The role of sex and gender in the diagnosis and treatment of lung cancer: the 6th ICAPEM Annual Symposium

The incidence and mortality of lung cancer in women are rising, with both increasing by 124% between 2003 and 2019. The main risk factor for lung cancer is tobacco use, but indoor radon gas exposure is one of the leading causes in nonsmokers. The most recent evidence demonstrates that multiple factors can make women more susceptible to harm from these risk factors or carcinogens. For this consensus statement, the Association for Lung Cancer Research in Women (ICAPEM) invited a group of lung cancer experts to perform a detailed gender-based analysis of lung cancer. Clinically, female patients have different lung cancer profiles, and most actionable driver alterations are more prevalent in women, particularly in never-smokers. Additionally, the impact of certain therapies seems to be different. In the future, it will be necessary to carry out specific studies to improve the understanding of the role of certain biomarkers and gender in the prognosis and evolution of lung cancer (AU)

The role of sex and gender in the diagnosis and treatment of lung cancer: the 6th ICAPEM Annual Symposium.

The incidence and mortality of lung cancer in women are rising, with both increasing by 124% between 2003 and 2019. The main risk factor for lung cancer is tobacco use, but indoor radon gas exposure is one of the leading causes in nonsmokers. The most recent evidence demonstrates that multiple factors can make women more susceptible to harm from these risk factors or carcinogens. For this consensus statement, the Association for Lung Cancer Research in Women (ICAPEM) invited a group of lung cancer experts to perform a detailed gender-based analysis of lung cancer. Clinically, female patients have different lung cancer profiles, and most actionable driver alterations are more prevalent in women, particularly in never-smokers. Additionally, the impact of certain therapies seems to be different. In the future, it will be necessary to carry out specific studies to improve the understanding of the role of certain biomarkers and gender in the prognosis and evolution of lung cancer.

Consenso sobre el estándar de atención psicooncológica, complejidad psicosocial y actividad asistencial en el Instituto Catalán de Oncología / Consensus on the standard of psycho-oncological care, psychosocial complexity and care activity at the Catalan Institute of Oncology

Introducción: La atención psicosocial de las personas con enfermedad oncológica y la familia debe formar parte de todo modelo integral de atención que pretenda reducir el impacto vital del cáncer. Las intervenciones psicosociales han probado su eficacia en la ayuda a pacientes y familiares para afrontar las situaciones de alta complejidad psicosocial emergentes a consecuencia de un diagnóstico de cáncer. Objetivo: Definir y explicar el modelo de Atención Psicosocial del Comité Psicosocial del Instituto Catalán de Oncología (ICO) utilizando criterios de vulnerabilidad, complejidad y derivación; enmarcado y basado en los valores del ICO (centrados en las necesidades de pacientes con cáncer y sus familias). Método: El modelo que se presenta en este documento consta de cinco pilares: 1) Principios de la Práctica Psicosocial en Oncología; 2) Áreas de actuación en la Atención Psicosocial del paciente con cáncer y la familia; 3) Cribado de malestar emocional y derivación del paciente con cáncer y la familia para una atención psicooncológica específica; 4) Comité Psicosocial: (objetivos; funciones; organización; composición; disciplinas participantes; criterios de derivación y niveles de complejidad; y procedimiento); y 5) Índice de productividad. Resultados: Pacientes y familiares atendidos por el CPS mostraron mejoría estadísticamente significativa en los niveles del malestar emocional, pasando de una media inicial de 8,12/10 (EVA/ENV) a una media 6,27/10 (EVA/ENV). Asimismo, se constata que las intervenciones derivadas del comité psicosocial redujeron el porcentaje de casos iniciales de alta complejidad, pasando de un 69,3% a un 49,3% (AU)

Introduction: Psychosocial care for cancer patients and their families should be part of all comprehensive model of care that aims to reduce the life impact of cancer. Psychosocial interventions have proven to be effective in helping patients and families to cope with the highly complex psychosocial situations that arise as a result of a cancer diagnosis. Aim: To define and explain the model of Psychosocial Care in the Psychosocial Committee of the Catalan Institute of Oncology (ICO) using criteria of vulnerability, complexity and referral; framed and based on the values of the ICO (focused on patients and family’s needs). Method: The model presented in this document consists of five pillars: 1) Principles of Psychosocial Practice in Oncology; 2) Areas of action in the Psychosocial Care of the cancer patient and family; 3) Screening for emotional distress and referral of the cancer patient and family for specific psycho-oncological care; 4) PsychosocialCommittee: (objectives; functions; organization; composition; participating disciplines; referral criteria and levels of complexity; and procedure); and 5) Productivity index. Results: Patients and relatives who were attended by the CPS showed statistically significant improvement in the levels of emotional distress, going from an initial mean of 8.12 / 10 (VAS / ENV) to a mean of 6.27 / 10 (VAS / ENV). It also shows that the interventions derived from the psychosocial committee reduced the percentage of initial cases of high complexity, from 69.3% to 49.3% (AU)

The Multidisciplinary Team (MDT) Approach and Quality of Care.

