and social support, which play a key role in influencing caregiver burden.(AU)

Alteraciones cognitivas asociadas al tratamiento de hormonoterapia en pacientes con cáncer de mama: una revisión sistemática / Cognitive alterations associated with hormone therapy in patients with breast cancer: A systematic review

Objetivo: determinar las alteraciones cognitivas asociadas al tratamiento de hormonoterapia en pacientes con cáncer de mama. Método: el presente trabajo consiste en una revisión sistemática de estudios experimentales internacionales sobre los efectos de la hormonoterapia en las funciones cognitivas en mujeres con cáncer de mama, siguiendo la declaración PRISMA. Para su selección se han seguido unos criterios metodológicos estrictos, incluyendo únicamente estudios longitudinales con evaluaciones de línea base y/o grupo control. Resultados: a pesar de las discrepancias descritas, los resultados muestran deterioro significativo en memoria verbal, funciones ejecutivas, aprendizaje verbal y velocidad de procesamiento. Conclusiones: de cara a futuras investigaciones se recomienda utilizar unos criterios metodológicos más estrictos y realizar seguimientos a largo plazo, teniendo en cuenta que la media de administración de estos tratamientos oscila entre 5 y 10 años.(AU)

Objective: to determine the cognitive alterations associated with hormone therapy in breast cancer patients. Methods: the present work consists of a systematic review of international experimental studies on the effects of hormone therapy on cognitive functions in women with breast cancer, following the PRISMA statement. Strict methodological criteria were followed for its selection, including only longitudinal studies with baseline and/or control group evaluations. Results: despite the discrepancies described, the results show significant impairment in verbal memory, executive functions, verbal learning, and processing speed. Conclusions: for future research it is recommended to use stricter methodological criteria and to carry out long-term follow-ups, considering that the average time of administration of these treatments’ ranges between 5 and 10 year.(AU)

Quality of life, adherence to voice rehabilitation therapy and psychological variables in patients with head and neck cancer / Calidad de vida, adherencia al tratamiento de rehabilitación de voz y variables psicológicas en pacientes con cáncer de cabeza y cuello

Introduction: Voice problems can affect quality of life (QoL), other psychological aspects, and the adequate adherence to voice rehabilitation therapy. Objective: To determine the association between QoL and treatment adherence (TA) to voice rehabilitation with symptoms of anxiety, depression, and coping strategies. Method: A longitudinal study was conducted with 97 participants with head and neck cancer (H&N) who were attending voice rehabilitation therapy. Instruments: EORTC QLQ-C30 and QLQ-H&N35, Treatment Adherence Checklist, Cancer Coping Questionnaire and HADS. Results: The mean overall QoL was 83.33, and mean TA was 8.80. Lower overall QoL and emotional functioning scores, as well as higher dry mouth scores were associated with higher levels of anxiety. Greater problems with social contact and lower TA were associated to higher depression scores. Conclusion: Consistent with the literature, TA and QoL were associated to depression and QoL was also correlated to anxiety. These results are among the first to explore such aspects in Latino patients and emphasize the importance of multidisciplinary care for H&N cancer patients in voice rehabilitation therapy, given that during their treatment they may encounter psychological barriers that could hinder their progress in voice quality and QoL.(AU)

Introducción: Los problemas de la voz pueden afectar la calidad de vida (CV) y otros aspectos psicológicos, así como la adecuada adherencia a la terapia de rehabilitación de voz. Objetivo: Determinar la relación entre la CV y la adherencia al tratamiento (AT) de rehabilitación de voz con síntomas de ansiedad, depresión y estrategias de afrontamiento. Método: Se realizó un estudio longitudinal en 97 participantes con cáncer de cabeza y cuello (CyC) que asistían a terapia de rehabilitación de voz. Instrumentos: EORTC QLQ-C30 y QLQ-H&N35, Lista de Verificación de Adherencia al Tratamiento, la Escala de Afrontamiento al Cáncer y la HADS. Resultados: La CV global promedio fue de 83.33 y el puntaje promedio de AT fue de 8.80. La calidad de vida global, la función emocional y boca seca se asociaron con la ansiedad. La dimensión de la CV contacto social y la AT tuvieron relación con la depresión. Conclusiones: Consistente con la literatura la AT y la CV tuvieron relación con la depresión y solo la CV se relacionó con la ansiedad. Los resultados presentados son de los primeros en explorar estos aspectos en pacientes latinos y enfatizan la importancia de la atención multidisciplinaria a pacientes con cáncer de CyC en terapia de rehabilitación de voz, dado que en el curso de sus tratamientos pueden encontrar barreras psicológicas que obstaculicen la mejora en la calidad de la voz y la CV.(AU)

