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)

Eficacia de los tratamientos psicológicos para el miedo a la recurrencia del cáncer de mama / Efficacy of psychological treatments for fear of breast cancer recurrence

Introducción: El miedo a la recurrencia del cáncer es una de las consecuencias más frecuentes en los supervivientes del cáncer. El cáncer de mama fue el tipo de cáncer más diagnosticado en el 2020 en todo el mundo, aunque se ha evidenciado una baja tasa de mortalidad de este tipo de cáncer en España, lo que favorece una mayor prevalencia de miedo a la recurrencia en el cáncer de mama. Objetivo: Realizar una revisión sistemática sobre las intervenciones utilizadas para reducir el miedo a la recurrencia del cáncer en supervivientes de cáncer de mama. Metodología: Se realizó la búsqueda en las bases de datos SCOPUS, APA PsycInfo, APA PsycArticles, MEDLINE y E-Journals, limitando los resultados a los estudios controlados aleatorizados de los últimos siete años. Resultados: Se incluyeron finalmente 18 estudios. Las intervenciones que se centran en los sesgos atencionales y en las preocupaciones y las rumiaciones resultaron ser las más eficaces. Se discuten los resultados en base al modelo de Miedo a la Recurrencia del Cáncer desarrollado por Lee-Jones et al. (1997) y se proponen futuras líneas de investigación. Conclusiones: Existen varias intervenciones eficaces sobre el miedo a la recurrencia del cáncer, destacando el programa ConquerFear por sus resultados y su bajo coste (AU)

Introduction: Fear of cancer recurrence is one of the most frequent consequences in cancer survivors. Breast cancer was the most diagnosed type of cancer in 2020 worldwide, although a low mortality rate of this type of cancer has been evidenced in Spain, which favors a higher prevalence of fear of recurrence in breast cancer. Objective: To conduct a systematic review of the interventions used to reduce the fear of cancer recurrence in breast cancer survivors. Methodology: We searched the SCOPUS, APA PsycInfo, APA PsycArticles, MEDLINE, and E-Journals databases, limiting the results to randomized controlled studies from the last seven years. Results: Eighteen studies were finally included. Interventions targeting attentional biases and worries, and ruminations were found to be the most effective. Results are discussed based on the Fear of Cancer Recurrence model developed by Lee-Jones et al. (1997) and future lines of research are proposed. Conclusions: There are several effective interventions on fear of cancer recurrence, with the ConquerFear program standing out for its results and low cost (AU)

La eficacia de la terapia cognitivo-conductual para el duelo prolongado / Efficacy of cognitive-behavioral therapy for prolonged grief

Antecedentes: El Duelo Prolongado (DP) es una forma patológica del duelo dados los síntomas patentes y el tiempo que perduran, generando malestar y limitando la funcionalidad psicosocial. Durante años se ha empleado la Terapia Cognitivo-Conductual (TCC) para el tratamiento del DP, pero se sugiere que la activación conductual no específica es suficiente, se hallan fallos metodológicos en las muestras de TCC, o se cuestiona si es necesaria la exposición. Objetivo: Analizar si la TCC es realmente eficaz para mejorar el DP en adultos. Método: Se realizó una revisión sistemática mediante la búsqueda en las bases de datos Medline, PsycINFO, PubMed, Scopus y Web of Science desde junio de 2022 hasta febrero de 2023, así como mediante una comunicación personal. Se identificaron 9 estudios que cumplían los criterios de inclusión y exclusión establecidos. Resultados: Se comparan las evaluaciones basales, del postratamiento y seguimiento. Todos los estudios reflejan mejorías superiores en la condición de TCC frente a otras modalidades terapéuticas o frente a la propia TCC sin exposición, a excepción de uno que establece igualdad de eficacia con Eye Movement Desensitization and Reprocessing (EMDR). Se analiza el riesgo de sesgo siguiendo los criterios Cochrane, presentando una adecuada calidad metodológica; el nivel de evidencia científica, 1+; y el grado de recomendación, A. Conclusiones: Los resultados respaldan la eficacia de la TCC para el tratamiento del DP en la población adulta, aunque es fundamental realizar nuevos estudios que fortalezcan esta evidencia. Hasta entonces, se recomienda su aplicación a quienes padezcan DP (AU)

