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1.
Eur J Cancer ; 136: 132-139, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32683273

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has inevitable consequences for medical care of patients without COVID-19. To assess the impact of this pandemic on oncological care, a nationwide survey was conducted among patients with cancer in the Netherlands. METHODS: The patients' perspective on oncological care was investigated using an online survey between March 29th 2020 and April 18th 2020. The survey consisted of 20 questions on four topics: patients' characteristics, contact with the hospital, consequences of the COVID-19 pandemic and concerns about COVID-19. RESULTS: Five thousand three hundred two patients with cancer completed this nationwide survey. Overall, 30% of patients reported consequences for their oncological treatment or follow-up. In the majority of cases, this resulted in conversion from hospital visit to consultation by phone or video. The most frequently adjusted treatments were chemotherapy (30%) and immunotherapy (32%). Among patients with delay and discontinuation of treatment, 55% and 63% of patients, respectively, were (very) concerned about these consequences of the COVID-19 pandemic. Consequences were independent of regional differences in COVID-19 incidence. However, patients in regions with high COVID-19 incidence were significantly more concerned. CONCLUSION: This is the first study investigating perspectives of patients with cancer during the COVID-19 pandemic. The study demonstrates the significant impact of the COVID-19 crisis on oncological care, indicating the need for psycho-oncological support during this pandemic.


Assuntos
Antineoplásicos/uso terapêutico , Atitude Frente a Saúde , Infecções por Coronavirus/epidemiologia , Neoplasias/terapia , Pneumonia Viral/epidemiologia , Telemedicina , Tempo para o Tratamento , Idoso , Betacoronavirus , Feminino , Humanos , Imunoterapia , Incidência , Masculino , Oncologia , Pessoa de Meia-Idade , Neoplasias/psicologia , Países Baixos/epidemiologia , Pandemias , Psico-Oncologia , Inquéritos e Questionários
2.
Oncology (Williston Park) ; 34(7): 270-271, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32674215

RESUMO

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


Assuntos
Infecções por Coronavirus , Procedimentos Clínicos/tendências , Assistência à Saúde/organização & administração , Neoplasias , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Psico-Oncologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/métodos , Humanos , Neoplasias/epidemiologia , Neoplasias/psicologia , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Psico-Oncologia/métodos , Psico-Oncologia/tendências , Angústia Psicológica
3.
Schmerz ; 34(4): 303-313, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32488422

RESUMO

The corona pandemic has led to a number of restrictions and prohibitions, which in turn place large psychosocial or spiritual burdens on patients with COVID-19, their families and relatives and the treating personnel in the healthcare system. Patients with COVID-19 are not allowed to receive visitors and many hospitals and nursing homes have completely banned visitors. Many support services have been reduced or stopped completely. Necessary treatment interventions for other patients with critical and life-limiting diseases have been delayed or suspended in order to free resources for the expected COVID-19 patients; however, these people need to feel social connectedness with their relatives. Palliative care patients should be exempted from any ban on visitors. Families should be able to visit dying patients even on intensive care units or isolation wards, using adequate protective equipment. Alternative options, such as video telephone calls or via social media should be explored for patients in isolation. Families should also be enabled to say goodbye to the deceased with adequate protective equipment or should be offered alternative real or virtual options for remembrance and commemoration. Health care professionals coping with the exceptional stress should be continuously supported. This requires clear communication and leadership structures, communication training, psychosocial support, but most of all optimal framework conditions for the clinical work.


Assuntos
Infecções por Coronavirus/psicologia , Pesar , Cuidados Paliativos , Pneumonia Viral/psicologia , Betacoronavirus , Aconselhamento , Medicina de Emergência , Terapia Familiar , Alemanha , Humanos , Neoplasias , Estresse Ocupacional , Medicina Paliativa , Pandemias , Psico-Oncologia , Serviço Social , Visitas a Pacientes
4.
Support Care Cancer ; 28(8): 3467-3475, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32342221

RESUMO

The term 'supportive care' arose from the medical oncology literature predominantly in the context of managing the toxicities of cancer treatment but embraces all symptom management through treatment and survivorship. Supportive care should be patient-centred with good communication which includes family and carers and applies across the cancer experience from diagnosis, treatment, survivorship to end of life care. Supportive care encompasses physical and functional, psychological, social and spiritual well-being to improve the quality of life. Supportive care must be evidence-based and thus further research is essential. Supportive care requires screening for some symptoms and tools for patients to report their outcomes. Supportive care has to accommodate new physical toxicities, emotional distress as well as financial toxicity. Supportive care is often delivered by medical oncologists but any organ-related specialist, geriatrician, palliative care clinician, pain specialist, nutritionist, psycho-oncologist, social worker, physiotherapist, nurse or allied health worker who is required to relieve a patient's symptoms or side effects may be involved in a multidisciplinary way. The field is evolving to embrace technology such as eHealth and mHealth capabilities which will enhance integrated care.