Stress and Post-traumatic Growth of people with cancer: identification of associated factors / Estrés y Crescimiento Postraumático de personas con cáncer: identificación de factores asociados

Objectives: Evaluate indicators and identify associated factors of post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) in individuals undergoing oncological treatment. Method: Quantitative, cross-sectional, analytical survey design with a non-probabilistic sample of 74 participants. Six instruments measuring PTSD, PTG, spiritual well-being, illness perception, and social support were employed. Data were analyzed using descriptive and inferential statistics in the Statistical Package for Social Science (SPSS). Results: It was evidenced that 21.60% of patients presented clinical indices of PTSD, and 85.12% showed a high index for PTG. High satisfaction indices were also observed for social support (86.48%), spiritual well-being (95.94%), and in identifying cancer as a potential threat to life (71.57%). Females, unmarried individuals, those inactive or unemployed, and those receiving public health support exhibited higher PTG indices. Women exhibit higher PTSD indices than men. Negative correlations were found between PTSD and spiritual well-being, and positive correlations with illness perception. Illness perception emerged as the variable with the greatest predictive power for PTSD indices. Conclusions: It is concluded that the threatening perception of the illness is a predictor of PTSD, highlighting it as a risk factor that requires attention in health prevention plans.(AU)

Objetivos: Evaluar los indicadores e identificar los factores asociados al trastorno de estrés postraumático (TEPT) y al crecimiento postraumático (CPT) en personas sometidas a tratamiento oncológico. Método: Diseño cuantitativo, transversal, analítico y de encuesta, con una muestra no probabilística compuesta por 74 participantes, utilizando seis instrumentos que miden TEPT, CPT, bienestar espiritual, percepción de la enfermedad y apoyo social, analizados a través de estadísticas descriptivas e inferenciales, en el Programa Estadístico para Ciencias Sociales (SPSS). Resultado: Se evidenció que 21,60% de los pacientes presentaron índices clínicos de TEPT y 85,12% un índice elevado para CPT. También se observaron índices elevados de satisfacción con el apoyo social (86,48%), bienestar espiritual (95,94%) e identificación del cáncer como una posible amenaza a la vida (71,57%). Las personas del género femenino, solteras, inactivas o desempleadas y atendidas por el servicio público de salud presentan mayores índices de CPT. Las mujeres muestran mayores índices de TEPT que los hombres. Se encontraron correlaciones negativas entre TEPT y bienestar espiritual y correlaciones positivas con la percepción de la enfermedad. La percepción de la enfermedad fue la variable con mayor poder predictivo para los índices de TEPT. Conclusiones: Se concluye que la percepción amenazante de la enfermedad es un predictor de TEPT, siendo esta una variable de riesgo que requiere atención en los planes de prevención de daños a la salud.(AU)

Preparación psicológica para radioterapia en paciente con tumor en SNC: presentación de un caso / Psychological preparation for radiotherapy on a patient with a brain tumor: case report

Introducción: los meningiomas forman el 27% de los tumores de encéfalo en población adulta. La radioterapia es uno de los tratamientos para tumores primarios del SNC más efectivos, en el cual se administran altas dosis de radiación que destruye el ADN de las células cancerosas para detener su multiplicación o lentificar su crecimiento. Para este tratamiento es necesaria la inmovilización del paciente, que se asegura por medio de máscaras termoplásticas que fijan al paciente a la camilla del acelerador lineal. Este tipo de inmovilización ha representado una incidencia de ansiedad significativa previa al tratamiento y durante el mismo, puede causar niveles altos de estrés, miedo, malestar físico, dolor e incluso claustrofobia. Tomando en cuenta estos aspectos, como preparación psicológica para el tratamiento se sugiere ofrecer información clara previa y durante la simulación, identificar a los pacientes con niveles altos de ansiedad, y brindar estrategias cognitivas y conductuales para regular la misma. Objetivo: Describir un reporte de caso de preparación para radioterapia en SNC. Método: Se presenta el caso de una mujer de 61 años de edad que fue referida a psico-oncología con el objetivo de la preparación psicológica para radioterapia en SNC. El motivo de la referencia a psico-oncología fue evitar la sedación durante la radioterapia debido a los altos niveles de ansiedad que presentaba la paciente. Se realizaron dos sesiones de preparación psicológica en donde se incluyeron estrategias psicoeducativas, de desensibilización sistemática y respiración diafragmática. Resultados: La paciente disminuyó el reporte subjetivo de ansiedad, logró terminar las 25 sesiones de radioterapia sin necesidad de sedación. Conclusión: La preparación psicológica utilizada en esta paciente fue efectiva para disminuir ansiedad. Es importante realizar estudios aleatorizados y controlados para conocer realmente la efectividad.(AU)