Background: Prolonged Grief (PG) is a pathological form of bereavement given the overt symptoms and the period of time they endure, generating distress and limiting psychosocial functioning. For years, Cognitive Behavioral-Therapy (CBT) has been used for the treatment of PG. Nonetheless, it is suggested that non-specific behavioral activation could be sufficient, methodological problems are found in CBT samples, or it is questioned whether the exposure component is necessary or not. Objective: To analyze whether CBT is really effective to improve PG among the adult population. Methods: A systematic review was conducted through Medline, PsycINFO, PubMed, Scopus and Web of Science databases from June 2022 to February 2023, as well as by means of personal communication. 9 studies that met the established inclusion and exclusion criteria were identified. Results: Baseline post-treatment and follow-up assessments are compared. All studies reflect superior improvements in the CBT condition compared to other therapeutic modalities or compared to CBT without exposure, excluding one study that establishes equal efficacy with Eye Movement Desensitization and Reprocessing (EMDR). The risk of bias was analyzed according to Cochrane criteria, presenting an adequate methodological quality; the level of scientific evidence, 1+; and the grade of recommendation, A. Conclusions: The results support the efficacy of CBT for the treatment of PG in the adult population. Nevertheless, it is essential to conduct new studies that strengthen this evidence. Until then, it is recommended its application among those suffering from PG (AU)

Evaluación del Miedo a la Recurrencia del cáncer en español: el Cuestionario de Miedo a la Recurrencia del Cáncer y Escala General del Miedo a la Recurrencia del Cáncer: un estudio piloto / Assessment of fear of cancer recurrence in Spanish: Fear of Recurrence Questionnaire and he General Scale of Fear of Cancer Recurrence: A pilot study

El objetivo de este estudio es la elaboración de un cuestionario de evaluación del miedo a la recurrencia del cáncer en español. Método: se presenta un estudio piloto de diseño correlacional trasversal elaborado en dos fases: 1) creación del cuestionario del miedo a la recurrencia del cáncer (CMRC) y de la Escala General del Miedo a la Recurrencia del Cáncer (EGMRC); 2) evaluación de sus propiedades psicométricas. Resultados: para la elaboración de los cuestionarios se utilizó el acuerdo entre expertos medido por la V de Aiken. El CMRC queda finalmente configurado con 8 ítems que se responden con una escala tipo Likert de 0-4 y un Alfa de Cronbach de 0,85. La EGMRC de una sola pregunta que se responde con una escala de 0-100 correlaciona hasta un 0,84 con el CMRC. Se utilizó una muestra de 50 mujeres supervivientes de cáncer ginecológico seleccionadas en el Hospital Universitario Clínico San Carlos de Madrid. Ambas escalas correlacionan con el nivel de ansiedad de las pacientes y la función emocional de calidad de vida. No se hallan correlaciones con los niveles de depresión. Conclusiones: El CMRC y la EGMRC son dos instrumentos que pueden ser válidos para la evaluación del miedo a la recurrencia del cáncer en pacientes supervivientes de cáncer ginecológico (AU)

The objective of this study is the elaboration of a questionnaire for the evaluation of the fear of recurrence of cancer in Spanish. Method: A pilot study with a cross-sectional correlational design is presented, elaborated in two phases: 1) creation of the Fear Cancer recurrence Questionnaire (CMRC) and the General Scale of Fear of Cancer Recurrence (EGMRC); 2) evaluation of their psychometric properties. Results: for the elaboration of the questionnaires, the agreement between experts was used, measured by Aiken’s V. The CMRC questionnaire is finally configured with 8 items that are answered with a Likert-type scale of 0-4 and a Cronbach’s Alpha of 0.851. The EGMRC consists of a single question that is answered with a scale of 0-100 correlates up to 0.84 with the CMRC. A sample of 50 female survivors of gynecological cancer selected from the Hospital Universitario Clínico San Carlos in Madrid was used. Both scales correlate with the level of anxiety of the patients and the emotional function of quality of life. No correlations with levels of depression were found. Conclusions: The CMRC and the EGMRC are two instruments that may be valid for the evaluation of FCR in Spanish for survivors of gynecological cancer (AU)

Effectiveness of a cognitive-behavioral group therapy for complicated grief in relatives of patients with cancer: A randomized clinical trial.

