Does it hurt to know the worst?—psychological morbidity, information preferences and understanding of prognosis in patients with advanced cancer

10115 Background: SD have been described as a significant symptom burden for cancer patients and their caregivers. However, in advanced cancer, the prevalence of SD and its impact on the quality of life (QOL) and psychological morbidity of ACP over time has not been described. Methods: A prospective cohort of ACP participating in phase I trials was assessed at baseline (T1) and one month (T2) using psychosocial instruments: cognition (MMSE); depression(CES-D), state anxiety (STAI-S), QOL(FACIT-Pal), global health (SF-36). Semi-structured interviews evaluated SD patterns including: quality/latency, habitual efficiency, daytime dysfunction. Results: To date,152 subjects (76 ACP and 76 CG) have been separately interviewed at T1 and T2. For the total population: median age 61 (28-78y); 51% male; 100% married; 90% Ca; 64% > HS educ; 52% GI dx; 51% income < $65,000 yr; ACP median survival 7.9 months (0.41-18.2). At T1, 57% of ACP reported experiencing SD within the past week including: 55.6% insomnia, 44% nonrestorative sleep, 49% low energy, 48% daytime somnolence. For CG, 72% reported experiencing SD: 68% insomnia, 64% nonrestorative sleep, 69% fatigue, 66% daytime somnolence. At T2, rates remained consistent over time for both ACP and CG across time with the exception of increased insomnia at 61% and 76% respectively. After controlling for pain, mood, and fatigue, ACP with self-reported SD had higher STAI-S (33 ±11 v 29 ±8 , p = 0.02) and poor global health (54 ± 19 v. 64 ± 21, p = 0.01) at T2. CG with SD had higher STAI-S anxiety (39 ± 17 v 35 ± 13, p = 0.03) and poor global health (75 ±26 v 88±16, p = .0002) at T2.Regression analyses revealed ACP with self-reported insomnia had poorer FACIT-Pal QOL (59 ± 9 v 63 ± 10, p = 0.01) over time. Prior chemotherapy was associated with ACP SD (70% v. 33%, p = 0.02). Regarding prognosis, ACP with insomnia had shorter median survival (5.5 v. 7.2 months, p = 0.01). Conclusions: SD are prevalent among ACP participating in clinical trials and were associated with disease progression, QOL, and anxiety. Multidisciplinary supportive care interventions designed to address SD are warranted.

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Validation of the Distress Thermometer in patients with advanced cancer receiving specialist palliative care in a hospice setting

Palliative Medicine ◽

10.1177/0269216320954339 ◽

2020 ◽

pp. 026921632095433

Author(s):

Lisa Graham-Wisener ◽

Martin Dempster ◽

Aaroon Sadler ◽

Luke McCann ◽

Noleen K McCorry

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Screening Tool ◽

Hospice Care ◽

Depression Scale ◽

Area Under The Curve ◽

Distress Thermometer ◽

Psychological Morbidity ◽

Specialist Palliative Care ◽

Operating Characteristics

Background: Ongoing assessment of psychological reaction to illness in palliative and end of life care settings is recommended, yet validated tools are not routinely used in clinical practice. The Distress Thermometer is a short screening tool developed for use in oncology, to detect individuals who would benefit from further psychological assessment. However the optimal cut-off to detect indicative psychological morbidity in patients with advanced cancer receiving specialist palliative care is unclear. Aim: To provide the first validation of the Distress Thermometer in an advanced cancer population receiving specialist palliative care in a UK hospice setting. Design: Receiver Operating Characteristics analysis was used to compare the sensitivity and specificity of cut-offs indicative of psychological morbidity on the Distress Thermometer in comparison to the Hospital Anxiety and Depression Scale. Setting/Participants: Data were derived from 202 patients with advanced cancer who were approached on admission to inpatient or day hospice care, with 139 patients providing complete data on both measures. Results: The area under the curve was optimal using a Distress Thermometer cut-off score of ⩾6 for total distress and for anxiety, and a cut-off score of ⩾4 optimal when screening for depression. Conclusions: The Distress Thermometer is a valid, accurate screening tool to be used in advanced cancer but with caution in relation to the lack of specificity. With little variation between the area under the curve scores, arguably a Distress Thermometer cut-off score of ⩾5 is most appropriate in screening for all types of psychological morbidity if sensitivity is to be prioritised.

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Caring Advanced Cancer Patients at Home During COVID-19 Outbreak: Burnout and Psychological Morbidity Among Palliative Care Professionals in Italy

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2020.11.026 ◽

2020 ◽

Author(s):

Silvia Varani ◽

Rita Ostan ◽

Luca Franchini ◽

Giacomo Ercolani ◽

Raffaella Pannuti ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Psychological Morbidity ◽

Advanced Cancer Patients ◽

At Home

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Prognostic Understanding in Advanced Cancer Patients

Psycho-Oncology ◽

10.1093/med/9780190097653.003.0075 ◽

2021 ◽

pp. 599-606

Author(s):

Laura C. Polacek ◽

Leah E. Walsh ◽

Allison J. Applebaum ◽

Barry Rosenfeld

Keyword(s):

Health Information ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Prognostic Information ◽

Cultural Variations ◽

Information Preferences ◽

Healthcare Decision Making ◽

Patient Health ◽

Patient Provider Communication

This chapter provides an overview of prognostic understanding in patients with advanced cancer. It reviews how the construct has been defined and measured historically, including current research on the multidimensional nature of prognostic understanding. It further highlights the importance of prognostic understanding for patients and their loved ones. Specifically, this chapter reviews the relationship between prognostic understanding and psychosocial outcomes, as well as the role of prognostic understanding in patient health information preferences, patient-provider communication, and healthcare decision-making at the end of life. It provides information on current communication practices and recent interventions to improve disclosure of prognostic information. Lastly, cultural variations in health information preferences and prognostic understanding are discussed, along with future directions for research and clinical practice.

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