Introduction:Meningiomas represent 27% of brain tumors in adults. Radiotherapy is one of the most frequent treatments for CNS tumors, in which high radiation doses destroy cancer cell’s DNA in order to stop their multiplication or to slow their growth. Patient’s inmovilization is necessary in this treatment, so he has to be attached to treatment bed with a thermogenic mask. This inmovilization has represented significant anxiety prior and during treatment, it can also represent a trigger for stress, fears, physical symptoms, pain and even claustrophobia. Considering this, a psychological preparation is suggested before radiotherapy. It is suggested o include clear information before and during simulation, and to identify patients with high levels of anxiety, and to deliver cognitive and behavioral strategies to regulate it. Aim: to describe a case report of a psychological preparation for CNS radiotherapy. Method: A case of a 61 year old woman who was referred to psycho-oncology service with the aim of psychological preparation for CNS radiation. The reason this patient was referred was to avoid sedation during treatment due to high levels of anxiety. Psychologic preparation consisted in two sessions that included psychoeducational, systematic desensibilization and diaphragmatic breathing strategies. Results: Subjective anxiety report was reduced with psychologic preparation, and the patient finished 25 sessions of radiotherapy without sedation. Conclusion: Psychological preparation in this patient was efective in anxiety reduction. It is important to design randomized controled studies in order to know the effectiveness of these strategies.(AU)

Post-traumatic growth in cancer survivors: What is its extent and what are important determinants? / Crecimiento postraumático en sobrevivientes de cáncer: ¿cuál es su alcance y cuáles son sus determinantes importantes?

Background/Objective: The aim was to investigate the extent and longitudinal determinants of post-traumatic growth (PTG) in cancer survivors. Methods: A sample of 1316 cancer survivors with various cancer types was examined using the EORTC QLQ-FA12 to assess fatigue, the EORTC QLQ-C30 pain items to assess pain and the Patient Health Questionnaire (PHQ-4) to assess emotional distress two years after diagnosis (t0). Additionally, patients rated how well they felt informed about fatigue at t0. PTG was assessed with the 21-item PTG-Inventory four years after diagnosis (t1) comprising the five subdimensions appreciation of life, relation to others, personal strengths, new possibilities and spiritual change. Results: Regarding the extent of PTG, most positive developments were experienced in the PTG subdimension appreciation of life whereas the subdimension spiritual change was the least pronounced domain. Fatigue, pain and emotional distress were longitudinal but non-linear predictors of long-term PTG. Additionally, poor informedness about fatigue was associated with less PTG. Conclusions: PTG can be perceived even years after a traumatic cancer event and is longitudinally associated with common cancer side effects like fatigue, emotional distress and pain. Further research into the role of individuals' informedness contributing to PTG is needed.(AU)

Is it time to discard the Diagnostic and Statistical Manual of Mental Disorders (DSM) in psycho-oncology?

The conceptual basis of psychopathology within cancer survivorship is critical, as the chosen conceptualisation informs assessment and explanatory models, as well as interventions and supportive care approaches. The validity of a chosen conceptualisation of psychopathology is therefore paramount for ensuring cancer survivors receive high-quality and efficacious care and support that can be iteratively improved via coordinated research efforts. In this paper, we discuss the traditional diagnostic approach to conceptualising psychopathology within cancer care, including the diagnostic system the 'Diagnostic and Statistical Manual of Mental Disorders' (DSM) [1], and the significant issues it presents within cancer survivorship. We detail and discuss how an alternate conceptualisation of psychopathology may enhance both research and practice within psycho-oncology. We ultimately pose, and provide our perspective, on the question "Is it Time to Discard the DSM in Psycho-Oncology?"

Finding a needle in a haystack: The identification of clinical practice guidelines for psychosocial oncology through an environmental scan of the academic and gray literature.

