Management of Fatigue in Patients with Advanced Cancer.

OPINION STATEMENT: Fatigue is a common and distressing symptom experienced by patients with cancer. It is most common in patients with locally advanced or metastatic incurable disease. It can have profound effects on quality-of-life and physical functioning. In addition to general supportive measures (directed at tackling contributory conditions and comorbidities), a variety of specific interventions have been developed which can be broadly categorised as physical therapies, psychological therapies or medication. There is some evidence that each of these approaches can have benefits in patients with earlier stage disease, those undergoing active treatment and in cancer survivors. The best evidence is for aerobic exercise, yoga, cognitive-behavioural therapy (CBT) and psycho-educational interventions. Less strong evidence supports the use of medications such as methylphenidate or ginseng. In patients with advanced disease, it is likely that the mechanisms of fatigue or the factors contributing to fatigue maintenance may be different. Relatively fewer studies have been undertaken in this group and the evidence is correspondingly weaker. The authors recommend the cautious use of aerobic exercise (e.g. walking) in those who are still mobile. The authors advise considering the use of psycho-educational approaches or CBT in those patients who are able to engage in such forms of therapy. In patients near the end-of-life, the authors advise use of dexamethasone (short-term use) and other pharmacological treatments only on the basis of a clinical trial.

Lessons Learned: Implementing UK-Developed Interprofessional Simulation Training Courses in a Canadian Setting.

OBJECTIVE: In response to the need for practitioners to improve their skills in integrating mental and physical healthcare, the Centre for Addiction and Mental Health (CAMH) (Canada) invited education specialists from Maudsley Simulation (UK) to pilot two of their existing interprofessional simulation courses on the mental-physical interface in Toronto. Participants' experiences as well as the courses' educational impact were evaluated. METHODS: Participants completed pre-and post-course questionnaires, a 2-week follow-up questionnaire, and individual interviews 6 months after course completion. RESULTS: Participants (n = 23) found the courses to be relevant and applicable to their practice. Over half of the participants interviewed (8/15) reported changing their practice as a result of the course. However, concerns regarding the sociological fidelity of these courses within the Canadian context were noted. CONCLUSION: The findings support the transferability of interprofessional simulation courses developed in other countries. It is important, however, to contextualize course material to fit local healthcare systems and to ensure sociological fidelity where professional roles may vary.

Mental health needs in cancer - a call for change.

There is continued under-recognition and underinvestment in the psychological and mental health aspects of care for cancer patients, despite the fact that increased patient survival rates in cancer mean that patients are living longer after diagnosis. In this article, we advocate for better integration and joint working between clinicians across all areas, including education and research, impacting positively on the outcomes and care of cancer patients.

Mental Health and Cancer: Why It Is Time to Innovate and Integrate-A Call to Action.

Surgical, radio-oncological, and medical anti-cancer therapies have developed at pace and scale in recent years, yet there remains a huge unmet need for mental health in cancer care. Recent experience in the COVID-19 pandemic has added to recognition of this unmet need. There needs to be more effective clinical integration of relevant services, which must be informed by patient choice and clinical need, and accessible throughout the patient's whole cancer journey. This needs to be accompanied by training and research integration as well as more effective and creative use of technology such as virtual reality and simulation, quality assuring apps, and mobile technologies. Finally, as a clinical community we need to drive a shift in culture towards measurement of patient quality of life as a marker of treatment effectiveness. We also need to support our own clinical workforce with their own mental health needs so that we prevent the alarming rates of burnout prevalent among clinicians treating cancer. The call to action for innovation and staff support has been amplified by experience in the COVID-19 pandemic. PATIENT SUMMARY: This report highlights the unmet need for mental health in cancer care. Patients need effective access to psychological support and mental health services throughout their cancer journey, including better use of technology. There is also a need to support the psychological wellbeing of cancer clinicians.

"Warriors": impact of a powerful television drama on the psychological health of U.K. Bosnia peacekeepers.

PURPOSE: The impact of secondary trauma, such as watching powerful images on television, on the etiology of posttraumatic stress disorder in adults remains controversial. We explored the impact of a powerful TV drama ("Warriors") on the psychological health of U.K. peacekeeping troops compared with other military personnel who also saw the program but did not deploy on the same mission. METHODS: Psychological health (health perception, fatigue, posttraumatic stress reactions and common mental disorders) was assessed via questionnaire in a group of 1463 U.K. Armed Forces personnel before and after the televising of an award-winning dramatic reconstruction ("Warriors") of events in Former Yugoslavia, a deployment in which some of the respondents had participated (Bosnia group) and some who had not (Era group). Information was also collected on whether participants had seen Warriors. RESULTS: Those who had deployed to Bosnia were more likely to have watched the drama, and viewers were more likely to be posttraumatic stress reactions and common mental disorders cases before transmission of the program. There were few health differences between viewers and nonviewers, and Bosnia viewers and Era viewers, posttransmission. Viewing status and group status (Bosnia/Era) restricted to viewers only did not predict posttransmission health outcomes, with one exception. Group status (viewers only) was a significant predictor of posttransmission fatigue, with Bosnia viewers more likely to be cases. Additional analyses, however, revealed the same finding for nonviewers. CONCLUSIONS: We found no evidence that those with symptoms of traumatic distress avoided watching a drama relevant to their experiences and no evidence of adverse effects on mental health.