Evaluation of a psychoneurological symptom cluster in patients with breast or digestive cancer: a longitudinal observational study.

BACKGROUND: A psychoneurological symptom cluster composed of cancer-related fatigue, emotional distress, sleep difficulties, and pain is very common among patients with cancer. Cognitive difficulties are also frequently associated with this cluster. Network analyses allow for an in-depth understanding of the relationships between symptoms in a cluster. This paper details the study protocol of a longitudinal assessment of the psychoneurological symptom cluster in two distinct cohorts: breast cancer and digestive cancer survivors, using network analyses. METHODS: Over two years, the symptoms involved in the psychoneurological symptom cluster, along with other common symptoms (e.g., digestive symptoms, financial difficulties) and variables (i.e., self-compassion, coping strategies) will be assessed in two cohorts: breast cancer survivors (N = 240) and digestive cancer survivors (N = 240). Online questionnaires will be completed at baseline, then 6, 12 and 24 months later. Network analyses will be used to assess the configuration of the symptom cluster at each measurement time and in each cohort. Comparison of networks between two measurement times or between the two cohorts will also be done with network comparison tests. DISCUSSION: This study will enable a better understanding of the relationships between common symptoms endured by patients with cancer. The results will be employed to develop more cost-effective interventions which, ultimately, will significantly improve the quality of life of patients with breast or digestive cancer. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05867966). Registered on the 27th of April 2023. url: https://classic. CLINICALTRIALS: gov/ct2/show/NCT05867966 .

The Effect of Intervention Approaches of Emotion Regulation and Learning Strategies on Students' Learning and Mental Health.

University students are a vulnerable population, and many recent studies show that anxiety, depressive symptoms, and academic burnout have been on the increase since the beginning of the COVID-19 pandemic. These findings point to a need for interventions to reduce these difficulties. The purpose of the present study was to assess the effects of 2 formats of an innovative program on students' mental health (anxiety, depressive symptoms, and academic burnout), intolerance of uncertainty, learned helplessness, and learning. Our sample was composed of 105 university students, recruited on a voluntary basis. They were divided into 3 groups: online intervention group (n = 36), face-to-face intervention group (n = 32), and control group (n = 37). The following variables were measured through online questionnaires: anxiety and depressive symptoms, academic burnout, intolerance of uncertainty, learned helplessness, perceived social support, learning strategies, and beliefs. There were 2 assessments 10 weeks apart (ie, before and after the program in the case of the 2 intervention groups). We performed nonparametric analyses to run comparisons between the 2 assessment timepoints in each group. Results showed that participants in the 2 intervention groups had lower levels of learned helplessness and intolerance of uncertainty at the end of the program. Furthermore, participants in the face-to-face group reported higher levels of perceived social support, academic self-efficacy, and help-seeking strategies. The present study highlighted the benefits of our innovative program, especially its face-to-face format.Clinical Trial - ID: NCT04978194.

Hypnosis and cognitive behavioral therapy with online sessions to reduce fatigue in patients undergoing chemotherapy for a metastatic colorectal cancer: Rational and study protocol for a feasibility study.

Background: In metastatic colorectal cancer (CRCm), fatigue is pervasive, reduces quality of life, and is negatively associated with survival. Its course is explained in part by psychosocial variables such as emotional distress, coping strategies, or perceived control. Thus, to reduce fatigue, psychosocial interventions appear to be relevant. In some cancers, Cognitive Behavioral Therapies (CBT) reduce fatigue. Hypnosis is also used as a complementary therapy to reduce the side effects of cancer. While CBT requires specific training often reserved for psychologists, hypnosis has the advantage of being increasingly practiced by caregivers and is therefore less expensive (Montgomery et al., 2007). On the other hand, CBT and hypnosis remain understudied in the CRC, do not focus on the symptom of fatigue and in Europe such programs have never been evaluated. Objectives: Implementing an intervention in a healthcare setting is complex (e.g., economic and practical aspects) and recruiting participants can be challenging. The primary objective will therefore be to study the feasibility of two standardized interventions (hypnosis and CBT) that aim to reduce fatigue in patients with CRCm treated in a French cancer center. Methods and design: A prospective, single-center, randomized interventional feasibility study, using mixed methods (both quantitative and qualitative). A total of 60 patients will be allocated to each intervention group [Hypnosis (n = 30) and CBT (n = 30)]. Participants will be randomized into two parallel groups (ratio 1:1). Both programs will consist of 6 weekly sessions focusing on the CRF management over a period of 6 weeks. Trained therapists will conduct the program combining 3 face-to-face sessions and 3 online sessions. The feasibility and experience of interventions will be evaluated by the outcome variables, including the adhesion rate, the reasons for acceptability, relevance or non-adherence, the satisfaction, the fatigue evolution (with ecological momentary assessments), and the quality of life. All questionnaires will be self-assessment using an online application from the cancer center. Discussion: Results will highlight the barriers/facilitators to the implementation of the program and the relevance of the program to the patients, and will be used to generate hypotheses for a randomized control trial. Clinical trial registration: ClinicalTrials.gov Identifier: NCT04999306; https://clinicaltrials.gov/ct2/show/NCT04999306.

