Integración del modelo biopsicosocial en la implantación de Comprehensive Medication Management para pacientes tratados en una institución oncológica en Colombia / Biopsychosocial Model Integration in the implementation of Comprehensive Medication Management for patients treated in an oncological institution in Colombia

Introducción: Las personas con cáncer necesitan recibir cuidados enfocados en aspectos biopsi-cosociales considerando la experiencia con la medicación (MedExp), la evolución de esta enfermedad y la calidad de vida relacionada con la salud (CRVS). Se presentan los resultados del Compre-hensive Medication Management (CMM) implanta-do en una institución colombiana especializada en oncología. Método: Diseño cuali-cuantitativo mixto observacional, descriptivo y prospectivo. Los datos se obtuvieron mediante triangulación de técnicas cualitativas (entrevistas en profundidad y observación participante) y cuantitativas (entrevistas clínicas con cuestionarios validados). Las entrevistas fueron presenciales y telemáticas por la pandemia (febrero-octubre 2021). Según los estándares del CMM, se generó la historia farmacoterapéutica, se registró la información biopsicosocial y se analizó la MedExp y la CVRS utilizando Medicines Optimisation Software®. Resultados: Se evaluaron los estándares antes y después de su implantación. La valoración inicial tuvo un análisis DAFO (Debilidades, Amenazas, Fortalezas, Oportunidades) consensuando estrategias para desarrollar CMM. El servicio de oncología derivó 17 personas, 10 mujeres aceptaron participar. Se completaron 30 entrevistas recogiendo narrativas sobre experiencias, observaciones y datos clínicos contextualizados a partir de las que se realizaron intervenciones biopsicosociales. Se resolvieron 2 condiciones clínicas, 2 mejoraron, 7 permanecieron estables, 9 mejoraron parcialmente y 4 no tuvieron mejoría. Tras recibir CMM, las participantes mejoraron su autopercepción en salud, y mejoraron principalmente las dimensiones de movilidad, realización de actividades cotidianas y ansiedad/depresión. Conclusiones: En la implantación del CMM se integró el modelo biopsicosocial considerando las experiencias reales de padecer cáncer alcanzando mejoría en condiciones clínicas y en CVRS de las pacientes atendidas. (AU)

Introduction: People with cancer need to receive care focused on biopsychosocial aspects, consid-ering medication experience (MedExp), disease and illness progression, and health-related quality of life (HRQoL). The results of the Comprehensive Medication Management (CMM) implemented in a Colombian institution specialized in oncology are presented. Method: Mixed observational, descriptive, and pro-spective qualitative-quantitative design. Data were obtained by triangulating qualitative (in-depth inter-views and participant observation) and quantitative techniques (clinical interviews with validated ques-tionnaires). Data was collected through interviews carried out face-to-face and remotely due to the pandemic situation during February-October 2021. According to CMM standards, the pharmacothera-peutic history was obtained, recorded, and MedExp and HRQoL were analyzed using Medicines Optimi-zation Software®. Results: The standards of pharmaceutical care practice were established through the implemen-tation of a SWOT analysis to support care process. The oncology service referred 17 people; 10 women agreed to participate. Thirty interviews were completed collecting narratives about experiences, observations and contextualized clinical data from which biopsychosocial interventions were carried out. Clinical results obtained were: 2 clinical condi-tions resolved, 2 improved, 7 stable, 9 partially im-proved and 4 unimprovement. After receiving CMM, the participants improved their self-perception of health, and HRQoL dimensions of mobility, daily activities, and anxiety/depression improved. Conclusions: Through the implementing of CMM, clinical conditions related to the patients’ medica-tions were improved. Results guided the actions to be followed when implementing this biopsychoso-cial model in the institution. Providing benefits for patients and caregivers, in terms of avoiding the deterioration of quality of life despite suffering from of oncological diseases.