OBJECTIVE: Clinical practice guidelines (CPGs) are evidence-based tools well-suited to translate the latest research evidence into recommendations for routine clinical care. Given the rapid expansion of psychosocial oncology research, they represent a key opportunity for informing the treatment decisions of overburdened clinicians, standardizing service delivery, and improving patient-reported outcomes. Yet, there is little consensus on how clinicians can most effectively access these tools and little to no information on the current availability and scope of CPGs for the range of psychosocial symptoms and concerns experienced by patients with cancer. METHOD: Our environmental scan consisted of an academic and gray literature designed to identify currently available CPGs addressing a range of cancer-related psychosocial symptoms. RESULTS: Findings revealed a total of 23 existing psychosocial oncology CPGs that met full eligibility criteria. The gray literature search was found to be more effective at identifying CPGs (n = 22) compared to the academic search (n = 9). CONCLUSION: Several concerns arose from the systematic search. The limited publication of CPGs in peer-reviewed journals may make clinicians and stakeholders more hesitant to implement CPGs due to uncertainties about the methodological rigor of the development process. Further, many existing CPGs are outdated or failed to be updated according to guideline recommendations, meaning that the recommendations may fall short of their purpose to translate up-to-date research findings. FUTURE DIRECTIONS: Future research should seek to systematically assess the quality of existing psychosocial oncology CPGs and shed light on the current state of implementation and adherence in clinical practice in order to better inform guideline developers on the current needs of the psychosocial oncology community.

Core-curriculum in psycho-oncology: Towards the certification of the psycho-oncologist profession.

BACKGROUND: Issues relating to certification of the Psycho-oncology profession require clarification in order to provide high quality comprehensive psychosocial care within oncology. We conducted a survey identifying existing training, professional registration requirements and accreditation programs, at national levels, for the specialty of psycho-oncology as well as the mandatory presence of this specialist in cancer teams. METHODS: This survey was conducted within the International Psycho-Oncology Society Federation of psycho-oncology societies and included representatives of each national federated society and some countries not belonging to the Federation. Survey questions were emailed requesting specific details, from the registered contact person, for each country, about psycho-oncology training, professional registration and accreditation. RESULTS: Of 43 countries contacted (34 Federated and 9 non-federated members), 39 replied and answered the questionnaire (90, 7%). Disparities were reported between countries, with details indicating differences from having no national program, to quite detailed and legally accredited requirements. The majority of countries had no formally recognized profession of "Psycho-oncologist," while some countries reported that it is mandatory (or recommended to have) a specialist in psycho-oncology in cancer centers and, thus, that an accredited, nationally recognized and certified training in this specialty exists. CONCLUSIONS: The study underlines the need to create a curriculum for the specialty (certification and accreditation) for the profession of psycho-oncology. Given the lack of internationally recognized core standards, ideas and proposals for minimum standards of good care and the training required to deliver this, are explored to clarify who may use the designation "Clinical Psycho-oncologist."

Toward implementation of an evidence-based intervention for fear of cancer recurrence: Feasibility in real-world psycho-oncology practice.

OBJECTIVE: Few evidence-based interventions addressing high levels of fear of cancer recurrence (FCR) have been implemented. Understanding how these might be implemented is crucial to bridge the research-practice gap. This study investigated the feasibility of implementing the blended Survivors' Worries of Recurrent Disease (SWORD) intervention in real-world psycho-oncology practice. METHODS: SWORD was offered for 15 months (2021-2022) as the standard care for clinical FCR in a university hospital, a general hospital, and psycho-oncological center. We evaluated using a mixed-methods design six feasibility outcomes based on Bowen's framework: demand, limited effectiveness, degree of execution, acceptability, practicality, and integration. Anonymous data were collected for all oncology patients on referral. Study participants completed questionnaires before and after treatment, including the Cancer Worry Scale (CWS-6) as the primary measure of effectiveness. Qualitative data included interviews with patients and psychologists, and field notes. RESULTS: Regarding demand, 81 of 644 patients referred (13%) were eligible for SWORD. The uptake of SWORD was 79% (n = 63/80) and the completion rate 73% (n = 46/63). SWORD was effective in reducing FCR (p < 0.001, ηp2  = 0.694). Regarding execution, a variability in the length, planning and number of treatment sessions was found between different settings. Adherence to the treatment manual's content was high (89%). Regarding acceptability, most patients were satisfied with SWORD (average 8.2/10) and psychologists valued the blended format. Psychologists reported SWORD was practical to deliver given their knowledge and skills. Although differences between settings were found, SWORD integrated well into practice. Referral for FCR and a reluctance to contract new eHealth providers were barriers for implementation. CONCLUSIONS: Despite differences between healthcare settings, the implementation of SWORD was evaluated well. The feasibility of SWORD in different settings should inform a national implementation strategy.