INTRODUCTION: Complicated grief can affect a large number of individuals who have lost a relative due to cancer. OBJECTIVES: To assess the efficacy of a cognitive-behavioral grief therapy (CBGT) group for complicated grief (CG) in those who have lost a relative due to cancer in comparison with a psychoeducational and emotional expression intervention group (PSDEEI). METHODS: A randomized clinical trial was used, in which 249 relatives of deceased cancer patients with CG were randomly assigned to CBGT or PSDEEI. Complicated grief (Inventory of Complicated Grief [ICG]), depression (Beck Depression Inventory [BDI-II]), hopelessness (Beck Hopelessness Scale [BHS]), anxiety (Beck Anxiety Inventory [BAI]) symptoms, and general health (Goldberg's General Health Questionnaire [GHQ28]) were assessed at pretreatment, posttreatment, and follow-up at 6 and 12 months. RESULTS: The CBGT group improved significantly (p < 0.001), with the scores in ICG, BDI-II, BAI, BHS, and GHQ28 (p < 0.001) being higher than those for the PSDEEI group in each of the assessed moments, with high effect sizes: ICG (η2 = 0.16), BDI (η2 = 0.10), BAI (η2 = 0.06), BHS (η2 = 0.21), and GHQ28 (η2 = 0.21). At the 12-month follow-up, the number of cases of CG decreased by 81.1% for the CBGT group vs. 31.7% in the PSDEEI group. SIGNIFICANCE OF RESULTS: The CBGT treatment was effective for CG, depression, anxiety, and hopelessness symptoms and for mental health and was superior to the PSDEEI treatment.

Psychological well-being in palliative care: A systematic review.

OBJECTIVE: To review which are the most influential variables in achieving levels of psychological well-being at the end of life and to verify whether, as certain studies suggest, spirituality, resilience and social support are the pillars on which the psychological well-being construct is based. METHOD: A systematic search through the Scopus, Pubmed and PsycInfo electronic databases was carried out using keywords such as: "wellbeing" OR "psychological-well-being" AND "resilience" AND "spirituality" AND "social support" AND "palliative care" and their multiple combinations. RESULTS: Eleven studies were selected, in which terms such as spiritual well-being, absence of discomfort and quality of life were used in substitution of psychological well-being and a certain consensus was found regarding whether resilience, spirituality and social support are predictive variables of psychological well-being. CONCLUSIONS: Resilience, social support and spirituality are highly relevant variables at the end of life and contribute decisively towards psychological well-being.

Predictors of Complicated Grief in Caregivers of Palliative Care Patients.

Introduction: It is important to identify the factors s associated with complicated grief (CG) in order to prevent it. Objective: To determine the factors associated with CG in the end-of-life phase within the palliative care context. Method: The PRISMA model was followed for the review. We accessed the following databases: PUBMED, SCOPUS, and PsycoINFO, to review publications from 2006. Results: A total of 17 studies were obtained. A direct relationship between factors prior to bereavement and CG is established: intensity of anticipated grief, previous mental and physical health of the caregiver, social support; quality of patient care, communication at the end-of-life, preparation for death, spirituality, and sociodemographic factors. Conclusions: Previous mental health and level of anticipatory grief in the main caregiver are shown to be the most powerful predictors of CG. Patient age and quality of care are factors considered as strong predictors of CG in almost every study.

Aplicación de hipnosis al miedo al contagio por COVID-19 en un cuidador de paciente oncológico / Hypnosis applied to the fear of COVID-19 in a cancer caregiver

Objetivo: Se presenta el caso de un familiar de paciente oncológico durante la situación generada por la pandemia de COVID-19, con el que se utiliza un programa multicomponente en el que se incluye la hipnosis clínica como herramienta para gestionar el miedo al contagio y la adaptación a la enfermedad oncológica en el cuidador principal. Método: Una intervención a través de hipnosis clínica para el manejo del miedo al contagio durante el proceso oncológico de su enfermedad. Resultado: Se produce la reducción de la sintomatología ansiosa, en relación con el miedo al contagio, permitiendo a PS abordar diferentes situaciones sin aplicar un afrontamiento evitativo, usando su miedo como una estrategia de protección frente al COVID-19. Ha conseguido mejorar el insomnio, reduciendo los problemas de conciliación y mejorar su autoestima y reforzar el autoconcepto. Conclusión: La hipnosis se revela como una técnica útil rápida y eficaz, que permite manejar de manera adecuada la sintomatología de carácter ansioso dentro de un programa multicomponente. (AU)

