Prevalence of trauma history and symptoms in patients who have received vaginal brachytherapy as part of their endometrial cancer treatment.

OBJECTIVE: Vaginal brachytherapy (VBT) is an essential component of curative intent treatment for many patients with endometrial cancer. The prevalence of trauma history in this population is unknown and important to understand considering VBT requires patients to have an instrument vaginally inserted while in the vulnerable lithotomy position. We aim to identify patients treated with intracavitary VBT and collect survey data to assess trauma endpoints. METHODS: We retrospectively identified patients with endometrial cancer who underwent intracavitary VBT at our institution between 01/2017 and 08/2022. Patients were mailed and/or electronically mailed a survey that included demographics, psychosocial background, and validated trauma surveys to be filled out as they relate to their trauma experiences prior to VBT and again considering any trauma symptomatology related to VBT. Electronic medical record review was performed. Descriptive statistics as well as multivariate analysis were performed. RESULTS: 206 patients met inclusion criteria, 66 (32.1%) of whom returned the survey and were included for analysis. Thirty-two percent of patients self-reported a personal history of any prior mental health diagnosis. Eighty-eight percent of patients screened positive for a history of trauma exposure, 23% endorsed symptoms of PTSD related to their VBT experience, and 5% screened positive for a likely PTSD diagnosis from VBT. CONCLUSION: A majority of included patients had a history of trauma exposure prior to VBT. In a subset of patients, VBT re-induced trauma and was considered to be an independent traumatic event. This study highlights the importance of practicing trauma informed care, particularly in this patient population.

Implementing a cognitive behavioral intervention for patients with head and neck cancer.

PURPOSE: Sequelae of and therapies for head and neck cancers (HNC) are associated with physical and functional impairment as well as increased levels of psychological distress post treatment. Given the impact of HNC and treatment on functioning (i.e., eating and talking), health-related quality of life (HRQOL) is a significant area of survivorship concern within this population. Although prior research indicates that the incidence of anxiety and depression ranges from 15 to 50%, to date, there is a paucity of research on specific psychosocial interventions related to HNC treatment and completed studies have been limited by infrequent use of a randomized design and provision of non-standardized psychosocial interventions. This study aimed to address these gaps and utilize a brief cognitive behavioral intervention (CBI) to improve (1) self-efficacy for coping with cancer, (2) depressive symptoms, (3) other psychological symptoms, and (4) HRQOL among patients with HNC. METHODS: In an effort to conduct a randomized clinical trial of those undergoing treatment for HNC, eighty-eight patients were assigned to receive either a standardized CBI or usual psychological care (N = 47 and 41, respectively) with a 1-year follow-up. The means of all variables for both groups, adjusted for baseline, were visually compared at 3, 6, and 12 months post treatment. RESULTS: As has been a challenge in other longitudinal HNC studies, a high degree of attrition occurred, with a loss of 35 patients from the CBI group and 29 from the usual care group. Despite the high attrition, analysis of existing data indicated that the effect of CBI was discernable among the patients who completed the course of the study. Of the 38 comparisons, 34 showed that the CBI group had the favorable outcome. Important considerations for implementation of a structured psychotherapy intervention during active cancer treatment with multiple barriers including communication challenges and practical limitations were realized. CONCLUSIONS: The impact of HNC treatment can be particularly distressing as it often results in functional impairment and markedly changed activities of daily living among survivors. However, engaging in therapeutic methods to cope and manage distress during treatment can influence QOL and mood into the survivorship phase.

Post-traumatic Stress Disorder Following Acute Delirium.

Delirium is a significant medical condition that is common in hospitalized patients. Beyond the increased risk of mortality, patients who experience an episode of delirium often go on to develop long-term psychiatric disturbance, including symptoms of post-traumatic stress disorder (PTSD). While there is a growing interest in understanding the complex relationship between delirium and PTSD, the existing literature is sparse and lacking harmony. Thus, this review seeks to develop a unified and thorough description of the cognitive and psychiatric underpinnings of post-delirium PTSD with the aims of promoting awareness of this condition amongst clinicians in medical settings, improving patient care, and sparking further research on this topic. While specific underlying mechanisms are yet unclear, PTSD was found to be associated with delirium in that delirious patients may have decreased factual recall of hospital events and increased hallucinations/delusions of a traumatic nature. Several potential interventions were identified, as well as suggestions for future research and clinical practice.

The effects of traumatic stressors and HIV-related trauma symptoms on health and health related quality of life.

The study identified relations among traumatic stressors, HIV-related trauma symptoms, comorbid medical conditions, and health related quality of life (HRQL) in individuals with HIV. Participants (N = 118) completed a structured clinical interview on HIV as a traumatic stressor and other severe traumatic stressors and completed the Impact of Event Scale to assess HIV-related trauma symptoms and the Medical Outcomes Study 36-item Short Form (SF-36) to assess HRQL. Medical chart reviews determined comorbid conditions. Path analysis findings indicated participants with prior severe traumatic stressors experienced their HIV diagnosis as traumatic and in turn were more likely to have current HIV-related trauma symptoms which were negatively related to HRQL. HIV as a traumatic stressor was related to coronary artery diseases and HRQL. Traumatic stressors and HIV-related trauma symptoms impact health in individuals with HIV and highlight the need for psychological interventions prior to diagnosis and throughout treatment.

Non-conventional practices and immune functioning among individuals receiving conventional care for HIV.

OBJECTIVE: to examine the relationships among non-conventional practices, adherence and immune functioning in individuals with HIV. METHODS: 92 participants completed an interview on non-conventional practices (complementary and alternative medicines (CAM), psychosocial therapies, and religious practice). They also completed the Psychiatric Symptom Index and the AIDS Clinical Trials Group Adherence Follow-up Questionnaire. Medical chart reviews determined CD4 count and viral load. RESULTS: Hierarchical logistic regressions revealed religious practice was associated with adherence and CAM was associated with viral load. CONCLUSION: Participation in non-conventional practices in HIV populations may lead to positive health and health behaviors. Clinical implications are discussed.