Assuntos
Neoplasias/terapia , Cuidados Paliativos/métodos , Assistência Centrada no Paciente/métodos , Comunicação , Humanos , Neoplasias/psicologia , Medicina Paliativa/métodos , Psico-Oncologia/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Epidemiol Psychiatr Sci ; 29: e89, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915101

RESUMO

Because of the increasing global cancer burden and the WHO epidemiological estimation in terms of number of new cases, deaths and long-survivors worldwide, an interdisciplinary approach, including psychiatric and psychoncology care is mandatory in oncology. About 50% of cancer patients have in fact been shown to have psychiatric disorders, including clinically significant emotional distress and/or unrecognised or untreated psychosocial conditions as a consequence of cancer at some point during the cancer trajectory. These problems are associated with the patient's reduction of quality of life, impairment in social relationships, longer rehabilitation time, poor adherence to treatment and abnormal illness behaviour. Because of these reasons, the internationally recognised IPOS Standards of Quality Cancer Care underline that psychosocial cancer care should be recognised as a universal human right; that quality cancer care must integrate the psychosocial domain into routine care and that distress should be measured as the sixth vital sign after temperature, blood pressure, pulse, respiratory rate and pain. In spite of social inequalities still existing between countries in the organisation and implementation of psychosocial oncology, recommendations and guidelines are available regarding screening, assessment and intervention to psychiatric and psychosocial disorders across the trajectory of cancer. The clinical and political agenda of psychoncology as a mandatory component of a whole comprehensive person-centred approach to cancer should therefore be acknowledged in psychiatry.


Assuntos
Transtornos Mentais/etiologia , Neoplasias/psicologia , Qualidade de Vida , Humanos , Oncologia , Transtornos Mentais/psicologia , Neoplasias/complicações , Psico-Oncologia , Encaminhamento e Consulta
6.
Epidemiol Psychiatr Sci ; 29: e86, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915100

RESUMO

With cancer incidence increasing over time worldwide, attention to the burden of psychiatric and psychosocial consequences of the disease is now mandatory for both cancer and mental health care professionals. Psychiatric disorders have been shown to affect at least 30-35% of cancer patients during all phases of the disease trajectory, and differ in nature according to stage and type of cancer. Other clinically relevant distressing psychosocial and existential conditions (e.g. demoralisation, health anxiety, loss of meaning and existential distress) not included as 'disorders' in the usual diagnostic and nosological systems (i.e. meta-diagnostic conditions) have also been shown to be present in another 15-20% of cancer patients. In this editorial, we will present a summary of the extensive literature regarding the epidemiology of the several psychosocial disorders affecting cancer patients as a cause of distress and burden to be taken into consideration and addressed in cancer care through evidence-based intervention.


Assuntos
Transtornos Mentais/complicações , Saúde Mental , Neoplasias/psicologia , Estresse Psicológico/psicologia , Ansiedade/etiologia , Disfunção Cognitiva/etiologia , Efeitos Psicossociais da Doença , Depressão/etiologia , Humanos , Transtornos Mentais/psicologia , Neoplasias/complicações , Neoplasias/diagnóstico , Psico-Oncologia , Qualidade de Vida , Estresse Psicológico/diagnóstico , Estresse Psicológico/etiologia
7.
Support Care Cancer ; 28(3): 1163-1171, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31203512