Objective: Treatment of fear of contagion during the COVID-19 pandemic and the adaptation to the oncological disease through a multicomponent program that includes clinical hypnosis, in the main caregiver. Method: An intervention using clinical hypnosis to manage the fear of contagion during the process of caring for an oncological patient. Results: There is a reduction in anxiety symptoms, in relation to the fear of contagion, which allows the patient to address different situations without applying avoidant coping, using fear as a protection strategy against COVID-19. Insomnia problems were improved, reducing problems with conciliation insomnia, improving self-esteem and reinforcing self-concept. Conclusion: Hypnosis is revealed as a useful, fast and effective technique that allows to adequately manage anxiety symptoms within a multicomponent program. (AU)

Preoperative detection and evaluation of the need for psychological intervention in cancer and non-cancer patients referred to thoracic surgery.

OBJECTIVES: (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. METHOD: The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression "Do you feel depressed?" (DEPQ). RESULTS: The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. CONCLUSIONS: A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.

Spanish Version of the Death Attitude Profile-Revised. Translation and Validation Into Spanish.

The Death Attitude Profile-Revised (DAP-R) was developed in English-speaking cultures with the aim of measuring attitudes towards death. This measure consists of 32 items, grouped into five factors (Fear of Death, Avoidance of Death, Neutral Acceptance, Approach Acceptance, and Escape Acceptance). The DAP-R was translated and adapted to Spanish (DAP-RSp), and the psychometric properties were analyzed accross a general sample. The face validity was evaluated by 20 experts in palliative care. N = 417 (X = 39.06 years) took part in the validation. DAP-RSp showed adequate internal consistency (Cronbach's alpha ranging from 0.67 for Neutral Acceptance to 0.95 for Escape a Acceptance, and 0.88 for the total), a multitrait scaling analysis and a confirmatory factor analysis reproduced the five dimensions of the original scale. The Spanish version of the DAP-R can be used as a valid scale to assess attitudes towards death in Spanish speaking population.

El Modelo Transteórico y el ejercicio en supervivientes de cáncer de mama / Transtheoretical Model and exercise in breast cancer survivors

Se presenta una revisión sistemática sobre el uso del Modelo transteórico del cambio (MTC) como predictor de adherencia al ejercicio físico (EF) en supervivientes de cáncer de mama. La revisión sistemática de literatura se hizo siguiendo el método PRISMA, en las bases de datos: Scopus, Pubmed y Psycinfo. Tanto en inglés como en español. Se incluyeron 13 artículos publicados desde junio de 2005 hasta junio de 2020. Todos ellos utilizaron constructos del MTC en sus programas. Los resultados muestran que las variables del MTC que presentan asociación con el EF son los estadios de cambio y la autoeficacia. De este modo las intervenciones que siguen el MTC ayudan a comprender la utilización del ejercicio. Sin embargo, estos resultados están limitados por el escaso tamaño de la muestra, los sesgos de selección y la falta de mediciones a largo plazo de los seguimientos. (AU)

A systematic review on the use of the Transtheoretical Model of Change (TTM) as a predictor variable of adherence to Physical Exercise (PE) in breast cancer survivors is presented. The systematic literature review was carried out following the PRISMA method in Scopus, Pubmed, and Psycinfo databases. Both in English and Spanish. Thirteen articles published from June 2005 to June 2020 were included. All of them used TTM constructs in their programs. The results show that the TCM variables that demonstrated its association with PE were stages of change and self-efficacy. Therefore, TCM-based interventions help to understand the adoption of exercise behavior. However, these findings are limited by the small sample size, selection biases, and lack of long-term measurements of follow-ups. (AU)

Efficacy of Meaning-Centered Psychotherapy in adult patients with advanced cancer: A systematic review and meta-analysis / Eficacia de la Psicoterapia Centrada en el Sentido en pacientes adultos con cáncer avanzado: revisión sistemática y meta-análisis