Psychiatric disorders in older adults with cancer referred to psycho-oncology service in a tertiary care cancer centre: a 7-year real world experience from India.

BACKGROUND: Cancer affects mental health in older adults with cancer (OAC), affecting almost 50% of the patients. There are only a few studies on psychiatric disorders in OAC, especially in low resource settings. We report on our real-world experience of prevalence of and factors associated with psychiatric disorders in OAC referred to a psycho-oncology service in an Indian tertiary care cancer institute. METHODS: We retrospectively analysed medical and psycho-oncology records of patients aged 60 + on cancer-directed treatment or follow-up for < 2 years after treatment completion, referred to psycho-oncology services in a tertiary care cancer centre in Mumbai, India, from Jan 2011-Dec 2017. We recorded sociodemographic, clinical, and treatment-related variables, as well as past psychiatric disorders. The ICD-10 was used to record current psychiatric disorder type and presence. IBM SPSS version 24 (Armonk, NY, USA) was used for descriptive measures, tests of association, and logistic regression analysis. The study protocol was approved by Institutional Ethics Committee and registered with the Clinical Trials Registry-India (CTRI/2020/06/026095). RESULTS: Of 763 patients included in the study, 475 (62.3%) were males and 436 (57.1%) were inpatients, with a median age of 65 years. 93% of the patients had a solid tumour and 207 (27.1%) had a history of psychiatric disorder. A current psychiatric diagnosis was noted in 556 patients (72.9%) on initial presentation, of which adjustment disorders, delirium and depression and anxiety disorders were most frequently seen in 25.2%, 21% and 11.1%, respectively. On univariate analysis, a past history of psychiatric disorders (χ2 = 34.6, p < 0.001), lower performance status (χ2 = 9.9, p = 0.002) and haematolymphoid malignancy (χ2 = 4.08, p = 0.04) significantly increased the risk of current psychiatric diagnosis. Logistic regression confirmed these variables as significant. CONCLUSION: Older adults with cancer referred to psycho-oncology services have high rates of psychiatric disorders at their initial presentation, mainly adjustment disorders, delirium and depression and anxiety. A past history of psychiatric disorders, lower performance status and haematolymphoid cancers significantly increased the risk of psychiatric disorders. Multidisciplinary psycho-oncology teams including a psychiatrist should be integrated in comprehensive care of this group of patients. Further research outcomes and effect of psycho-oncological interventions is required in older adults with cancer in LMIC settings.

Assessing the implementation of a comprehensive quality management system for cross-sectoral psycho-oncology in Germany.

INTRODUCTION: Quality management in healthcare is essential for safe, effective, and patient-centered services. Quality management systems (QMS) monitor and improve healthcare quality. Integrating QMS is crucial for optimal quality of care, but previous studies show gaps in integration. This study aims to assess program adherence to a QMS in cross-sectoral psycho-oncological care and to develop strategies for better integration, ultimately improving healthcare quality. MATERIALS AND METHODS: The study used a utility analysis to assess the program adherence of a cross-sectoral psycho-oncology care program using a 5-point scale. The evaluation process involved breaking down the program into distinct areas, and used key figures and developed indicators to assess adherence. Descriptive statistics were used. RESULTS: The study conducted a comprehensive assessment of program adherence in a complex care program, analysing 4460 evaluation cases based on 128 quality indicators. The results showed a score of 4.2 out of 5 points (84%), indicating a highly effective implementation of the QMS. Notably, the study observed successful implementation of top-down elements, while encountering more challenges in integrating bottom-up aspects. CONCLUSION: The study demonstrates effective implementation of a comprehensive QMS. Successful integration was observed in areas such as care concept, care management, quality assurance, and IT-based documentation, while challenges remain in quality development and indicators. Active leadership involvement, staff training, data collection, and a learning culture are essential for successful implementation. Future research should assess the impact and cost-effectiveness of QMSs and develop tailored approaches to sustain healthcare professionals' motivation in quality improvement efforts.