Utilidad de la terapia de aceptación y compromiso en pacientes oncológicos: revisión sistemática / Utility of acceptance and commitment Tterapy with cancer patients: Systematic Review

Utility of Acceptance and Commitment Therapy in cancer patients: Systematic Review. Cancer patients have multiple alternatives in psychotherapy to address the emotional difficulties that accompany this disease. Within these alternatives, Acceptance and Commitment Therapy is being provided due to its functionality in this population. It is necessary to review the results of the scientific literature regarding the efficacy of Acceptance and Commitment Therapy on psychological difficulties in cancer patients. Databases of MedLine, PubMed, Cochrane, and Google Scholar were reviewed to access information in English and Spanish related to this therapy in the last 15 years. From the articles found, we selected 16 that take into account dimensions such as experiential avoidance or psychological flexibility; limitations were also analyzed. Acceptance and Commitment Therapy is observed as one of the most successful therapy in Psycho-oncology to improve depressive and anxiety symptoms due to the increase in psychological flexibility and decrease in the avoidance of cognitions and emotions related to cancer (AU)

The flourishing scholarship of psychosocial oncology viewed across 30 years through the lens of this journal, Psycho-Oncology.

OBJECTIVE: This issue celebrates the 30th anniversary of Psycho-Oncology as a journal, a home for scholarship integrating the psychological, social and behavioural dimensions of cancer. Psycho-oncology developed as an evidence-based discipline to offer an alternative to unproven therapies and to optimise coping and support for patients with cancer and their families. METHODS: A review of key articles was undertaken for this editorial. RESULTS: Empirical studies have defined the prevalence of morbidity arising from cancer and the acute, longer-term and late effects of its varied treatments. Interventions have been adapted to respond to existential challenges, death anxiety, fear of recurrence, disease progression, palliative care and have been continued into bereavement. Mixed modality treatments have combined psychotropic and psychotherapeutic interventions. Survivorship studies have examined rehabilitation, fertility, sexuality, body image and relational impacts of illness. CONCLUSION: This journal has helped the discipline to flourish by publishing the innovative outputs of its community of researchers.

Efectividad de la Realidad Virtual (RV) en la disminución del distrés de niños y adolescentes con cáncer: Revisión sistemática / Effectiveness of Virtual Reality (VR) in reducing distress in children and adolescents with cancer: A systematic review

Introducción: Aunque se han publicado muchos estudios que han intentado demostrar la eficacia de diferentes tratamientos psicológicos en pacientes con cáncer; hasta la fecha no se ha revisado la evidencia disponible sobre la eficacia de la Realidad Virtual (RV) para disminuir el distrés en niños y adolescentes con cáncer. Objetivo:El objetivo principal es evaluar la efectividad de la intervención con Realidad virtual en la disminución del distrés que padecen los niños y adolescentes con cáncer ante los procedimientos médicos, la hospitalización, o la propia enfermedad. Resultados:De los 22 artículos encontrados, se han seleccionado para la revisión un total de 8, que seguían un diseño experimental o cuasiexperimental en pacientes niños y jóvenes diagnosticados de cáncer tratados con RV. Conclusiones: Los resultados, aunque heterogéneos, sugieren mejorías a medio–largo plazo en las variables de ansiedad, depresión, aceptación, calidad de vida, distrés y flexibilidad psicológica. Además, la RV ha resultado ser más eficaz que otras técnicas. De este modo, a pesar de las limitaciones encontradas en este estudio, se han obtenido resultados prometedores para futuras revisiones y/ o metaanálisis (AU)

Introduction: Although many studies have been published that have attempted to demonstrate the efficacy of different psychological treatments in cancer patients, to date there has been no review of the available evidence on the efficacy of Virtual Reality (VR) in reducing distress in children and adolescents with cancer. Objective: The main aim is to evaluate the effectiveness of virtual reality intervention in reducing the distress suffered by children and adolescents with cancer in the face of medical procedures, hospitalization, or the disease itself. Results: Of the 22 articles found, a total of 8 were selected for the review, which followed an experimental or quasi-experimental design in children and young people diagnosed with cancer treated with VR. Conclusions: The results, although heterogeneous, suggest medium to long-term improvements in the variables of anxiety, depression, acceptance, quality of life, distress, and psychological flexibility. Moreover, VR has proved to be more effective than other techniques. Thus, despite the limitations found in this study, promising results have been obtained for future reviews and/or meta-analysis (AU)

Family attitudes about and experiences with medical cannabis in children with cancer or epilepsy: an exploratory qualitative study.