Objective: We conducted a PRISMA-compliant systematic review of clinical trials, and a meta-analysis of randomised clinical trials (RCTs) of manualised Meaning-Centered Psychotherapy (MCP) interventions for adult advanced cancer patients. We searched seven databases for trials published in English and Spanish, until March 27, 2021. Results: Seven trials were included in the systematic review, and four in the meta-analysis. The systematic review favoured the effectiveness of MCP for the improvement of spiritual well-being, quality of life (QoL), sense of meaning and psychological distress, although inconsistencies between the trials were found. In pre-post meta-analytic estimates, MCP had a superior therapeutic effect than control conditions for spiritual well-being (d=0.52, p<0.001), QoL (d=0.60, p<0.001), anxiety symptoms (d=-0.47, p<0.001), depressive symptoms (d=-0.50, p<0.001) and desire for hastened death (d=-0.28, p<0.001). No differences were observed in between-group comparisons. MCP was not associated with an increased risk of abandonment at post-treatment (OR=0.86, p=0.57). Conclusion: Manualised MCP interventions are a promising treatment for the improvement of spiritual well-being and quality of life and the reduction of psychological distress in adult patients with advanced cancer. The evidence base is still in an emerging state and should be expanded by higher methodological quality studies (AU)

Objetivo: se realizó una revisión sistemática de ensayos clínicos siguiendo los criterios PRISMA, y un meta-análisis de ensayos clínicos aleatorizados (ECA), sobre la efectividad de las intervenciones manualizadas de Psicoterapia Centrada en el Sentido (PCS) para pacientes adultos con cáncer avanzado. Se realizaron búsquedas en siete bases de datos de ensayos publicados en inglés y español, hasta el 27 de marzo de 2021. Resultados: siete artículos fueron incluidos en la revisión sistemática y cuatro en el meta-análisis. La revisión sistemática favorece la efectividad de la PCS para mejorar el bienestar espiritual, la calidad de vida, y la experiencia de sentido, así como disminuir el malestar emocional, aunque se encontraron inconsistencias entre los estudios. En los análisis meta-analíticos pre-post, la PCS tuvo un efecto terapéutico superior a la condición control para bienestar espiritual (d=0,52, p<0,001), calidad de vida (d=0,60, p<0,001), sintomatología ansiosa (d=-0,47, p<0,001) y depresiva (d=-0,50, p<0,001), y deseos de muerte acelerada (d=-0,28, p<0,001). No se encontraron diferencias en las comparaciones intergrupo. La PCS no se asoció a un mayor riesgo de abandono en el post-tratamiento (OR=0,86, p=0,57). Conclusión: los programas manualizados de PCS constituyen un tratamiento prometedor para aumentar el bienestar espiritual y calidad de vida, y reducir el malestar emocional, en pacientes con cáncer avanzado. La evidencia se encuentra aún en un estado emergente, y deberá ser complementada con nuevos estudios de mayor calidad metodológica.Palabras clave: Psicoterapia Centrada en el Sentido, cáncer avanzado, bienestar espiritual, malestar emocional (AU)

Valoración de la eficacia de la Terapia Basada en Mindfulness para el trastorno obsesivo compulsivo. Una revisión sistemática / Mindfulness Based Therapy efficacy assessment for Obsessive Compulsive Disorder. A Systematic Review

Antecedentes y objetivos: Las intervenciones basadas en Mindfulness podrían ser tan útiles para el Trastorno Obsesivo Compulsivo (TOC), con igual o mejores resultados que los tratamientos actuales. El objetivo es revisar la investigación reciente sobre la eficacia y aplicabilidad de una Intervención Basada en Mindfulness (IBM) para el tratamiento del TOC. Material y Métodos: Se seleccionaron 13 estudios (2008-2020), de las bases PsycINFO, Scopus, EBSCO, Web of Knowledge, CINAHL y PSICODOC. Resultados: Siete estudios obtuvieron una mejora de síntomas en comparación con el grupo control, pero tan solo en 3 dicho cambio se relacionaba con diferencias en Mindfulness. Se hace un análisis de los problemas metodológicos y del estado de la investigación sobre los procesos activados por Mindfulness. Conclusiones: Los resultados no indican superioridad de una IBM. No obstante, existen multitud de razones metodológicas y teóricas por las que estos hallazgos deben ser tomados con cautela y se necesita más investigación.(AU)