The core function of a multidisciplinary team (MDT) is to bring together a group of healthcare professionals from different fields in order to determine patients' treatment plan. Most of head and neck cancer (HNC) units are currently led by MDTs that at least include ENT and maxillofacial surgeons, radiation and medical oncologists. HNC often compromise relevant structures of the upper aerodigestive tract involving functions such as speech, swallowing and breathing, among others. The impairment of these functions can significantly impact patients' quality of life and psychosocial status, and highlights the crucial role of specialized nurses, dietitians, psycho-oncologists, social workers, and onco-geriatricians, among others. Hence, these professionals should be integrated in HNC MDTs. In addition, involving translational research teams should also be considered, as it will help reducing the existing gap between basic research and the daily clinical practice. The aim of this comprehensive review is to assess the role of the different supportive disciplines integrated in an MDT and how they help providing a better care to HNC patients during diagnosis, treatment and follow up.

Abordaje de la complejidad psicosocial en pacientes con cáncer / Approaching psychosocial complexity in patients with cancer

ANTECEDENTES Y OBJETIVO: Evaluar el malestar emocional y el nivel de complejidad de pacientes presentados al Comité de Atención Psicosocial. MATERIALES Y MÉTODOS: Estudio pre-post con un solo grupo en pacientes con cáncer. De los 144 pacientes, 27 fueron derivados por el comité a especialistas del área psicosocial, y sus niveles de malestar emocional y de complejidad fueron revisados un mes después. RESULTADOS: Tras ser atendidos según indicaciones del comité, los pacientes mostraron un descenso significativo de los valores en malestar emocional: la media inicial de 8 puntos en la escala visual analógica de malestar emocional descendía a 5,8 puntos. El descenso se reflejó también en los niveles de complejidad: antes de ser revisados, el 70,4% de los pacientes mostraban un alto nivel de complejidad y el 7,4%, un nivel bajo. Después de ser atendidos, los porcentajes de pacientes con alta complejidad se redujeron al 48,1% en los enfermos con alta complejidad, y aumentaron al 22,3% en los de baja complejidad. CONCLUSIONES: El comité ofrece un instrumento para derivar los casos de mayor complejidad que requieren atención preferente y multidisciplinar, permitiendo optimizar recursos, por su eficacia en la resolución de casos complejos

BACKGROUND AND AIM: To assess emotional distress and complexity of patients referred to the Psychosocial Committee. MATERIAL AND METHODS: A pre-post single group study was performed in a sample of oncological patients. From the 144 patients referred to the committee, 27 were attended by psychosocial specialists. The patients' levels of emotional distress and psychosocial complexity were reviewed one month later. RESULTS: After having been attended according to the committee's indications, the patients showed significant decreases in emotional distress. The initial mean of 8 points on the emotional distress scale decreased to 5.81 points after having been referred to the specialist. This decline was also observed in psychosocial complexity. Before attendance, 70.4% patients showed high levels of complexity, and 7.4% showed low levels. After attendance, the percentages of patients with high levels of psychosocial complexity reduced to 48.1% and patients with low complexity increased to 22.2%. CONCLUSIONS: The committee provides an instrument to refer patients who show high levels of psychosocial complexity and require preferential and multidisciplinary attention. The committee optimizes resources due to its efficiency in resolving complex cases

Approaching psychosocial complexity in patients with cancer. / Abordaje de la complejidad psicosocial en pacientes con cáncer.

BACKGROUND AND AIM: To assess emotional distress and complexity of patients referred to the Psychosocial Committee. MATERIAL AND METHODS: A pre-post single group study was performed in a sample of oncological patients. From the 144 patients referred to the committee, 27 were attended by psychosocial specialists. The patients' levels of emotional distress and psychosocial complexity were reviewed one month later. RESULTS: After having been attended according to the committee's indications, the patients showed significant decreases in emotional distress. The initial mean of 8 points on the emotional distress scale decreased to 5.81 points after having been referred to the specialist. This decline was also observed in psychosocial complexity. Before attendance, 70.4% patients showed high levels of complexity, and 7.4% showed low levels. After attendance, the percentages of patients with high levels of psychosocial complexity reduced to 48.1% and patients with low complexity increased to 22.2%. CONCLUSIONS: The committee provides an instrument to refer patients who show high levels of psychosocial complexity and require preferential and multidisciplinary attention. The committee optimizes resources due to its efficiency in resolving complex cases.