BACKGROUND: Cannabis is legal for recreational and medical use in Canada. Our aim was to explore family experiences using medical cannabis for children with severe conditions in the context of legalization. METHODS: We conducted a qualitative study using semistructured interviews between April and July 2019. Participants were parents of children attending BC Children's Hospital oncology or palliative care clinics, recruited through posters, emails or referral. Participants were included if they spoke English and their child used any type of cannabis for medical purposes. Interviews included open-ended questions about the child's cannabis use. Interviews were recorded and transcribed, and thematic analysis was performed using qualitative description. RESULTS: Ten interviews were completed with 9 mothers and 1 mother-father pair. The age range of the children was 22 months to 16 years. The primary reasons for cannabis use were epilepsy (6 children) or chemotherapy management (4 children). Five major themes were identified. 1) Child and family context, and cannabis as a last resort: children were seen as severely ill; parents sought cannabis out of desperation and responsibility to their child. 2) Varied information sources informed decision-making: parents lacked resources from health care providers and sought support from social media, industry and other families. 3) Cannabis as an ambiguous medicine: cannabis was viewed as both a serious drug that doctors should prescribe and as a natural alternative health product, safe to pursue alone. 4) Perceived effects: parents perceived medical benefits with few concerns about adverse effects. 5) Legal and financial challenges: parents were willing to obtain cannabis despite high costs and uncertain legality. INTERPRETATION: Parents of children with severe conditions pursued medical cannabis despite obstacles and needed unbiased information to access alone. Scientific investigation is needed to develop pediatric medical guidelines to inform decisions.

Cross-cultural adaptation and validation of the Turkish version of the Musculoskeletal Tumor Society scoring system in patients with musculoskeletal tumors.

OBJECTIVE: This study aimed to translate and cross-culturally adapt the musculoskeletal tumor society (MSTS) scoring system into Turkish and to determine the reliability and validity of the translated version for the functional evaluation of patients with musculoskeletal tumors. METHODS: A total of 36 patients (16 women, 20 men; mean age=36.6; age range=13-75 years) who underwent limb-salvage surgery owing to benign aggressive or malignant musculoskeletal tumors were included in the study. Translation and back translations of the MSTS were performed according to the published guidelines. Short form (SF) 36 physical component, Western Ontario and McMaster Universities Arthritis Index (WOMAC), disabilities of the arm, shoulder, and hand (DASH), and range of motion scale (ROMS) that were previously analyzed for Turkish validation were used for validity. Reliability of MSTS Turkish version was evaluated by calculating test-retest reliability and internal consistency. Intraclass correlation coefficient (ICC) was used to evaluate the inter-observer consistency and test-retest reliability. Alpha coefficient (Cronbach's alpha) was used to evaluate the internal consistency. RESULTS: It was observed that total MSTS score has a strong negative correlation with DASH (r=-0.689; p<0.001) and WOMAC scores (r=-0.634; p<0.001) and moderate correlation with the ROMS score (r=0.521; p<0.001). Total MSTS score also had a statistically significant strong correlation with SF-36 scores (r values ranging from 0.425 to 0.609, p<0.001). Inter and intra-observer reliability of the MSTS scale was found to be excellent (Cronbach's α=0.97 p<0.001; ICC: 0.97 (0.96-0.99; p<0.001). Unlike other subscales, statistical correlation between dexterity and hand-positioning subscales of MSTS with DASH scores was found to be insignificant (r=-0.533, p =0.061 and r=-0.336, p=0.261, respectively). CONCLUSION: The Turkish version of the MSTS scoring system seems to be a valid and reliable scale that measures the correct and desired values in the evaluation of health-related quality of life in orthopedic oncology. Reliability coefficients of the Turkish version of MSTS were determined to be strong. LEVEL OF EVIDENCE: Level II, Diagnostic Study.