Introduction and Objectives: Mindfulness-based interventions might be equally helpful for obsessive compulsive disorder (OCD), with equal or better results than standard treatments. A systematic review is conducted to assess the efficacy and applicability of a Mindfulness Intervention for OCD symptoms. Materials and Method: Thirteen studies (2008-2020) were selected, from the bases PsycINFO, Scopus, EBSCO, Web of Knowledge, CINAHL and PSICODOC. Results: Seven studies obtained an improvement in symptoms compared to the control group, but only in 3 was this change related to differences in Mindfulness. Conclusions: The amount of methodological problems and the Mindfulness research premature state makes the exhibited results as inconclusive. Better methodological and clinical standards are necessary for future research, which include better methodological and clinical standards, is necessary.(AU)

Preoperative detection and evaluation of the need for psychological intervention in cancer and non-cancer patients referred to thoracic surgery.

OBJECTIVES: (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. METHOD: The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression "Do you feel depressed?" (DEPQ). RESULTS: The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. CONCLUSIONS: A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.

Eficacia de la terapia de pareja con pacientes con cáncer: una revisión sistemática / Efficacy of couple-based intervention with cancer patients: A Systematic Review

OBJETIVO: Conocer la eficacia o utilidad de la terapia de pareja en casos donde uno de los miembros de la pareja padecen cáncer. Así como conocer en qué casos o en qué momentos puede ser más útil este tipo de terapia. MÉTODO: Se realizó una búsqueda sistemática en las bases de datos electrónicas: Scopus, Pubmed y PsycInfo, utilizándose palabras clave, tales como: Couple sex therapy, Cancer, Breast cancer, Prostate cancer, Couple psychological therapy, Intimacy, Clinical trial y Efficacy; y sus múltiples combinaciones. Se han incluido artículos en inglés de entre los años 2007 y 2019. RESULTADOS: Los 11 estudios seleccionados únicamente trataban de cáncer de mama y próstata y la mayoría de ellos se lleva a cabo con una media relativamente pequeña. La mayoría de los tratamientos se aplica desde la corriente cognitivo-conductual y existen mejores resultados si el tratamiento está manualizado. En los casos de cáncer de próstata se trata con más normalidad aspectos relacionados con la sexualidad que en casos de cáncer de mama. Se observan mayores mejoras en cáncer de próstata ya que tienen que ver con aspectos sexuales además de psicológicos (pese a que con tiempo se pierdan dichas mejoras). CONCLUSIONES: Se aprecia eficacia inicial en lo que a satisfacción de la relación y problemas sexuales en la pareja se refiere, pero estos resultados no se mantienen a lo largo del tiempo. Por lo que en general hablaríamos de una eficacia real baja

OBJECTIVE: To know the efficacy or usefulness of couples therapy in cases where one of the partners has cancer. As well as knowing in which cases or at what times this type of therapy may be more useful. METHOD: A systematic search was caried out in the electronic databases: Scopus, Pubmed and PsycInfo, using keywords such as: Couple sex therapy, Cancer, Breast cancer, Prostate cancer, Couple psychological therapy, Intimacy, Clinical trial and Efficacy; and its multiple combinations. Articles in English from 2007 to 2019 have been included. RESULTS: The 11 selected studies only dealt with breast and prostate cancer and most of them are carried out with a relatively small mean. Most treatments are applied from the cognitive-behavioral current and there are better results if the treatment is manualized. In prostate cancer cases, sexuality-related aspects are treated more normally than breast cancer. Further improvements in prostate cancer are observed since they have to do with sexual aspects as well as psychological aspects (although these improvements are lost in time)

A screening method for sleep disturbances at the end-of-life.

