scholarly journals The Sickness Behavior Inventory-Revised: Sickness behavior and its associations with depression and inflammation in patients with metastatic lung cancer

2020 ◽  
pp. 1-10
Author(s):  
Daniel C. McFarland ◽  
Leah E. Walsh ◽  
Rebecca Saracino ◽  
Christian J. Nelson ◽  
William Breitbart ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Depressive Symptoms ◽  
Depression Scale ◽  
Stage Iv ◽  
Sickness Behavior ◽  
Test Theory ◽  
Metastatic Lung Cancer ◽  
Sample Mean ◽  
Factor Loadings ◽  
Metastatic Lung

Abstract Background Inflammation may contribute to the high prevalence of depressive symptoms seen in lung cancer. “Sickness behavior” is a cluster of symptoms induced by inflammation that are similar but distinct from depressive symptoms. The Sickness Behavior Inventory-Revised (SBI-R) was developed to measure sickness behavior. We hypothesized that the SBI-R would demonstrate adequate psychometric properties in association with inflammation. Method Participants with stage IV lung cancer (n = 92) were evaluated for sickness behavior using the SBI-R. Concomitant assessments were made of depression (Patient Hospital Questionniare-9, Hospital Anxiety and Depression Scale) and inflammation [C-reactive protein (CRP)]. Classical test theory (CTT) was applied and multivariate models were created to explain SBI-R associations with depression and inflammation. Factor Analysis was also used to identify the underlying factor structure of the hypothesized construct of sickness behavior. A longitudinal analysis was conducted for a subset of participants. Results The sample mean for the 12-item SBI-R was 8.3 (6.7) with a range from 0 to 33. The SBI-R demonstrated adequate internal consistency with a Cronbach's coefficient of 0.85, which did not increase by more than 0.01 with any single-item removal. This analysis examined factor loadings onto a single factor extracted using the principle components method. Eleven items had factor loadings that exceeded 0.40. SBI-R total scores were significantly correlated with depressive symptoms (r = 0.78, p < 0.001) and CRP (r = 0.47, p < 0.001). Multivariate analyses revealed that inflammation and depressive symptoms explained 67% of SBI-R variance. Significance of results The SBI-R demonstrated adequate reliability and construct validity in this patient population with metastatic lung cancer. The observed findings suggest that the SBI-R can meaningfully capture the presence of sickness behavior and may facilitate a greater understanding of inflammatory depression.

Integration of palliative care services into standard oncology practice at diagnosis of metastatic lung cancer at VA New York Harbor Healthcare System.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 165-165
Author(s):  
Felix Manuel Rivera Mercado ◽  
Carol Luhrs ◽  
Alice Beal ◽  
Maura Langdon ◽  
Joan Secrest ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Stage Iv ◽  
Major Advance ◽  
Metastatic Lung Cancer ◽  
Care Services ◽  
National Quality ◽  
Metastatic Lung ◽  
Palliative Care Services ◽  
Oncology Practice

165 Background: The 2012 ASCO provisional clinical opinion addressed the integration of palliative care into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. The inclusion of Palliative Care among the National Quality Forum (NQF) framework represented a major advance in palliative care. NQF metrics include chemotherapy administered in the last 14 days of life, hospice less than 3 days before death, ICU or hospital admission, more than one Emergency Room visit in the last 30 days, and death in hospital. Although the use of hospice and other palliative care services has increased, many are enrolled in hospice less than 3 weeks before death. By improving quality of life, cost, and survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Methods: Retrospective chart review study of lung cancer patients diagnosed at VA from 2010-2013. Inclusion criteria: > 18 years of age with new diagnosis of metastatic lung cancer. Exclusion criteria: < 18 years of age, Stage I-III lung cancer. Results: Total of 125 patients were diagnosed with Stage IV lung cancer. The mean time from diagnosis to death was only 185 days (6.1 months). The VA NYHHS patients were more likely to visit the ED, be admitted to the hospital and ICU in the last 30 days of life, and subsequently die in the hospital. Conclusions: Several confounders were identified, including climate related closure of facilities (2012 Sandy storm), lack of social support, low ICU admission criteria, burial benefits for patients dying in a VA, and delay in transition to Hospice. Currently 392 patients with stage IV solid tumors diagnosed 2010-2014 are being studied. [Table: see text]

scholarly journals INGUINAL LYMPHADENOPATHY IN PRIMARY METASTATIC LUNG CANCER

2021 ◽  
Vol 27 (1) ◽  
pp. 53-57
Author(s):  
Vasilisa Yurievna Rain ◽  
◽  
Maxim Anatolievich Egorkin ◽  
Anastasia Viktorovna Motornaya
Keyword(s):  
Lung Cancer ◽  
Stage Iv ◽  
Metastatic Lung Cancer ◽  
Metastatic Lung ◽  
Mri Scans ◽  
History Of ◽  
Medical Counseling ◽  
Stage Iv Lung Cancer ◽  
Patient’S History ◽  
Ct And Mri