Breaking bad news to cancer patients in times of COVID-19.

Breaking bad news is a mandatory provision in the professional life of nearly every physician. One of its most frequent occasions is the diagnosis of malignancy. Responding to the recipients' emotions is a critical issue in the delivery of unsettling information, and has an impact on the patient's trust in the treating physician, adjustment to illness and ultimately treatment. Since the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, several measures of social distancing and isolation have been introduced to our clinical setting. In the wake of these restrictions, it is important to reexamine existing communication guidelines to determine their applicability to face-to-face counseling in the context of social distancing, as well as to new communication technologies, such as telemedicine. We address these issues and discuss strategies to convey bad news the most empathetic and comprehensible way possible.

Lessons learned from the delivery of virtual integrative oncology interventions in clinical practice and research during the COVID-19 pandemic.

The outbreak of the coronavirus disease 2019 (COVID-19) and subsequent need for disease transmission mitigation efforts have significantly altered the delivery of cancer care (e.g., rise of telemedicine), including within the field of integrative oncology. However, little has been described about how National Cancer Institute-Designated Cancer Centers have transformed integrative oncology care delivery in response to the COVID-19 pandemic. The purpose of this commentary is to describe the delivery of integrative oncology clinical services and conduct of research at The Leonard P. Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute during the COVID-19 pandemic. Clinical services transitioned from an array of in-person appointment-based services, such as acupuncture and massage, and group programs, such as yoga and nutrition seminars to a combination of live-streamed and on-demand virtual group programs and one-on-one virtual appointments for services such as acupressure and self-care massage. Group program volume grew from 2189 in-person program patient visits in the 6 months prior to onset of the COVID pandemic to 16,366 virtual (e.g., live-streamed or on-demand) patient visits in the first 6 months of the pandemic. From a research perspective, two integrative oncology studies, focused on yoga and music therapy, respectively, were transitioned from in-person delivery to a virtual format. Participant accrual to these studies increased after the transition to virtual consent and intervention delivery. Overall, our clinical and research observations at Dana-Farber Cancer Institute suggest that the delivery of virtual integrative oncology treatments is feasible and appealing to patients. Trial Registration: NCT03824860 (Yoga); NCT03709225 (Music Therapy).

Intervención psicológica en los cuidadores de los pacientes oncológicos menores de edad: revisión sistemática / Psychological intervention in caregivers of underage cancer patients: a systematic review

OBJETIVOS: Revisar y analizar la evidencia científica con respecto a las posibles intervenciones psicológicas realizadas en los cuidadores de los pacientes oncológicos menores de edad. MÉTODOS: Revisión sistemática de los artículos recuperados de las bases de datos bibliográficas MEDLINE (vía PubMed), Embase, Cochrane Library, PsycINFO, PSICODOC, Scopus, Web of Science y MEDES. hasta julio de 2020. La ecuación de búsqueda se formuló́ mediante los descriptores «Psychotherapy» y «Caregivers» y «Neoplasms», utilizando también los Entry Terms relacionados y los filtros: «Humans» y «Child: birth-18 years». La calidad de los artículos se evaluó́ mediante el cuestionario CONSORT y el nivel de evidencia y grado de recomendación mediante los criterios GRADE. RESULTADOS: De las 255 referencias recuperadas, tras aplicar los criterios de inclusión y exclusión, se seleccionaron 11 artículos. Al evaluar la calidad de los artículos mediante CONSORT, las puntuaciones oscilaron entre mínimo de 14,5 y máximo de 20,8 con mediana de 18,5 (puntuación máxima de 21). Según criterios GRADE se obtuvo un grado de recomendación fuerte (evidencia de moderada a alta calidad) clasificada entre los rangos de 1B a 1A. La intervención más frecuente fue la terapia cognitivo-conductual, en 7 de 11 ensayos, estando dirigidas por un psicólogo, siendo las sesiones presenciales la forma de intervención más utilizada. CONCLUSIONES: La mayoría de los ensayos midieron sintomatología depresiva, ansiosa y postraumática. La intervención que más se realizó fue la terapia cognitivo-conductual, constatándose una disminución del estrés postraumático. También se observó, que disminuía la depresión y la ansiedad en el grupo de la intervención y sensación de una menor carga emocional. Ahora bien, en algunos ensayos no se encontró diferencias significativas en cuanto a sintomatología en esas áreas. Pero, aun así, las madres cuidadoras calificaron la intervención como favorable