OBJECTIVE: To evaluate sleep disturbances and to verify the accuracy of three screening tests to detect them in patients at the end-of-life admitted in a hospital palliative care unit. METHOD: The level of sleep disturbances was evaluated through the Pittsburgh Sleep Quality Index (PSQI) in 150 palliative patients. This questionnaire was the criterion variable for testing the three screening tests used: Edmonton Symptom Assessment System (ESAS-Sleep subscale); the single question "How much do you worry about your sleep problems?" which is answered on a scale of 0-10 (Sleep-Worry-Q) and another single question: "Do you think you have sleep problems?" with two response categories, Yes/No (Sleep-Problem-Q). RESULTS: According to the PSQI (cut-off point: 8), 87% of patients presented sleep disturbances. The ESAS-Sleep (cut-off point: 3) showed a sensitivity of 0.87, a specificity of 0.58, and an AUC of 0.729; the Sleep-Worry-Q (cut-off point: 4) showed a sensitivity of 0.95, a specificity of 0.68, and an AUC of 0.854; the Sleep-Problem-Q obtained a sensitivity of 0.92 and a specificity of 0.65. SIGNIFICANCE OF RESULTS: Patients at the end-of-life, near the time of death, have high levels of sleep disturbances that can be detected early, with better diagnostic accuracy, with the Sleep-Worry-Q. Although from a clinical point of view, the application of the Sleep-Problem-Q may be more advantageous, as it presents good diagnostic accuracy, greater simplicity, and brevity.

Use of hypnosis for the placement of a midline catheter in a patient at the end of life.

OBJECTIVE: The case of a non-oncological patient at the end of his life, admitted to a Palliative Care Unit (PCU), is presented. After a failed attempt to place a central venous catheter (CVC) and another placement of a peripherally inserted central catheter (PICC), the patient exhibited high anxiety regarding a midline catheter (MC) and refused its placement, even though this was necessary for the administration of intravenous drugs to control dyspnea and other complex symptoms that he presented. METHOD: An intervention through clinical hypnosis for successful MC placement and symptom control is described. RESULT: Through clinical hypnosis and interdisciplinary teamwork, it was possible to place a MC, necessary for symptomatic control of a complex patient. SIGNIFICANCE OF RESULT: This case exemplifies hypnosis as a simple procedure that is easy to apply, accepted by the patient, and effective in the implementation of invasive procedures and symptom control in PCUs.

Implementación de un programa de cribado del malestar emocional en un servicio de cirugía torácica / Implementing a distress screening program in a thoracic surgery service

Introducción: El objetivo del presente estudio es examinar la precisión diagnóstica de los test de cribado utilizados para detectar la necesidad de atención psicológica en pacientes remitidos para cirugía torácica. Métodos: Se evaluó la presencia de malestar emocional en un total de 105 pacientes remitidos para cirugía torácica por medio de la entrevista clínica psicológica (variable criterio). Los métodos de cribado utilizados fueron: el juicio del médico (sí/no), la Escala Hospitalaria de Ansiedad y Depresión (HADS), la pregunta única para evaluar depresión "¿se siente usted deprimido?" (ADEP) (1-5) y la pregunta única para medir ansiedad "¿se siente ansioso?" (AANA) (1-5). Resultados: De acuerdo con la entrevista entrevista clínica psicológica, el 34% de los pacientes fueron casos clínicos que requerían intervención psicológica. La puntuación total de la escala HADS (punto de corte 10) mostró una sensibilidad del 0,89, especificidad del 0,75 y un ABC de 0,883; la ADEP (punto de corte 1) mostró una sensibilidad del 0,79, especificidad del 0,74 y ABC del 0,795; la AANS (>1) obtuvo una sensibilidad del 0,78, especificidad del 0,41 y ABC de 0,69 y el juicio del médico mostró una sensibilidad del 0,47 y especificidad del 0,86. Conclusiones: Un alto porcentaje de pacientes remitidos para cirugía torácica requirieron intervención psicológica. El mejor instrumento para identificar a aquellos pacientes con necesidades psicológicas, tomando la entrevista psicológica como variable criterio, fue la puntuación total del HADS. Este instrumento es simple y breve, bien aceptado por los pacientes, de fácil aplicación en un servicio de cirugía torácica y tiene buena capacidad diagnóstica