El sentido de la vida como recurso espiritual para el cuidado en oncología / The meaning of life as spiritual resource for care in oncology

Introducción: Descubrir el sentido de la vida es una de las necesidades espirituales del ser humano, y funciona como un recurso interior para el enfrentamiento de las adversidades de una forma más positiva. Es considerado el motor fundamental para la existencia, ya que quién tiene por qué vivir puede soportar cualquier cómo hacerlo. Una de las enfermedades que más produce síntomas espirituales de pérdida del sentido de la vida es el cáncer. Objetivo: Reflexionar sobre el sentido de la vida como un recurso espiritual de cuidado al paciente con enfermedad oncológica y para el profesional de enfermería que lo atiende. Métodos: Estudio de análisis crítico, descriptivo y reflexivo, donde se consideraron libros de texto, artículos sobre el sentido de la vida y una revisión de la literatura que fue realizada en las bases de datos Medline, Bdenf y Lilacs a través de la Biblioteca Virtual en Salud BVS Brasil, mediante las siguientes palabras clave en inglés y operadores boléanos, para ampliar los resultados: ¨Cancer¨ AND ¨Nursing care¨ OR ¨Care¨ AND ¨Spirituality¨ AND ¨Meaning of Life¨. Fueron seleccionados los artículos originales y de revisión, nacionales e internacionales, publicados entre 2013 y 2016. Conclusión: El sentido de la vida funciona para el paciente como un mecanismo de protección frente a la enfermedad, y proporciona una mejor sensación de bienestar espiritual y una mejor calidad de vida. Ya para los profesionales de la enfermería actúa como un recurso de cuidado espiritual para sí mismo, posibilita una mejor sensación de bienestar y adecuación a su función(AU)

Introduction: Discovering the meaning of life is one of the spiritual needs of the human being and functions as an internal resource for facing up to the adversities in a more positive way. It is considered as the fundamental driving force for human existence, since the person having reasons to be alive is able to endure hardship. One of the diseases causing spiritual symptoms of the loss of the meaning of life is cancer. Objective: To make a reflection on the meaning of life o spiritual resource for care of oncological patient and for the nursing professional taking care of him/her. Methods: Critical, descriptive and reflective study that analyzed textbooks, articles on the meaning of life and literture review and conducted in Medline, Bdef and Lilacs databases through the Virtual Library of Health in Brazil by using the following keywords in English and the Boolean operators to increase the results. Cancer AND "Nursing care" OR "Care" AND "Spirituality" AND "Meaning of Life". National and international original and review articles, which had been published from 2013 to 2016, were selected. Conclusions: The meaning of life works as a protective mechanism against disease in the patient and provides better perception of spiritual wellbeing and better queality of life. Regarding the nursing professionals, it acts as a resource of spiritual care for themselves, and makes better sensation of wellbeing and adaptation to their function possible(AU)

Análisis cualitativo de temas construidos y emergentes a partir de una experiencia piloto de psicoterapia centrada en la compasión (PCC) en pacientes con cáncer avanzado / Qualitative analysis of constructed and emerging themes from a pilot experience of Compassion Centered Psychotherapy (PCC) in patients with advanced cancer

Introducción: Desde el Instituto Catalán de Oncología de Duran i Reinals, se desarrolla un modelo de «Psicoterapia grupal Centrada en la Compasión» (PCC), enfocada a pacientes con cáncer en fase avanzada. El modelo trabaja constructos terapéuticos como «compasión» o«autocompasión», junto a la atención consciente (mindfulness) para mejorar el bienestar emocional y ayudar al crecimiento personal y espiritual de estos pacientes. Objetivo: El presente estudio piloto tiene como objetivo evaluar la adecuación del nuevo modelo de PCC propuesto. Concretamente evalúa la adecuación de los constructos trabajados por la terapia, la existencia de nuevos temas relevantes para el paciente no contemplados en el modelo, y la consistencia global del modelo a nivel de estructura, tareas y contenido. Método: La metodología fue cualitativa, se grabó y transcribió un ciclo de 8 sesiones de PCC y se hizo un análisis temático del contenido de las sesiones. El análisis fue realizado por dos evaluadores de forma independiente. La muestra final estuvo formada por 9 pacientes. Resultado: Los resultados obtenidos indican que hay una buena adecuación de los constructos trabajados en la terapia y del modelo en general. Sin embargo, será necesario incluir el tema de las «relaciones interpersonales», tema muy relevante para el paciente no contemplado en el modelo. Además, se obtuvo información sobre principales preocupaciones de los pacientes, dificultades a la hora de realizar algunas tareas propuestas y un feedback positivo de la propia psicoterapia y de su participación. Conclusiones: Este estudio piloto aporta información relevante que permite ajustar y mejorar la propuesta del modelo de PCC inicial (AU)