OBJECTIVE: To review and analize the scientific evidence regarding the psychological interventions carried out in the caregivers of underage cancer patients. METHOD: A systematic review of articles from peer-reviewed journals was conducted. Articles were recovered from MEDLINE (through PubMed), Embase, Cochrane Library, PsycINFO, PSICODOC, Scopus, Web of Science and MEDES until July 2020. The search equation was formulated using the descriptors «Psychotherapy» and «Caregivers» and «Neoplasms», also using the related Entry Terms and filters: «Humans» and «Child: birth-18 years». The quality of the articles was evaluated using the CONSORT questionnaire and the level of evidence and grade of recommendation using the GRADE criteria. RESULTS: After applying the inclusión and exclusión criteria 11 articles were selected from the 255 articles initially retrieved. In the evaluation of the quality of the articles using CONSORT the scores ranged from a mínimum of 14,5 to a maximum of 20,8 with a median of 18,5 (maximum score of 21). According to GRADE criteria a strong recommendation grade (moderate to high quality evidence) was obtained, classified between the ranges from 1B to 1A. The most frequent intervention was cognitive behavioral therapy, in 7 of 11 clinical trials, being directed by a psychologist, with face to face sessions being the most used form of intervention. CONCLUSIONS: Most of the clinical trials measured depressive, anxious and post-traumatic symptoms. The most used intervention was cognitive behavioral therapy with a decrease in post-traumatic stress. It was also observed that depression, anxiety and the feeling of less emotional charge decreased in the intervention group. However, in some trials no significant differences were found in terms of symptoms in these areas. But even so, the caregiving mothers rated the intervention as favorable

Managing cancer in context of pandemic: a qualitative study to explore the emotional and behavioural responses of patients with cancer and their caregivers to COVID-19.

OBJECTIVES: Having to access life-sustaining treatment during the emerging COVID-19 outbreak has placed patients with cancer at an especially vulnerable position notwithstanding their immunocompromised condition. The present study aimed to elucidate cancer patients' and their caregivers' experiences during this outbreak. DESIGN: Face-to-face semistructured interviews were conducted. SETTING: A tertiary cancer care facility. PARTICIPANTS: 16 patients with cancer and 14 caregivers. Inclusions criteria were: (A) diagnosed with cancer, (B) receiving active treatment or follow-ups, (C) aged 21 years and above and (D) fluent in English or Mandarin. RESULTS: Thematic analysis was conducted. Five themes were identified: heightened sense of threat, impact on healthcare experience, responsibility falls on oneself, striving for normalcy and sense of safety and trust. Heightened threat of COVID-19 was more pronounced in patients and linked to vulnerability and fear, uncertainty and actions of socially irresponsible others. Dominant in their healthcare experience was prioritising cancer and treatment amidst heightened threat and anticipatory worry about treatment disruptions. Both noted on the importance of taking responsibility for one's health, with caregivers reporting a reinforced sense of duty towards patients. They strived to maintain normalcy by viewing COVID-19 as beyond personal control, downplaying and living life as usual. Their resolve was supported by a sense of safety from the actions of authorities, hospitals and trust towards healthcare providers. CONCLUSIONS: Cancer intensifies threat and the emotional impact of COVID-19 and may trigger specific concerns related to treatment. Psychoeducation interventions led by healthcare providers over digital platforms could help address cancer-specific concerns and support patients and caregivers during the pandemic.

Factors associated with psychological distress among patients with breast cancer during the COVID-19 pandemic: a cross-sectional study in Wuhan, China.