Introduction: The aim of the present study was to examine the diagnostic accuracy of screening tests in detecting cases requiring psychological intervention among patients referred for thoracic surgery. Methods: Emotional distress was evaluated in 105 patients referred for thoracic surgery by means of a diagnostic psychological interview (criterion variable). The screening ability of the following methods was analyzed: the physician's opinion (Yes/No), Hospital Anxiety and Depression Scale (HADS), single-item interview: «Are you depressed?» (Depression Question, ADEP) (1-5) and the single-item interview: «Are you anxious?» (Anxiety Question, ANXQ) (1-5). Results: According to the clinical interview, 34% of the patients were clinical cases requiring psychological intervention. The total HADS (cut-off point of 10) showed a sensitivity = 0.89, specificity = 0.75 and AUC = 0.883; the ADEP scale (>1) showed a sensitivity = 0.79, specificity = 0.74 and AUC = 0.795; the ANXQ scale (>1) showed a sensitivity = 0.78, specificity = 0.41 and AUC = 0.690; and the physician's opinion showed a sensitivity = 0.47 and specificity = 0.86. Conclusions: A high percentage of patients referred for thoracic surgery required psychological intervention. The best instrument to identify those patients requiring psychological care, taking a psychological interview as the criterion variable, was the total HADS score. This test is brief, simple and well accepted by patients; it is easy to implement within a thoracic surgery service and has a good diagnostic accuracy

Implementing a distress screening program in a thoracic surgery service. / Implementación de un programa de cribado del malestar emocional en un servicio de cirugía torácica.

INTRODUCTION: The aim of the present study was to examine the diagnostic accuracy of screening tests in detecting cases requiring psychological intervention among patients referred for thoracic surgery. METHODS: Emotional distress was evaluated in 105 patients referred for thoracic surgery by means of a diagnostic psychological interview (criterion variable). The screening ability of the following methods was analyzed: the physician's opinion (Yes/No), Hospital Anxiety and Depression Scale (HADS), single-item interview: «Are you depressed?¼ (Depression Question, ADEP) (1-5) and the single-item interview: «Are you anxious?¼ (Anxiety Question, ANXQ) (1-5). RESULTS: According to the clinical interview, 34% of the patients were clinical cases requiring psychological intervention. The total HADS (cut-off point of 10) showed a sensitivity=0.89, specificity=0.75 and AUC=0.883; the ADEP scale (>1) showed a sensitivity=0.79, specificity=0.74 and AUC=0.795; the ANXQ scale (>1) showed a sensitivity=0.78, specificity=0.41 and AUC=0.690; and the physician's opinion showed a sensitivity=0.47 and specificity=0.86. CONCLUSIONS: A high percentage of patients referred for thoracic surgery required psychological intervention. The best instrument to identify those patients requiring psychological care, taking a psychological interview as the criterion variable, was the total HADS score. This test is brief, simple and well accepted by patients; it is easy to implement within a thoracic surgery service and has a good diagnostic accuracy.

La intervención psicológica en mindfulness con pacientes supervivientes de cáncer de mama. Revisión sistemática / The psychological intervention in mindfulness with surviving patients of breast cancer. Systematic review

Objetivo. Valorar la eficacia de las intervenciones psicológicas en mindfulness con pacientes supervivientes de cáncer de mama. Método. Buscamos en las bases de datos: Pubmed, CINAHL y Psycinfo, investigaciones con intervenciones en mindfulness a pacientes adultas supervivientes de cáncer de mama, que incluyeran grupos experimentales y control, así como seguimiento tras finalizar las intervenciones durante el período de enero 2011 hasta octubre de 2017. Resultados. Se obtuvieron 10 investigaciones con diseños aleatorios controlados y seguimientos que aplicaron la intervención psicológica en mindfulness con supervivientes adultas de cáncer de mama. Conclusiones. Las intervenciones psicológicas en mindfulness inciden positivamente en la reducción de sintomatología psicológica y física de las pacientes supervivientes con cáncer de mama mejorando la calidad de vida de estas (AU)

Objetive. To assess the effectiveness of psychological interventions in mindfulness with patients surviving breast cancer. Method. We searched the databases: Pubmed, CINAHL and Psycinfo, investigations with interventions in mindfulness to adult patients surviving breast cancer, which included experimental groups and control and monitoring after completing the interventions during the period from January 2011 to October 2017. Results. We obtained 10 investigations with randomized controlled designs and follow-ups that apply the psychological intervention in mindfulness with adult breast cancer survivors. Conclusions. The psychological interventions in mindfulness positively affect the reduction of psychological and physical symptoms of the surviving patients with breast cancer improving their quality of life (AU)