Introduction: People from the Catalan Institute of Oncology of Duran i Reinals have developed a model of «Psicoterapia grupal Centrada en la Compasión» (PCC), focused on patients with advanced cancer develops. The model works therapeutic constructs as «compassion» or «self-compassion» with mindfulness to improve emotional distress and help to the personal and spiritual growth of these patients. Objective: This pilot study aims to assess the adequacy of the new model proposed of PCC. Specifically evaluates the adequacy of the constructs therapy worked and the existence of new issues relevant to the patient not included in the model, and the overall consistency of the model for the structure, tasks and content. Method: The methodology was qualitative, one cycle of 8 sessions of PCC was recorded and transcribed, and was made a thematic analysis of the content of the sessions. The analysis was performed by two reviewers independently. The final sample consisted of 9 patients. Result: The results indicate that in general there is a good adequacy of the constructs worked in therapy and the model. However, it will be necessary to include the issue of «interpersonal relationships», very important for the patient and not included in the model. In addition, information of the main concerns of patients, difficulty performing some tasks proposed and positive feedback of psychotherapy and its participation, were obtained. Conclusions: This pilot study provides relevant information to adjust and improve the initial proposed model of PCC (AU)

Psicoterapia centrada en el sentido: "Vivir con Sentido". Estudio Piloto / No disponible

Introducción: Los pacientes con cáncer avanzado expresan sentimientos de desesperanza, deseo de adelantar la muerte, y niveles elevados de ansiedad y sintomatología depresiva asociada a la pérdida de sentido de vida. Objetivos: El principal objetivo de la Psicoterapia de Grupo Centrada en el Sentido (PGCS) es ayudar a los pacientes con cáncer a vivir con sentido, de una manera plena, manteniendo y ampliando el sentido de su vida, viviendo en paz y con un objetivo en la vida. Participantes y Método: Actualmente, estamos realizando el estudio piloto, como primer paso del proyecto de validación del Modelo de Psicoterapia Centrada en el Sentido. Hemos realizado dos de los tres grupos de pacientes con cáncer avanzado que corresponde al presente estudio piloto, y estamos realizando las trascripción de cada una de la sesiones de los grupos, para su posterior análisis cualitativo. Resultados: Los grupos de psicoterapia centrada en el sentido muestran una reducción de la sintomatología ansiosa y depresiva, desesperanza y deseo de adelantar la muerte en pacientes con cáncer avanzado, a la vez de aumentar el bienestar espiritual y la sensación de sentido (AU)

Introduction: The patients with advanced cancer express feelings of hopelessness, wish to advance the death, and high levels of anxiety and depression associated to the loss of sense of life. Aims: The main aim of the Meaning-Centered Group Psychotherapy is to help to the patients with cancer to live with sense, of a full way, keeping and expanding the sense of his life, living in peace and with an aim in the life. Participants and Method: At present, we are conducting the pilot study, as first step of the project of validation of the Meaning-Centered Group Psychotherapy Model. We have performance two of the three groups of patients with advanced cancer that corresponds to the present pilot study, and are doing the transcription of each one of the sessions of the groups, for his back qualitative analysis. Results: The Meaning-Centered Group Psychotherapy show a reduction of anxiety and depression, hopelessness and wish to advance the death in patients with advanced cancer, at the same time to increase the spiritual welfare and the feeling of sense (AU)

Discriminación del malestar emocional en pacientes oncológicos utilizando la escala de ansiedad y depresión hospitalaria (HADS) / Screening distress in cáncer patients using the hospital anxiety and depression scale (HADS

Resumen: Una de las pruebas de cribado más utilizadas para detectar malestar emocional en pacientes oncológicos ha sido la escala de Ansiedad y Depresión Hospitalaria (HADS). El objetivo de este estudio fue calcular los puntos de corte óptimos que permitan detectar probable sintomatología (ansiedad y depresión) clínicamente significativa en pacientes oncológicos, utilizando como criterio externo la entrevista psiquiátrica según criterios DSM-IV. Evaluamos a un total de 234 pacientes oncológicos ambulatorios con la entrevista psiquiátrica para el DSM-IV (SCID-I) y con el HADS. Se realiza un análisis factorial exploratorio con rotación varimax. Los puntos de corte son hallados mediante la curva de ROC. Los índices de fiabilidad para cada subescala son adecuados, el coeficiente alfa en la subescala de ansiedad fue de 0,82 y en la subescala de depresión de 0,84. El 31,2% de pacientes cumplen criterios clínicos para el diagnóstico de trastorno psiquiátrico. Con unos índices de sensibilidad y especificidad de alrededor del 70% el punto de corte optimo para detectar probable sintomatología clínicamente significativa fue una puntuación 8 en la subescala de ansiedad y una puntuación de 4 en la subescala de depresión. Una puntuación total en el HADS mayor o igual a 10 permite discriminar malestar emocional clínicamente significativo (AU)