PURPOSE: This study aimed to examine the prevalence of psychological distress and the corresponding risk factors among patients with breast cancer affected by the outbreak of coronavirus disease 2019 (COVID-19). METHODS: This cross-sectional, survey-based, region-stratified study was conducted from March 14 to March 21, 2020. An online survey was used to collect the basic characteristics of patients with breast cancer. The degree of depression, anxiety, and insomnia symptoms were assessed using the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7), and the Insomnia Severity Index (ISI) questionnaires, respectively. Multivariate logistic analysis was performed to identify factors associated with psychological distress outcomes. RESULTS: Among the 834 patients with breast cancer included in the study, the prevalence of depression, anxiety, and insomnia was 21.6%, 15.5%, and 14.7%, respectively. No statistically significant difference in the prevalence of these symptoms was observed between patients in Wuhan and those outside Wuhan. Multivariate logistic regression analyses revealed that comorbidity, living alone, deterioration of breast cancer, and affected treatment plan were risk factors for psychological distress including depression, anxiety, and insomnia. When stratified by location, living alone was associated with depression and insomnia only among patients in Wuhan, but not those outside Wuhan. CONCLUSIONS: This study shows an elevated prevalence of depression, anxiety, and insomnia among patients with breast cancer during part of the COVID-19 pandemic. Patients with comorbidity, living alone, deterioration of breast cancer, and whose treatment plan was affected should be paid more attention to prevent mental disorders.

Personalised support of brain tumour patients during radiotherapy based on psychological profile and quality of life.

PURPOSE: Psychological distress in primary malignant brain tumour (PMBT) patients is associated with poorer outcomes. Radiotherapy (RT) often induces side effects that significantly influence patients' quality of life (QoL), with potential impact on survival. We evaluated distress, anxiety, depression, and QoL over time to identify patients with difficulties in these areas who required more intense psychological support. METHODS: Psychological questionnaires-Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy (FACT-G and FACT-Br)-were completed at the beginning (T0), in the middle (T1), directly after RT (T2), and 3 months after RT (T3). We personalised the psychological support provided for each patient with a minimum of three sessions ('typical' schedule) and a maximum of eight sessions ('intensive' schedule), depending on the patients' psychological profiles, clinical evaluations, and requests. Patients' survival was evaluated in the glioblastoma multiforme (GBM) patients, with an explorative intent. RESULTS: Fifty-nine consecutive PMBT patients receiving post-operative RT were included. For patients who were reported as 'not distressed' at T0, no statistically significant changes were noted. In contrast, patients who were 'distressed' at T0 showed statistically significant improvements in DT, HADS, FACT-G, and FACT-Br scores over time. 'Not distressed' patients required less psychological sessions over the study duration than 'distressed' patients. Interestingly, 'not distressed' GBM patients survived longer than 'distressed' GBM patients. CONCLUSIONS: Increased psychological support improved distress, mood, and QoL for patients identified as 'distressed', whereas psychological well-being was maintained with typical psychological support in patients who were identified as being 'not distressed'. These results encourage a standardisation of psychological support for all RT patients.

Integrating psycho-oncology services in cancer care in India.

Psychological distress is often an under-diagnosed problem in cancer care. Addressing psychosocial issues would enhance treatment compliance, physician-patient relationship, treatment efficacy and quality of life. This article emphasizes the importance of integrating psycho-oncology services in cancer care and attempts to define the various roles that a psycho-oncologist can play across the entire trajectory. It also highlights the indispensable role played by the oncologists' referrals in maximizing the benefits of psycho-oncology services received by patients and their caregivers.

Psycho-oncology: My chosen journey.

