Does chemotherapy reduce stress?

2010 ◽  
Vol 8 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Francisco Gil ◽  
G. Costa ◽  
F.J. Pérez
Keyword(s):  
Cancer Patients ◽  
Performance Status ◽  
Adjustment Disorder ◽  
Clinical Interview ◽  
Screening Tools ◽  
Anxiety And Depression ◽  
Chemotherapy Treatment ◽  
Psychological Care ◽  
Care Needs ◽  
Low Performance

AbstractObjective:The purpose of this study was to assess the psychological care needs of cancer patients throughout the healthcare process: after diagnosis, after medical treatment (surgery, chemotherapy, radiotherapy) and during follow-up.Method:A total of 703 ambulatory cancer patients were assessed in this study. The inclusion period was from April 1, 2005 to April 30, 2007. The first psychological scales used were the 14-item Hospital Anxiety and Depression Scales (HADS), which has two sub-scales for anxiety (7 items) and for depression (7 items). All patients with a score ≥14 were assessed through the Structured Clinical Interview for Psychiatric Disorder (SCID-I) of the DSM-IV. All data were compared with sociodemographic and medical characteristics.Results:Of the 703 cancer patients in the study, 349 were men and 354 women, with a mean age of 53 years. The median time between the cancer diagnosis and our clinical interview was 6 months (range, 12 days to 190 months). Overall, the screening tools indicated that one in four patients needed psychological care. The most common psychiatric diagnosis was adjustment disorder (129 cases), whereas 10 patients were diagnosed with major depression. Using a HADS cut-off score of >7 for anxiety and depression, 28% and 17% of patients, respectively, were classified as “possible clinical cases.” Risk factors for distress included age <65 years, asthenia, constipation, and a low performance status. However, chemotherapy treatment was found to be a protector against distress in cancer patients.Significance of Results:Chemotherapy treatment is interpreted by the patients as a protector against cancer, thereby reducing distress levels.

scholarly journals Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review

2021 ◽  
pp. 026921632110073
Author(s):  
Christine Lau ◽  
Christopher Meaney ◽  
Matthew Morgan ◽  
Rose Cook ◽  
Camilla Zimmermann ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Performance Status ◽  
Retrospective Chart Review ◽  
Care Needs ◽  
Care Facilities ◽  
Palliative Care Services ◽  
Low Performance ◽  
Electronic Referral

Background: To date, little is known about the characteristics of patients who are admitted to a palliative care bed for end-of-life care. Previous data suggest that there are disparities in access to palliative care services based on age, sex, diagnosis, and socioeconomic status, but it is unclear whether these differences impact access to a palliative care bed. Aim: To better identify patient factors associated with the likelihood/rate of admission to a palliative care bed. Design: A retrospective chart review of all initiated palliative care bed applications through an electronic referral program was conducted over a 24-month period. Setting/participants: Patients who apply and are admitted to a palliative care bed in a Canadian metropolitan city. Results: A total of 2743 patients made a total of 5202 bed applications to 9 hospice/palliative care units in 2015–2016. Referred and admitted cancer patients were younger, male, and more functional than compared to non-cancer patients (all p < 0.001). Referred and admitted patients without cancer were more advanced in their illness trajectory, with an anticipated prognosis <1 month and Palliative Performance Status of 10%–20% (all p < 0.001). On multivariate analysis, a diagnosis of cancer and a prognosis of <3 months were associated with increased likelihood and/or rate of admission to a bed, whereas the presence of care needs, a longer prognosis and a PPS of 30%–40% were associated with decreased rates and/or likelihood of admission. Conclusion: Patients without cancer have reduced access to palliative care facilities at end-of-life compared to patients with cancer; at the time of their application and admission, they are “sicker” with very low performance status and poorer prognoses. Further studies investigating disease-specific clinical variables and support requirements may provide more insights into these observed disparities.

The PROVIEW+ tool: Developing and validating a tool to predict risk of poor performance status and severe symptoms in cancer patients over time.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12095-12095
Author(s):  
Hsien Seow ◽  
Rinku Sutradhar ◽  
Lisa Catherine Barbera ◽  
Peter Tanuseputro ◽  
Dawn Guthrie ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Cancer Patients ◽  
Severe Pain ◽  
Performance Status ◽  
Well Being ◽  
Assessment System ◽  
Low Performance ◽  
Performance Scale ◽  
Over Time