Psychometric Properties and Measurement Invariance of the Herth Hope Index in Spanish Cancer Patients / Propiedades Psicométricas y Medida de Invarianza del Índice de Esperanza de Herth en Pacientes Oncológicos Españoles

Background: The aim of this study was to evaluate the psychometric properties, differential item functioning, factorial invariance, and convergent validity of the Spanish version of the Herth Hope Index (HHI) in patients with cancer. Method: Exploratory and confirmatory factor analyses were conducted to explore the scale, dimensionality, functioning of items, test for strong measurement invariance across sex, age, tumor site, and expected survival, and an extended structural equation model to assess external validity in a cross-sectional, multicenter, prospective study of 863 cancer patients from 15 Spanish hospitals. Results: The results do not support the original 3-factor scale but instead suggest a one-factor structure, which explained 62% of the common variance. Scores from the unidimensional structure exhibited satisfactory reliability (ω= .88). A strong invariance solution demonstrated excellent fit across sex, age, tumor site, and survival. HHI exhibited substantial associations with resilience coping strategies and spiritual well-being. Conclusions: The findings of our study contribute to the diversity of earlier empirical findings regarding the construct of hope. Despite this, our results indicate that the Spanish version of the HHI is a short, easy-to-administer, valid, reliable tool for evaluating cancer patients’ levels of hope.(AU)

Antecedentes: El objetivo de este estudio fue evaluar las propiedades psicométricas, el funcionamiento de los ítems, la invariancia factorial y la validez convergente de la versión española del Herth Hope Index (HHI) en pacientes con cáncer. Método: Estudio transversal, multicéntrico, prospectivo de 863 pacientes con cáncer de 15 hospitales españoles. Se realizaron análisis factoriales exploratorios y confirmatorios para explorar la dimensionalidad, el funcionamiento de los ítems, la invariancia de medición según el sexo, la edad, el sitio del tumor y la supervivencia esperada, y la validez externa. Resultados: Los resultados obtenidos no respaldan la escala original de 3 factores y en cambio sugieren una estructura de un factor, que explicó el 62% de la varianza común, con una confiabilidad satisfactoria (ω = .88). Una solución de invariancia fuerte demostró un excelente ajuste en función del sexo, la edad, el sitio del tumor y la supervivencia. HHI reveló asociaciones sustanciales con la resiliencia y el bienestar espiritual. Conclusiones: Nuestros resultados indican que la versión en español del HHI es una herramienta corta, fácil de administrar, válida y confiable para evaluar el nivel de esperanza de los pacientes con cáncer.(AU)

Global trends in psycho-oncology research investments 2016-2020: A content analysis.

OBJECTIVE: An estimated one-third of cancer patients experience a clinically significant psychological disorder, however it is unclear to what extent this is reflected in research funding. To address this a systematic analysis the allocation of psycho-oncology research funding globally between 2016 and 2020 was conducted. METHODS: A global dataset of 66,388 cancer research awards, from 2016 to 2020 inclusive and totalling $24.5 billion USD was assembled from public and philanthropic funders. Each award was previously categorised by cancer site type and research theme, including psychosocial research and these awards were further sub-categorised for this analysis. RESULTS: There was $523m of funding awarded for psychological research across 1122 studies: 2.14% of all cancer research funding during this period ($24.5 billion). Median funding per award was $97,473 (IQR $36,864 - $453,051). Within psychological research, mental health received most funding ($174m, 33.5% of psychological funding). Cognitive behavioural therapy (CBT) focused research was the specific psychological support with the highest proportion of funding at $14 million. By country of funder, the USA provided most investment ($375.5 m, 71.8%). CONCLUSIONS: Psycho-oncology research received relatively little funding, for example, when compared with pre-clinical cancer research. There needs to be a shift from pre-clinical science to research that benefits cancer patients in the shorter-term. Low- and middle-income countries, and ethnic minorities in higher-income settings, were underrepresented despite having a large cancer burden, indicating inequities that need to be addressed.