RESUMO

PURPOSE: African American breast cancer survivors (AABCS) are underserved in medical and psychosocial care despite greater disease burden. We evaluated the effectiveness of a telephonic psycho-educational intervention trial on improving emotional well-being (EWB) in a sample of AABCS. METHODS: Secondary data analyses with 40 AABCS who reported elevated distress were randomly assigned to the intervention or control group. We used Wilcoxon signed rank tests to measure pre- to post-intervention score changes in individual EWB items (FACT-G). Independent t tests compared changes in mean scores between the intervention and control groups. RESULTS: Overall emotional well-being, as well as emotions pertaining to sadness, coping, and nervousness, showed some improvements as a result of the intervention. Changes in the subscale total score and all except one subscale item had clinically meaningful effect sizes (d ≥ 0.35). Statistically significant between-group differences in mean score changes were observed. CONCLUSIONS: Our results and approach advance supportive care interventions by illuminating the benefits and limitations of a paraprofessional delivered, licensed professional supervised psycho-educational intervention. Additionally, as emotional well-being is multifaceted, the individual item analysis approach used in this study provides insight into specific areas of improvement and vulnerability within the emotional well-being domain of health-related quality of life (HRQOL). Our findings can facilitate the development of culturally responsive and patient-centered survivorship care, psychosocial-oncology interventions and care-tailored to the emotional well-being and unmet needs of medically vulnerable and underserved patients.


Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Psico-Oncologia/métodos , Qualidade de Vida/psicologia , Adaptação Psicológica , Adulto , Afro-Americanos/psicologia , Ansiedade/psicologia , Neoplasias da Mama/terapia , Emoções , Feminino , Nível de Saúde , Humanos , Saúde Mental , Pessoa de Meia-Idade , Psicoterapia/métodos , Inquéritos e Questionários , Telefone
9.
Pathologe ; 40(Suppl 3): 347-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31705241

RESUMO

The label cancer in itself leads to complex psychological reactions in patients that are closely related to previous experiences and self-image. A cancer diagnosis can lead to increased distress and subsequent mental comorbidity such as depression or anxiety disorders. The responsibility of the pathologist, as the person who first uses the label cancer, is high. The pathologist must be conscious and focus not only on the accuracy of the anatomical pathology, but also on the potential influences the wording may have on the mental health of the patient. The word "carcinoma" should only be used in the case of tumors with the respective biological behavior. The example of non-invasive follicular thyroid neoplasm with papillary-like nuclear features shows that changing a label can lead to an improvement in distress and quality of life.


Assuntos
Adaptação Psicológica , Saúde Mental , Neoplasias/psicologia , Estresse Psicológico , Humanos , Patologistas/psicologia , Relações Profissional-Paciente , Psico-Oncologia/métodos , Qualidade de Vida
10.
Ther Umsch ; 76(4): 219-224, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31498042

RESUMO

Standardized distress screening programs do not replace discussing distress and psychosocial care needs with patients Abstract. Recommendations regarding the communication with the patient on the basis of the distress thermometer. In accordance with international standards, one of the high priority objectives is to introduce routine distress screening during cancer care in order to accurately identify those patients who are most in need of psycho-oncological treatment and to ensure that patients have access to appropriate supportive care services. The practice has been shown to increase the effectiveness of identifying comorbidities such as depression and anxiety, and to increase the number of referrals to psycho-oncological care. However, only a moderate proportion of the distressed patients also accepts referral to or utilizes psycho-oncological support. To optimize distress screening programs, patients' supportive care needs should be addressed and discussed in routine clinical practice. The present manuscript offers recommendations regarding the actual communication with the patient on the basis of a screening tool such as the distress thermometer.


Assuntos
Neoplasias , Psico-Oncologia , Humanos , Programas de Rastreamento , Neoplasias/psicologia , Encaminhamento e Consulta , Estresse Psicológico
11.
Eur J Cancer Care (Engl) ; 28(6): e13153, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31441564

RESUMO

OBJECTIVE: To explore the communication and resource needs of mothers diagnosed with breast cancer treated with curative intent in communicating with their young children and to identify gaps in the resources and support provided to these women. METHODS: Data were collected via semi-structured telephone interviews from 13 mothers who were diagnosed with breast cancer while parenting a young child (age 3-12 years), and 10 health professionals in Victoria, Australia. Data were analysed qualitatively using the Framework Method. RESULTS AND CONCLUSION: Mothers and health professionals prioritised communication with children about the cancer diagnosis; however, health professionals and mothers differed in their views of parents' communication needs both in terms of the nature of the support/information needed and the delivery of this support/information. Mothers wanted easily accessible resources that were both instructive and practical. Mothers also emphasised quality over quantity of support. Health professionals were mostly aware of mothers' needs, however, emphasised less instructive support and information. This study highlights the need for improved coordination and tailoring of psychosocial resources and supports for these parents and families communicating about a cancer diagnosis with their young children.