Before choosing psycho-oncology, there was a juncture in my life when I had to select my specialization for further education. It was overwhelming to choose one from all the areas available at that time and be solely responsible for this decision as it had a bearing on not just me, but also on my family. In 2013 (when I decided on my area of specialization), psycho-oncology was a new field. With just a belief to hold onto, that one day psycho-oncology would be widespread and welcomed in Indian cancer care, I pursued this field with dedication and passion. Despite knowing the risk of choosing a career of a barely trodden path, I took the plunge because I believed in its need and that I could contribute to this field meaningfully. Persistent efforts to integrate psycho-oncology into mainstream oncology are being made by psychologists, policymakers, oncologists, social workers and palliative care professionals and I will continuously strive to add my bit to this field. Cancer, as is commonly known, is an illness of the patient, as well as the family. Cancer impacts patients, caretakers, and oncologists. I observed that factors such as culture, age, caretakers beliefs, their perceptions about the illness, society, and the stigma associated with the illness are some of the barriers to truthful disclosure. This is an area within psycho-oncology that interests me and I have dedicated the past few years of my research to knowing it in depth. In this narration, I share with you an encounter with a patient which propelled me certainly and went deeply into psycho-oncology.

What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP).

AIMS: Translation of evidence-based psycho-oncology interventions into routine care can significantly improve patient outcomes, yet effective implementation remains challenging due to numerous real-world barriers. A key factor that may influence implementation is organisational readiness for change. This mixed method study sought to identify factors associated with organisational readiness for implementing the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). METHODS: We collected data from multidisciplinary staff across six Australian cancer services who were preparing to implement the ADAPT CP. Services were categorised as having 'high' versus 'mid-range' organisational readiness based on a median split on the Organizational Readiness for Implementing Change (ORIC) questionnaire (score range = 12-60). Qualitative data from the semi-structured interviews based on the Promoting Action Research in Health Services (PARiHS) framework were analysed thematically and compared for services with high- versus mid-range organisational readiness. RESULTS: Three services with high- (mean ORIC range, 52.25-56.88), and three with mid-range (range, 38.75-46.39) organisational readiness scores were identified. Staff at services reporting higher readiness described a more collaborative and proactive service culture, strong communication processes and greater role flexibility. They also reported greater confidence in overcoming anticipated barriers and clearer strategies for addressing issues. CONCLUSIONS: Levels of organisational readiness were related to distinct qualitative themes. Targeting these issues in services where readiness is mid-range or low prior to full-scale roll-out may improve staff levels of confidence and efficacy in implementing psycho-oncology-focused interventions.

Emotional Response of US Breast Cancer Survivors during the COVID-19 Pandemic.

In a sample of 633 US adult breast cancer survivors, we examined health-related worry as a function vulnerability as influenced by communication, trust, and planning with their cancer care team during the COVID-19 pandemic. We found significant positive correlations between communication and trust, communication and planning, and trust and planning. ANCOVAs with treatment status, immunocompromised status, and delays (separately) as IVs, trust as a covariate, and cancer-related worry as a DV, yielded significant models. A noteworthy finding is the presence of trust as a significant covariate in models of vulnerability and worry.

Efficacy of the Managing Cancer and Living Meaningfully (CALM) individual psychotherapy for patients with advanced cancer: A single-blind randomized controlled trial.

OBJECTIVE: We aimed to determine whether the Managing Cancer and Living Meaningfully (CALM) therapy is superior to a non-manualized supportive psycho-oncological counselling intervention (SPI). METHODS: Adult patients with advanced cancer and ≥9 points on the PHQ-9 and/or ≥5 points on the DT were randomized to CALM or SPI. We hypothesized that CALM patients would report significantly less depression (primary outcome) on the BDI-II and the PHQ-9 6 months after baseline compared to SPI patients. RESULTS: From 329 eligible patients, 206 participated (61.2% female; age: M = 57.9 [SD = 11.7]; 84.5% UICC IV stage). Of them, 99 were assigned to CALM and 107 to SPI. Intention-to-treat analyses revealed significantly less depressive symptoms at 6 months than at baseline (P < .001 for BDI-II and PHQ-9), but participants in the CALM and SPI group did not differ in depression severity (BDI-II: P = .62, PHQ-9: P = .998). Group differences on secondary outcomes were statistically not significant either. CONCLUSIONS: CALM therapy was associated with reduction in depressive symptoms over time but this improvement was not statistically significant different than that obtained within SPI group.