Integración del modelo biopsicosocial en la implantación de Comprehensive Medication Management para pacientes tratados en una institución oncológica en Colombia / Biopsychosocial Model Integration in the implementation of Comprehensive Medication Management for patients treated in an oncological institution in Colombia

Introducción: Las personas con cáncer necesitan recibir cuidados enfocados en aspectos biopsi-cosociales considerando la experiencia con la medicación (MedExp), la evolución de esta enfermedad y la calidad de vida relacionada con la salud (CRVS). Se presentan los resultados del Compre-hensive Medication Management (CMM) implanta-do en una institución colombiana especializada en oncología. Método: Diseño cuali-cuantitativo mixto observacional, descriptivo y prospectivo. Los datos se obtuvieron mediante triangulación de técnicas cualitativas (entrevistas en profundidad y observación participante) y cuantitativas (entrevistas clínicas con cuestionarios validados). Las entrevistas fueron presenciales y telemáticas por la pandemia (febrero-octubre 2021). Según los estándares del CMM, se generó la historia farmacoterapéutica, se registró la información biopsicosocial y se analizó la MedExp y la CVRS utilizando Medicines Optimisation Software®. Resultados: Se evaluaron los estándares antes y después de su implantación. La valoración inicial tuvo un análisis DAFO (Debilidades, Amenazas, Fortalezas, Oportunidades) consensuando estrategias para desarrollar CMM. El servicio de oncología derivó 17 personas, 10 mujeres aceptaron participar. Se completaron 30 entrevistas recogiendo narrativas sobre experiencias, observaciones y datos clínicos contextualizados a partir de las que se realizaron intervenciones biopsicosociales. Se resolvieron 2 condiciones clínicas, 2 mejoraron, 7 permanecieron estables, 9 mejoraron parcialmente y 4 no tuvieron mejoría. Tras recibir CMM, las participantes mejoraron su autopercepción en salud, y mejoraron principalmente las dimensiones de movilidad, realización de actividades cotidianas y ansiedad/depresión. Conclusiones: En la implantación del CMM se integró el modelo biopsicosocial considerando las experiencias reales de padecer cáncer alcanzando mejoría en condiciones clínicas y en CVRS de las pacientes atendidas. (AU)

Introduction: People with cancer need to receive care focused on biopsychosocial aspects, consid-ering medication experience (MedExp), disease and illness progression, and health-related quality of life (HRQoL). The results of the Comprehensive Medication Management (CMM) implemented in a Colombian institution specialized in oncology are presented. Method: Mixed observational, descriptive, and pro-spective qualitative-quantitative design. Data were obtained by triangulating qualitative (in-depth inter-views and participant observation) and quantitative techniques (clinical interviews with validated ques-tionnaires). Data was collected through interviews carried out face-to-face and remotely due to the pandemic situation during February-October 2021. According to CMM standards, the pharmacothera-peutic history was obtained, recorded, and MedExp and HRQoL were analyzed using Medicines Optimi-zation Software®. Results: The standards of pharmaceutical care practice were established through the implemen-tation of a SWOT analysis to support care process. The oncology service referred 17 people; 10 women agreed to participate. Thirty interviews were completed collecting narratives about experiences, observations and contextualized clinical data from which biopsychosocial interventions were carried out. Clinical results obtained were: 2 clinical condi-tions resolved, 2 improved, 7 stable, 9 partially im-proved and 4 unimprovement. After receiving CMM, the participants improved their self-perception of health, and HRQoL dimensions of mobility, daily activities, and anxiety/depression improved. Conclusions: Through the implementing of CMM, clinical conditions related to the patients’ medica-tions were improved. Results guided the actions to be followed when implementing this biopsychoso-cial model in the institution. Providing benefits for patients and caregivers, in terms of avoiding the deterioration of quality of life despite suffering from of oncological diseases.

Standards for psychosocial care in pediatric cancer: adapted proposal for Latin American and Caribbean countries / Normas para la atención psicosocial en el cáncer pediátrico: una propuesta adaptada para los países de América Latina y el Caribe / Padrões de atendimento psicossocial em câncer pediátrico: proposta adaptada para países da América Latina e do Caribe

[ABSTRACT]. Objective. To highlight the objectives, achievements, challenges, and next steps for the World Health Organization’s Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods. The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results. The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion. This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families.