Assuntos
Neoplasias da Mama/psicologia , Comunicação , Pessoal de Saúde/psicologia , Recursos em Saúde , Mães/psicologia , Adulto , Atitude Frente a Saúde , Neoplasias da Mama/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Pessoa de Meia-Idade , Poder Familiar/psicologia , Psico-Oncologia , Pesquisa Qualitativa , Vitória
12.
Curr Opin Psychiatry ; 32(5): 442-450, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31373929

RESUMO

PURPOSE OF REVIEW: Psycho-oncology has completed 25 years. There is growing recognition of the psychosocial needs of persons living with cancer and the role of sociocultural factors in addressing the needs. This review addresses the research in developing countries relating to distress associated with living with cancer and psychosocial care. RECENT FINDINGS: There is growing recognition of the emotional needs, understanding of the sociocultural aspects of the emotional responses of persons, caregivers, role of resilience and posttraumatic growth and spirituality in cancer care. Psychosocial aspects of cancer are largely influenced by social, economic, cultural, religious and health systems. A number of innovative approaches to care like use of yoga, financial and material support and involvement of caregivers have been implemented. A positive development is the increasing professional attention to document and develop innovative care programmes. SUMMARY: A significant proportion of the general population are living with cancer. There are significant psychosocial needs largely influenced by social, economic, cultural, religious aspects of the communities. There are a wide range of interventions from self-care to professional care to address the needs. In developing countries, there is need for longitudinal studies of psycho-social experiences, develop interventions that are culturally appropriate, along with enhanced use of information technology along with evaluation of interventions.


Assuntos
Neoplasias , Psico-Oncologia/métodos , Países em Desenvolvimento , Etnopsicologia/métodos , Humanos , Neoplasias/epidemiologia , Neoplasias/psicologia , Fatores Socioeconômicos
13.
Psychooncology ; 28(10): 2083-2090, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31397041

RESUMO

OBJECTIVE: Cancer in young adulthood is a nonnormative and critical life event. The experience of having cancer can have a strong impact on the mental health of young adults. This study investigated anxiety and depression in young adult cancer patients, examining changes over time and determining associated factors. METHODS: Young cancer patients (18-39 years at time of diagnosis, diagnosis less than 4 years) were examined. Anxiety and depression were measured at two time points (t2 = 12 months after t1) using the Hospital Anxiety and Depression Scale (HADS). Regression analyses were conducted to determine whether sociodemographic, medical, and/or psychosocial factors (social support, adjustment to the illness, unmet supportive care needs) were associated with patients' anxiety and depression. RESULTS: Five hundred fourteen young cancer patients (mean age 29.6 years, 75.1% women) completed both questionnaires. A higher proportion showed elevated levels of anxiety (t1: 42.2%; t2: 45.3%) than of depression (t1: 16.9%; t2: 17.7%), and no significant changes in anxiety and depression levels over time were observed. Psychosocial factors explained a major proportion of the variances for anxiety and depression levels at both time points (adjusted R2 between.50 and.59). Furthermore, significant associations were found for anxiety (t1) with gender (women↑); anxiety (t2) and depression (t2) with sick leave (sick leave yes↑); depression (t2) with time since diagnosis (longer time↑). CONCLUSION: Psychological distress among adolescents and young adults (AYA) manifests particularly as anxiety. Strong associations between anxiety/depression and psychosocial factors, as well as the stability of psychological distress over time, clearly illustrate the need for psycho-oncological care in this patient group.


Assuntos
Ansiedade/psicologia , Depressão/psicologia , Neoplasias/psicologia , Apoio Social , Adolescente , Adulto , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Neoplasias/complicações , Psico-Oncologia , Inquéritos e Questionários , Adulto Jovem
14.
Pediatr Blood Cancer ; 66(10): e27889, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31276304

RESUMO

OBJECTIVE: Currently, no evidence-based psychosocial clinical care pathways (PCCP) exist to triage psychosocial risk levels and guide delivery of psychosocial care to youth receiving a hematopoietic stem cell transplantation (HCT) and their families. The purpose of this paper is to describe the use of qualitative research methodologies to develop PCCP in pediatric HCT consistent with the Standards for Psychosocial Care developed for children with cancer. METHODS: We previously used qualitative methodologies to interview parents to identify four principles to inform the development of PCCPs. Then in this study a focus group with parents and multidisciplinary clinicians was conducted to assess the acceptability of the PCCP, suggest modifications, and provide input on its use. RESULTS: The PCCP is six-step pathway, starting with a standardized screening assessment with the Psychosocial Assessment Tool (PAT-HCT) that identifies the family's specific care needs. The focus group data support overall assessment with the PAT-HCT and the care principles underlying this approach. CONCLUSIONS: This PCCP is a systemic multidisciplinary model for providing psychosocial care that is ready for the next stage of development and evaluation in clinical care.