The importance of using ordinal scores for patient classification based on health-related quality of life trajectories.

Changes in health-related quality of life (HRQoL) over time are not necessarily homogeneous within a population of interest. Our study aim was twofold: to determine homogeneous patient subpopulations distinguished by HRQoL trajectories, and to identify the particular patient profile associated with each subpopulation. To classify patients according to HRQoL dimension scores, we compared mixtures of linear mixed models (LMMs) classically applied to scores defined by the EORTC procedure, and mixtures of random effect cumulative models (CMs) applied to scores treated as ordinal variables. A simulation study showed that the mixture of LMMs overestimated the number of subpopulations and was less able to correctly classify patients than the mixture of CMs. Considering HRQoL scores as ordinal rather than continuous variables is relevant when classifying patients. The mixture of CMs for ordinal scores is able to identify homogeneous subpopulations and their associated trajectories. The application focused on changes over time in HRQoL data (collected using the EORTC QLQ-C30 questionnaire) from 132 breast cancer patients from the Moral study. Once the classification is obtained only from HRQoL scores, class membership was then explained through a logistic regression model, given a large panel of variables collected at baseline. Analysis of data revealed that deterioration over time of role functioning and insomnia was closely related to patient anxiety: anxiety at baseline is a prognostic factor for a poor level and/or a deterioration over time of HRQoL. For functional dimensions, large tumor size and high education level were associated with worse HRQoL scores.

Effects of an online self-help intervention on university students' mental health during COVID-19: A non-randomized controlled pilot study.

The COVID-19 pandemic has had a major impact on university students, particulary on their mental health. However, little is yet known about how to prevent and/or reduce this impact. Prior to COVID-19, some studies have shown that online stress management programs were successful enough to improve students' mental health and stress adjustment strategies, suggesting that these interventions should be further developed during the pandemic. Our study explored the effects on mental health of an online program that targeted stress management and learning. A total of 347 university students were initially recruited to take part in a non-randomized controlled study. After dropout, our final sample consisted of 114 participants, divided into two groups: an intervention group (participants who took part in the program) and the control group (participants who did not participate in the program). The variables measured were: anxiety and depressive symptoms, academic burnout, learned helplessness, and coping strategies. Means comparisons between baseline (T0) and an assessment at 8 weeks (T1) revealed reductions in anxiety symptoms and learned helplessness in the intervention group, but not in the control group. Our pilot study reports promising effects of an online program on students' psychological state.

Determinants of Distinct Trajectories of Fatigue in Patients Undergoing Chemotherapy for a Metastatic Colorectal Cancer: 6-Month Follow-up Using Growth Mixture Modeling.

OBJECTIVES: This longitudinal prospective and observational study was designed to identify fatigue trajectories during a 6-month period of chemotherapy in patients with metastatic colorectal cancer, and examine the psychosocial factors predicting these trajectories. Associations between fatigue and survival were also investigated. METHODS: A total of 169 patients (Mage = 64.36 years, SD = 10.5) reported their fatigue levels every 2 weeks for 6 months. Psychological variables (anxiety, depression, internal control, and coping) were assessed at baseline. A Growth Mixture Model was used to identify latent trajectories of fatigue, and a multinomial logistic regression tested covariate predictors of patients' trajectories. RESULTS: Four clinically distinct fatigue trajectories were identified: intense fatigue (6.51%), moderate fatigue (48.52%), no fatigue (33%), and increasing fatigue (11.83%). Fatigue severity was directly associated with overall survival. High depression levels were associated with fatigue severity over time for intense (OR = 1.80 [1.32-2.47]) and for moderate (OR = 1.58 [1.25-2.00]) fatigue, compared to patients reporting no fatigue. Patients who did not report fatigue were better adjusted, and had more resources, such as better internal control over the disease and less emotion-focused coping (guilt and avoidance), than those who reported intense (ORcontrol = 0.77 [0.65-0.92]) or moderate (ORcontrol = 0.89 [0.79-0.99] and ORcoping = 1.13 [1.02-1.24]) fatigue. CONCLUSION: Fatigue trajectories differed considerably across patients with metastatic colorectal cancer. This first longitudinal study on colorectal cancer patients involving transactional variables suggests that psychosocial interventions should target these specific outcomes, in order to help patients manage their fatigue.

[Alopecia and cancers: From basics to clinical practice]. / Alopécie et cancers : de la physiopathologie à la pratique clinique.

Alopecia, although long considered an unavoidable consequence of cancer therapy, currently presents a multifaceted challenge. The knowledge of the physiology of the hair and consequently of the pathophysiology of alopecia has led to show that there is not one but several types of alopecia. Transposed to the world of oncology, different types of alopecia and subsequently molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. Thus, in patients with cancer, alopecia can be iatrogenic (chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy, surgery) or directly the consequence of the disease itself (malnutrition, scalp metastases, paraneoplastic syndromes). Knowledge of the incriminated mechanism(s) could thus make it possible to deploy an appropriate care component, whether on the preventive or curative sides or in terms of supportive care. These are particularly essential regarding the psychological repercussions caused by alopecia, with significant consequences on the quality of life of patients and with a potential impact on treatment compliance. On the preventive side, the last few years have seen the advent of the automated scalp cooling therapy, supported by several randomized clinical trials. On the curative side, several therapeutic proposals are currently deployed or under development in order to provide relevant treatments.