12095 Background: There are numerous predictive cancer tools that focus on survival. However, no tools predict risk of low performance status or severe symptoms, which are important for patient decision-making and early integration of palliative care. The aim of this study was to develop and validate a model for all cancer types that predicts the risk for having low performance status and severe symptoms. Methods: A retrospective, population-based, predictive study using linked administrative data from cancer patients from 2008-2015 in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). The derivation cohort was used to develop a multivariable logistic regression model to predict the risk of having the reported outcomes in the subsequent 6 months. Model performance was assessed using discrimination and calibration plots. The main outcome was low performance status using the Palliative Performance Scale. Secondary outcomes included severe pain, dyspnea, well-being, and depression using the Edmonton Symptom Assessment System. Outcomes were recalculated after each of 4 annual survivor marks. Results: We identified 255,494 cancer patients (57% female; median age of 64; common cancers were breast (24%) and lung (13%)). At diagnosis, the risk of having low performance status, severe pain, well-being, dyspnea, and depression in 6-months is 1%, 3%, 6%, 13% and 4%, respectively for the reference case (i.e. male, lung cancer, stage I, no symptoms). Generally these covariates increased the outcome risk by > 10% across all models: obstructive lung disease, dementia, diabetes; radiation treatment; hospital admission; high pain; depression; Palliative Performance Scale score of 60-10; issues with appetite; or homecare. Model discrimination was high across all models. Conclusions: The model accurately predicted changing cancer risk for low performance status and severe symptoms over time. Providing accurate predictions of future performance status and symptom severity can support decision-making and earlier initiation of palliative care, even alongside disease modifying therapies.

Survival Prediction in Terminally Ill Cancer Patients by Clinical Estimates, Laboratory Tests, and Self-Rated Anxiety and Depression

2007 ◽  
Vol 25 (22) ◽  
pp. 3313-3320 ◽  
Author(s):  
Stephan Gripp ◽  
Sibylle Moeller ◽  
Edwin Bölke ◽  
Gerd Schmitt ◽  
Christiane Matuschek ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Cancer Patients ◽  
Emotional Distress ◽  
Laboratory Tests ◽  
Performance Status ◽  
Univariate Analysis ◽  
Depression Scale ◽  
Tumor Board ◽  
Anxiety And Depression ◽  
Survival Prediction

Purpose To study how survival of palliative cancer patients relates to subjective prediction of survival, objective prognostic factors (PFs), and individual psychological coping. Patients and Methods Survival was estimated according to three categories (< 1 month, 1 to 6 months, and > 6 months) by two physicians (A and B) and the institutional tumor board (C) for 216 patients recently referred for palliative radiotherapy. After 6 months, the accuracy of these estimates was assessed. The prognostic relevance of clinical symptoms, performance status, laboratory tests, and self-reported emotional distress (Hospital Anxiety and Depression Scale) was investigated. Results In 61%, 55%, and 63% of the patients, prognoses were correctly estimated by A, B, and C, respectively. κ statistic showed fair agreement of the estimates, which proved to be overly optimistic. Accuracy of the three estimates did not improve with increasing professional experience. In particular, the survival of 96%, 71%, and 87% of patients who died in less than 1 month was overestimated by A, B, and C, respectively. On univariate analysis, 11 of 27 parameters significantly affected survival, namely performance status, primary cancer, fatigue, dyspnea, use of strong analgesics, brain metastases, leukocytosis, lactate dehydrogenase (LDH), depression, and anxiety. On multivariate analysis, colorectal and breast cancer had a favorable prognosis, whereas brain metastases, Karnofsky performance status less than 50%, strong analgesics, dyspnea, LDH, and leukocytosis were associated with a poor prognosis. Conclusion This study revealed that physicians' survival estimates were unreliable, especially in the case of patients near death. Self-reported emotional distress and objective PFs may improve the accuracy of survival estimates.

Development of a prognostic index in cancer patients with low performance status

2005 ◽  
Vol 13 (9) ◽  
pp. 752-756 ◽  
Author(s):  
José Ferraz Gonçalves ◽  
Isabel Costa ◽  
Carolina Monteiro
Keyword(s):  
Cancer Patients ◽  
Performance Status ◽  
Prognostic Index ◽  
Low Performance

Ambulatory 2 hours infusion of 5-FU modulated by low-dose leucovorin in the palliative treatment of advanced epithelial cancer patients with low performance status

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 20600-20600
Author(s):  
D. L. da Silva ◽  
A. F. Ferreira Filho ◽  
A. P. Wunder ◽  
M. P. dos Santos ◽  
C. Hummes ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Palliative Treatment ◽  
Low Dose ◽  
Performance Status ◽  
Epithelial Cancer ◽  
Low Performance

Results of implementing a novel supportive oncology screening tool for comprehensive evaluation of distress and other supportive care needs.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 61-61
Author(s):  
Paramjeet Khosla ◽  
Julia Rachel Trosman ◽  
James Gerhart ◽  
Urjeet Patel ◽  
Shelly S. Lo ◽  
...  
Keyword(s):  
Supportive Care ◽  
Physical Function ◽  
Screening Tool ◽  
Specific Treatment ◽  
Safety Net ◽  
Screening Tools ◽  
Anxiety And Depression ◽  
Distress Screening ◽  
Care Needs ◽  
Supportive Oncology