Assuntos
Procedimentos Clínicos , Transplante de Células-Tronco Hematopoéticas/psicologia , Neoplasias/terapia , Psico-Oncologia/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Grupos Focais , Humanos , Lactente , Masculino , Neoplasias/psicologia , Psicometria/métodos , Adulto Jovem
15.
Eur J Cancer Care (Engl) ; 28(4): e13136, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31318133
16.
Psychooncology ; 28(9): 1862-1870, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31257660

RESUMO

OBJECTIVE: Psychological therapies combined with medication are effective treatments for depression and anxiety in patients with cancer. However, the psycho-oncology workforce is insufficient to meet patient need and is hard to access outside of the major cities. To bridge this gap, innovative models of care are required. Implementation of a new model of care requires attention to the facilitators and barriers. The aim of this study was to explore stakeholders' attitudes to the feasibility and acceptability of a community-based, shared care model for the treatment of depression and anxiety. METHODS: Semi-structured interviews were conducted with community-based clinical psychologists (n = 10), general practitioners (n = 6), and hospital-based psychologists working in psycho-oncology (n = 9). Framework analysis was conducted to identify key themes. RESULTS: All stakeholders perceived the model as feasible and acceptable. Potential barriers/facilitators to implementation were summarised under six key themes: (a) initiative, ownership, and autonomy; (b) resources; (c) pathway establishment; (d) support; (e) skill acquisition; and (f) patient engagement. Facilitators included quality communication between health professionals across primary and tertiary care and appropriate education and support for community-based clinicians. CONCLUSIONS: This in-depth exploration of Australian health professionals' perceptions of the feasibility and acceptability of a community-based model of psycho-oncology care revealed that most clinicians were willing to adopt the proposed changes into practice. An RCT of a shared care intervention for depressed patients with cancer is needed.


Assuntos
Atitude do Pessoal de Saúde , Serviços de Saúde Comunitária/organização & administração , Pessoal de Saúde/psicologia , Psico-Oncologia/organização & administração , Adulto , Austrália , Estudos de Viabilidade , Feminino , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Pesquisa Qualitativa
17.
Eur J Cancer Care (Engl) ; 28(5): e13127, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31245886

RESUMO

OBJECTIVE: To compare patients' experiences with a systematic, integrated psycho-oncological care (IC) model to experiences with "care as usual" (CAU). METHODS: To improve patients' knowledge about psychosocial support options and to facilitate use, an IC model was developed by psycho-oncologists and a health insurance company and implemented in one German cancer care facility. Using a parallel, non-randomised design, these patients' experiences were compared to CAU patients. In 2015, both patient groups received questionnaires 6-12 months post-inpatient treatment. Main outcomes were awareness, use and opinion of psycho-oncological care (PC) and anxiety level (Generalized Anxiety Disorder Scale (GAD-7)). RESULTS: 228 patients (IC = 90; CAU = 138) participated (response rate 24%). More IC patients felt adequately informed about PC (63% vs. 46%, ORadj : 2.5 (CI: 1.3-4.8); p = 0.008). More IC patients recalled being offered various support options and had had at least one PC discussion (44% vs. 33%, ORadj of IC patient saying "yes" instead of "No, didn't want to" compared to a CAU patient: 0.4 (CI: 0.2-0.8); p = 0.01). More IC patients rated their care as good/excellent (49% vs. 38%, ORadj : 1.8 (CI: 0.7-4.1; p = 0.2)). Anxiety levels were similar (GAD-7 score>=10: IC 34% vs. CAU 28%; p = 0.4). CONCLUSION: Structured psycho-oncological care had some positive results on the outcomes, but anxiety levels did not differ.