Quality of life, fatigue and changes therein as predictors of return to work during breast cancer treatment.

PURPOSE: To our knowledge, only one study has assessed Quality of Life (QOL) as a predictor of return to work (RTW) during breast cancer treatment and one has evaluated multidimensional cancer-related fatigue (CRF) as a determinant of RTW. However, no study has assessed the impact of changes in these variables on RTW. The objective of this study was to evaluate QOL, multidimensional CRF and changes in these variables as determinants of RTW during breast cancer treatment. METHODS: We performed a longitudinal study of 68 patients with a mean age of 46.97 years (SD = 6.92), who were employed at the time of diagnosis. Women were assessed at the beginning of adjuvant treatments (T0) and followed up with by telephone at three (T1) and 6 months later (T2), using questionnaires (QLQ-C30; MFI-20). RESULTS: Global QOL, OR = 1.12 [1.01-1.25], sleep disturbance, OR = 1.04 [1.002-1.08], fatigue (QLQ-C30), OR = 0.93 [0.88-0.99], nausea-vomiting, OR = 0.84 [0.73-0.97], reduced motivation, OR = 1.49 [1.05-2.11] and general fatigue, OR = 0.79 [0.63-0.99] at T0 were associated with RTW at T1. At T2 global QOL, OR = 1.09 [1.01-1.17], cognitive functioning, OR = 1.10 [1.03-1.17], general fatigue, OR = 1.82 [1.04-3.17] and mental fatigue, OR = 0.29 [0.11-0.81] were associated with RTW. Furthermore, changes in mental fatigue were associated with RTW at T2, OR = 0.02 [0.001-0.29]. CONCLUSIONS: Quality of life, fatigue and their changes in them, especially cognitive functioning and mental fatigue, can play an important role in predicting the RTW of women with breast cancer. This confirms the importance of multidisciplinary care for cancer and the emergence of a theoretical psychological model of RTW.

Fatigue in cancer patients: Development and validation of a short form of the Multidimensional Fatigue Inventory (MFI-10).

PURPOSE: The MFI was developed in 1995 to assess fatigue as a multidimensional concept. This questionnaire has been widely translated and used; however, its multidimensional structure has not been consistent across studies. In addition there is a need for short questionnaires in the clinical context. Therefore, we aim to develop a MFI-short version which is easy-to-use for the patient, quick for the clinician, with solid psychometric properties. METHODS: We examined three MFI-20 validated versions and tested their structure, by leading a CFA on 422 cancer patients to evaluate their psychometric qualities (Study 1). Then, we conducted both EFA and CFA by deleting all reversed items. We assumed that 10 items were sufficient to conserve a good explanation of the data and a multidimensional structure (Study 2). RESULTS: Study 1 revealed that there is no consensus about the structure of the three MFI versions tested and CFA showed inadequate fit (RMSEA > .10; CFI < .9). Those three versions showed an inadequate fit with regard to expected fit indices. In study 2, the multidimensional structure was confirmed with only ten items. The best model gave a three-factor solution with a χ2 = 67.130, a RMSEA = .072 (95% CI [.048-.096]) and a CFI equal to .97. CONCLUSIONS: The MFI short-form maintains good psychometric quality. This new questionnaire is adapted to cancer populations, and may be useful for clinicians to screen their patients' fatigue. Further validations of this MFI-short form are warranted to confirm its psychometric properties in other populations.

Development and validation of the daily fatigue cancer scale (DFCS): Single-item questions for clinical practice.

PURPOSE: Cancer-Related Fatigue (CRF), subjective symptom, is considered the most prevalent and disabling in cancer. To help caregivers better understand it, we developed and evaluated the psychometric properties of a visual analog scale to assess daily CRF. METHOD: In our qualitative study, we conducted interviews with caregivers, patients and scientists (N = 30) to generate items and select the scale's format. We then administered the final scale to a sample of 104 patients hospitalized for cancer surgery. In our quantitative study, we evaluated psychometric items with standardized questionnaires to compare and identify the construct validity of our fatigue scale. Because clinicians need a cutoff to diagnose fatigue in daily care, we also analyzed the scale's sensitivity. RESULTS: Correlations evidenced good construct validity for our scale, with r = 0.886 (p > 0.01), confirming that both physical fatigue and psychological fatigue (r = 0.768) were effectively measured. The Receiver Operating Curve (ROC) showed good sensitivity and specificity (>0.80), giving clinicians a threshold to identify tired patients, with only a 3% chance of misdiagnosis. CONCLUSION: The Daily Fatigue Cancer Scale is a good tool to detect patient fatigue and improve patient care.