[RESUMEN]. Objetivo. Resaltar los objetivos, logros, desafíos y próximos pasos a seguir en el marco de la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud (GICC, por su sigla en inglés), un proyecto diseñado para mejorar la atención psicosocial (APSS) en los centros de atención oncológica pediátrica de América Latina y el Caribe. Métodos. El proyecto se inició en Perú, el primer país que puso en marcha esta iniciativa mundial, en noviembre del 2020. La fase de diagnóstico incluyó una encuesta y una entrevista semiestructurada con profesionales de la salud para evaluar las prácticas en materia de APSS en las instituciones, junto con una encuesta de evaluación de necesidades para las personas cuidadoras. En la segunda fase se elaboró un plan estratégico para abordar las necesidades reconocidas, el cual comprendió la adaptación de las normas en materia de APSS, la creación de grupos de trabajo multicéntricos, la ampliación de la propuesta y la elaboración de materiales. Resultados. En el estudio se descubrió que no se proporcionaba una APSS adecuada y conforme a las normas internacionales. Se propusieron y convalidaron 6 normas adaptadas, y más de 50 profesionales de la salud de la región participaron en las actividades en línea dirigidas a apoyar el proyecto. En estos momentos está en marcha el proceso de implementación, que incluye la creación de 5 grupos de trabajo multidisciplinarios, un comité regional y la elaboración de 16 productos técnicos. Conclusión. Este proyecto supone un gran avance para la mejora de la APSS de los pacientes pediátricos con cáncer y sus familias en los países de América Latina y el Caribe. La creación de grupos de trabajo y las intervenciones basadas en la evidencia permiten consolidar la propuesta y su implementación. Es necesario formular políticas de salud que comprendan una APSS basada en normas para lograr resultados sostenibles desde el punto de vista de la calidad de vida de los pacientes pediátricos con cáncer y sus familias.

[RESUMO]. Objetivo. Destacar os objetivos, as conquistas, os desafios e as próximas etapas da Iniciativa Global para o Câncer Infantil (GICC), um projeto criado pela Organização Mundial da Saúde para melhorar a atenção psicossocial em centros de câncer pediátrico na América Latina e no Caribe. Métodos. O projeto foi lançado no Peru, o primeiro país focal da GICC, em novembro de 2020. A fase de diagnóstico incluiu uma pesquisa e uma entrevista semiestruturada com profissionais de saúde para avaliar as práticas de atenção psicossocial nas instituições, bem como uma pesquisa para avaliar as necessidades dos cuidadores. Na segunda fase, foi desenvolvido um plano estratégico para atender às necessidades identificadas, incluindo uma adaptação de padrões de atenção psicossocial, o estabelecimento de grupos de trabalho multicêntricos, a expansão da proposta e o desenvolvimento de materiais. Resultados. O estudo constatou que, de acordo com padrões internacionais, a atenção psicossocial não estava sendo adequadamente oferecida. Seis padrões adaptados foram propostos e validados, e mais de 50 profissionais de saúde da região participaram de atividades on-line para apoiar o projeto. O processo de implementação está em andamento, com a formação de cinco grupos de trabalho multidisciplinares e um comitê regional e a produção de 16 relatórios técnicos. Conclusão. Este projeto representa um avanço substancial para melhorar a atenção psicossocial para pacientes pediátricos com câncer e suas famílias nos países da América Latina e do Caribe. A criação de grupos de trabalho e intervenções baseadas em evidências fortalecem a proposta e sua implementação. É preciso desenvolver políticas de saúde que incluam atenção psicossocial segundo padrões estabelecidos para alcançar resultados sustentáveis na qualidade de vida das crianças com câncer e de suas famílias.

Diving deeper into distress screening implementation in oncology care.

BACKGROUND: Responding to calls for additional research that identifies effective distress screening (DS) processes, including referral practices subsequent to screening and receipt of recommended care, we engaged in qualitative research as part of a larger (mixed methods) study of distress screening. This qualitative inquiry of oncology professionals across different facilities in the United States examined routine DS implementation, facilitators and challenges staff encounter with DS processes, and staff members' perceived value of DS. PARTICIPANTS AND METHODS: We conducted key informant interviews and focus groups with staff in 4 Commission on Cancer (CoC)-accredited oncology facilities (a total of 18 participants) to understand implementation of routine DS within oncology care. We used a rigorous data analysis design, including inductive and deductive approaches. RESULTS: Respondents believe DS enhances patient care and described ways to improve DS processes, including administering DS at multiple points throughout oncology care, using patient-administrated DS methods, and enhancing electronic health records infrastructure to better collect, record, and retrieve DS data. Respondents also identified the need for additional psychosocial staff at their facilities to provide timely psychosocial care. CONCLUSIONS: Results reinforce the value of DS in cancer care, including the importance of follow-up to screening with psychosocial oncology providers. Understanding and resolving the barriers and facilitators to implementing DS are important to ensure appropriate psychosocial care for people with cancer. Insights from oncology staff may be used to enhance the quality of DS and subsequent psychosocial care, which is an essential component of oncology care.