Abstract: The most commonly used distress screening questionnaire in oncology patients is the Hospital Anxiety and Depression Scale (HADS). The aim of this study was to determine the optimal cut-off score to discriminate patients with probable significant clinical symptomatology (anxiety and depression) in a sample of oncology out-patients. The DSM-IV psychiatric diagnosis interview was used as the external criteria. A total of 234 oncology out-patients were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I) and the HADS. An exploratory factorial analysis with varimax rotation was carried out. The cut-off scores were calculated by the ROC curve. Results show good internal reliability for each subscale, the alpha coefficient was 0,82 for the anxiety subscale, and 0,84 for the depression subscale. Thirty one point two percent of the patients met clinical criteria for psychiatric diagnoses. According to the sensitivity and specificity rates which were approximately 70%, the optimal cut-off score for screening probable significant clinical symptomatology was a score of 8 for the anxiety subscale, and a cut-off score of 4 for the depression subscale. A score of 10 or more on HADS total scale resulted useful for screening significant distress (AU)

[Psychological adjustment and prevalence of psychiatric disorders in cancer patients]. / Adaptación psicológica y prevalencia de trastornos mentales en pacientes con cáncer.

BACKGROUND AND OBJECTIVE: The main objective of this study was to determine the prevalence and the predictors of mental disorders in cancer patients. PATIENTS AND METHOD: 400 ambulatory cancer patients were included in the study. All the patients with a score of 14 or higher in the Hospital Anxiety and Depression Scale (HADS) received a structured clinical interview (SCID-I. DSMIV) with the objective of determining the prevalence of mental disorders. RESULTS: 24% cancer patients had criteria for a mental disorder. The predictors of mental disorders were radiotherapy treatment, psychopharmacological treatment and pain. CONCLUSIONS: These results support the need to assess the possible anxious and depressive symptoms during cancer treatment and follow up. The predictors found can help to detect possible psychiatric cases in cancer patients.

Adaptación psicológica y prevalencia de trastornos mentales en pacientes con cáncer / Psychological adjustment and prevalence of psychiatric disorders in cancer patients

Fundamento y objetivo: El principal objetivo del estudio ha sido determinar la prevalencia y los predictores de trastornos mentales en pacientes con cáncer. Pacientes y método: Se entrevistó a 400 pacientes oncológicos ambulatorios. A aquellos con una puntuación igual o mayor de 14 en la Escala de Ansiedad y Depresión Hospitalaria (HADS) se les administró la Entrevista Clínica Estructurada para los Trastornos del Eje I (SCID-I) del Manual Diagnóstico y Estadística de los Trastornos Mentales, cuarta edición (DSM-IV), con el fin de determinar la prevalencia de trastornos mentales en la muestra estudiada. Resultados: Un 24% de los pacientes con cáncer presentaba criterios de trastorno mental. En el análisis multivariante los predictores de presencia de trastorno mental fueron: haber recibido radioterapia, estar en tratamiento psicofarmacológico y la presencia de dolor. Conclusiones: Los datos aportados por el estudio señalan la necesidad de realizar un adecuado cribado de los posibles síntomas ansiosos y depresivos que el paciente puede desarrollar durante el proceso oncológico y que le incapacitan para su adaptación emocional a éste. El uso de los predictores hallados puede ayudar a identificar posibles casos de trastorno mental entre los pacientes con cáncer

Background and objective: The main objective of this study was to determine the prevalence and the predictors of mental disorders in cancer patients. Patients and method: 400 ambulatory cancer patients were included in the study. All the patients with a score of 14 or higher in the Hospital Anxiety and Depression Scale (HADS) received a structured clinical interview (SCID-I. DSMIV) with the objective of determining the prevalence of mental disorders. Results: 24% cancer patients had criteria for a mental disorder. The predictors of mental disorders were radiotherapy treatment, psychopharmacological treatment and pain. Conclusions: These results support the need to assess the possible anxious and depressive symptoms during cancer treatment and follow up. The predictors found can help to detect possible psychiatric cases in cancer patients