61 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from NCCN Distress Problem List, IOM report and CoC standards, with validated sub-tools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue and physical function. Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public & 1 safety-net). End points included correlation of PHQ-4 score with other supportive oncology needs. Descriptive statistics, Fisher’s exact test were used. Results: 2805 patients were screened. Average scores were: PHQ4 – Anxiety and Depression 1.8 (mild > 3), Pain 4.5 (mild > 4), Fatigue 8.8 (mild > 6), Physical Function 20.2 (mild < 20), see table for additional items. Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, , nutritional and specific treatment/care concerns, and lower physical function (p<.0001). (See Table). Conclusions: Patients with higher anxiety and depression also have many other supportive oncology concerns. Our results support the use of a comprehensive tool capturing a spectrum of each patient’s unique concerns. This may enable earlier interventions and personalized delivery of supportive care. [Table: see text]

Results of implementing a novel supportive oncology screening tool for comprehensive evaluation of distress and other supportive care needs.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21644-e21644
Author(s):  
Julia Rachel Trosman ◽  
James Gerhart ◽  
Urjeet Patel ◽  
Paramjeet Khosla ◽  
Patricia A. Robinson ◽  
...  
Keyword(s):  
Supportive Care ◽  
Physical Function ◽  
Screening Tool ◽  
Specific Treatment ◽  
Safety Net ◽  
Screening Tools ◽  
Anxiety And Depression ◽  
Distress Screening ◽  
Care Needs ◽  
Supportive Oncology

e21644 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from NCCN Distress Problem List, IOM report and CoC standards, with validated sub-tools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue and physical function. Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public & 1 safety-net). End points included correlation of PHQ-4 score with other supportive oncology needs. Descriptive statistics, Fisher’s exact test were used. Results: 2805 patients were screened. Average scores were: PHQ4 – Anxiety and Depression 1.8 (mild > 3), Pain 4.5 (mild > 4), Fatigue 8.8 (mild > 6), Physical Function 20.2 (mild < 20), see table for additional items. Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, nutritional and specific treatment/care concerns, and lower physical function (p<.0001). Conclusions: Patients with higher anxiety and depression also have many other supportive oncology concerns. Our results support the use of a comprehensive tool capturing a spectrum of each patient’s unique concerns. This may enable earlier interventions and personalized delivery of supportive care. [Table: see text]

scholarly journals Chemotherapy improves low performance status lung cancer patients

2007 ◽  
Vol 30 (6) ◽  
pp. 1186-1192 ◽  
Author(s):  
J. P. Sculier ◽  
J. J. Lafitte ◽  
M. Paesmans ◽  
J. Lecomte ◽  
C. G. Alexopoulos ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Performance Status ◽  
Lung Cancer Patients ◽  
Low Performance

Survival prediction in terminally ill cancer patients by clinical estimates, laboratory and psychometric tests

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8578-8578
Author(s):  
S. Gripp ◽  
S. Moeller ◽  
R. Willers
Keyword(s):  
Cancer Patients ◽  
Emotional Disorders ◽  
Advanced Cancer ◽  
Performance Status ◽  
Prognostic Models ◽  
Anxiety And Depression ◽  
Survival Prediction ◽  
Psychometric Tests ◽  
Life Table Analysis ◽  
Table Analysis

8578 Background: To improve general survival estimates in advanced cancer pat. we studied physicians’ clinical estimates, the impact of emotional disorders (anxiety and depression), and laboratory tests in palliative patients. Methods: From 12/03 to 7/04 patients with advanced cancer referred to radiation oncology for palliative treatment were invited to participate in this prospective cohort study. Pat. with adjuvant or curative treatment intent were not considered. The life span was independently estimated by two physicians and the institutional tumor board according to 3 categories (<1, 1–6, and >6 months). Agreement of survival predictions was analyzed with contingency tables and kappa statistics. Primary tumor, metastatic spread, performance status, pain, dyspnoea, weight loss, nausea, fatigue, serum enzymes (AP, LDH), function parameters (creatinine, bilirubin, CRP), and blood count (WBC, RBC) were also studied. Emotional disorders were measured using a validated psychometric self-assessment scale (Hospital Anxiety and Depression Scale, HADS). Life table analysis with log-rank test and stepwise Cox regression analysis with univariate significant variables were performed. Results: 216 pat. were enrolled and followed for at least 6 months. 580 prognoses were obtained. 94% (204) had complete blood tests. HADS questionnaires were completed by 71% (154). Survival was <1 mo in 15% (33), 1–6 mo in 36% (78), and >6 mo in 49% (105).Survival prediction was poor (kappa= 0.33) and consistently too optimistic (test of symmetry, p<0.0001). In life table analysis primary tumor (hazard ratio 2.0), brain metastases, performance status (HR 1.9), dyspnoea (HR 2.0), nausea (HR 2.0), LDH (HR 1.9), WBC (HR 2.1), fatigue, anxiety and depression (HADS) were highly significant (p< 0.0002). Conclusions: Physicians generally overestimated survival of advanced cancer patients emphasizing the need of objective prognostic models. Even short-term survival estimates (< 1 mo.) were unreliable. Combined objective variables may improve survival prediction. Psychometric tests are promising candidates to be incorporated in more accurate prognostic models. No significant financial relationships to disclose.

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