Assuntos
Assistência à Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Psico-Oncologia/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Inquéritos e Questionários , Adulto Jovem
18.
Psychooncology ; 28(8): 1595-1600, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31222864

RESUMO

OBJECTIVE: Growing rates of cancer and survivorship, in situations of severe resource constraints, force a rethink about managing cancer-related psychosocial distress (CRPD). Here, a prevention-oriented natural history of distress is proposed, derived from developments in our understanding of the evolution and decay of CRPD. METHODS: The literature indicates that at least four classes or natural histories of CRPD are identifiable. These are described in the context of prevention-oriented activities in psycho-oncology: (1) CRPD in persons with good coping resources, resulting from reaction to the diagnosis and treatment lifestyle disruption, which is largely self-limiting and preferably self-managed; (2) CRPD arising from residual, or late effects of disease or treatment, potentially persistent and debilitating; (3) CRPD in persons with preexisting coping difficulties; and (4) CRPD arising from existential issues such as mortality and fear of recurrence. RESULTS: It is hypothesized that different natural histories of CRPD display different evolution, indicating potential causal processes, treatment priorities, and preventive strategies. In particular, the effective management of residual symptoms is crucial to prevent CRPD chronicity. Optimal patient involvement in treatment decision-making is also required. CONCLUSIONS: There is a need to develop methods to differentiate if, early in the illness trajectory, the distressed patient is not able to self-manage the stress of cancer diagnosis and treatment. Not all distressed patients want or need help, and addressing just the CRPD may be inadequate where unresolved residual symptoms prevent renormalization after treatment. Improved doctor-patient communication around treatment decisions is warranted.


Assuntos
Neoplasias/prevenção & controle , Neoplasias/psicologia , Psico-Oncologia , Sociedades Médicas , Distinções e Prêmios , Saúde Global , Humanos
19.
PLoS One ; 14(6): e0218439, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220129

RESUMO

PURPOSE: To learn whether reported associations between major psychosocial stressors and lung cancer are independent of smoking history. METHODS: Subjects were at least 25 years old and without lung cancer at enrollment in the United States Census Bureau's National Longitudinal Mortality Survey in 1995-2008. Follow-up via Surveillance Epidemiology and End Results and National Death Index continued until lung cancer diagnosis, death, or December 2011. Involuntary unemployment, widowhood, and divorce, stratified by sex, were tested for association with subsequent lung cancer using proportional hazards regression for competing risks. Smoking status, years smoked, cigarettes per day, and years since quitting were imputed when missing. RESULTS: At enrollment, subjects (n = 100,733, 47.4% male, age 49.1(±15.8) years) included 17.6% current smokers, 23.5% former smokers. Of men and women, respectively, 11.3% and 15.0% were divorced/separated, 2.9% and 11.8% were widowed, and 2.9% and 2.3% were involuntarily unemployed. Ultimately, 667 subjects developed lung cancer; another 10,071 died without lung cancer. Adjusted for age, education, and ancestry, lung cancer was associated with unemployment, widowhood, and divorce/separation in men but not women. Further adjusted for years smoked, cigarettes per day, and years since quitting, none of these associations was significant in either sex. CONCLUSIONS: Once smoking is accounted for, psychosocial stressors in adulthood do not independently promote lung cancer. Given their increased smoking behavior, persons experiencing stressors should be referred to effective alternatives to smoking and to support for smoking cessation.


Assuntos
Neoplasias Pulmonares/epidemiologia , Psico-Oncologia/tendências , Percepção Social , Fumar Tabaco/epidemiologia , Adulto , Idoso , Feminino , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Abandono do Hábito de Fumar , Fumar Tabaco/efeitos adversos , Estados Unidos/epidemiologia
20.
Pediatr Blood Cancer ; 66(8): e27789, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31058418

RESUMO

The first decade of adolescent and young adult (AYA) oncology psychosocial care and research (2005-2015) was driven by a normative, developmental framework that assumed a generalizable life experience for AYAs that is distinct from both younger children and older adults. As we proceed through a second decade, new considerations emerge regarding diversity of life experiences as occurring within and influenced by a complex global context. The purpose of this paper is to review and provide commentary on the impact of global and contextual conditions on AYAs. We expound upon the effects of precarious labor conditions, changing timetables and priorities for developmental tasks, sexual and gender plurality, and expanding cultural diversity. We discuss the implications of social genomics and technology and social media for enhancing precision psychosocial medicine. To build a forward-looking approach, this paper calls for tailored, multilevel treatments that consider variability of AYAs within the social and global contexts in which they live.


Assuntos
Adaptação Psicológica , Neoplasias/psicologia , Neoplasias/terapia , Psico-Oncologia/métodos , Qualidade de Vida , Apoio Social , Estresse Psicológico , Adolescente , Adulto , Humanos , Adulto Jovem
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