Herein we describe a patient’s history of a 45 y.o. man presenting with swollen lymphnodes who was subsequently diagnosed with stage IV lung cancer. Primary verifi cation was obtained via cytological evaluation of the lymph nodes of concern. Further clinical and additional diagnostics are described and accompanied with CT and MRI scans. Unfortunately, the patient died in 3 months after diagnosis despite attempts of chemotherapy which emphasizes the importance of timely medical counseling.

Couple-based mind-body intervention for patients with metastatic lung cancer and their spouses.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 179-179
Author(s):  
Kathrin Milbury ◽  
Rosalinda Engle ◽  
Zhongxing X. Liao ◽  
Anne S. Tsao ◽  
April Owens ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Depressive Symptoms ◽  
Focus Groups ◽  
Sleep Disturbances ◽  
Controlled Trial ◽  
Well Being ◽  
Preliminary Evidence ◽  
Metastatic Lung Cancer ◽  
Structured Interviews ◽  
Metastatic Lung

179 Background: Given the incurable nature of metastatic lung cancer, patients and their spouses are at risk of experiencing psychological and spiritual distress. To address these concerns, we developed a couple-based mind-body (CBMB) intervention. This formative research aimed to examine intervention acceptability and initially efficacy in patients with metastatic lung cancer undergoing treatment and their spouses. Methods: We first conducted focus groups followed by a single-arm trial. Focus group participants completed program exercises and then semi-structured interviews and written evaluations including Likert-scale and open-ended questions. In the single-arm trial, the four intervention session were delivered over a 2-week period focusing on cultivating mindfulness, interpersonal connection, gratitude and purpose. Couples completed measures of depressive symptoms (CES-D), cancer distress (IES), spiritual well-being (FACT-Sp) and sleep disturbances (PSQI) before and after the program. Results: Focus groups (n = 7 dyads) revealed high acceptability ratings of the CBMB intervention (e.g., all participants would recommend the intervention). Consent and adherence rates (54% and 67%, respectively) were acceptable for the single arm trial (n = 7 dyads). All patients (67% male; µ age = 55 years) and partners (33% male; µ age = 59 years) rated the intervention as useful. Paired t-test analyses revealed large effects for sleep disturbances ( d= 1.83) and medium effects for cancer distress ( d= .61) for patients and large effects for depressive symptoms for spouses ( d= .90). Conclusions: Based on this two part study, the CBMB intervention appears to be acceptable and subjectively useful. There was also preliminary evidence regarding treatment gains for both patients and partners. A randomized controlled trial is warranted to further examine this supportive care strategy.

A Longitudinal Analysis of Inflammation and Depression in Patients With Metastatic Lung Cancer: Associations With Survival

2020 ◽  
pp. 109980042095972
Author(s):  
Daniel C. McFarland ◽  
Andrew H. Miller ◽  
Christian Nelson
Keyword(s):  
Lung Cancer ◽  
Depression Scale ◽  
Metastatic Lung Cancer ◽  
Time Points ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
Metastatic Lung ◽  
Significant Depression ◽  
Clinically Significant ◽  
Over Time

Background: Depression and inflammation are concomitantly elevated in patients with lung cancer and may have collective survival implications. However, the longitudinal relationship between depression and inflammation in patients with metastatic lung cancer is not fully appreciated. We hypothesized that longitudinal changes in inflammation and depression would be concordant; that longitudinally elevated inflammation would lead to greater depression over time; and that depression with inflammation would be more persistent than depression without inflammation. Methods: Patients with metastatic lung cancer (n = 68) were assessed for clinically significant depression (Hospital Anxiety and Depression Scale ≥ 8) and inflammation (C-Reactive Protein ≥ 1 mg/L) along with demographic variables. Survival estimations were made using Cox Proportional Hazard Model and Kaplan-Meier plot analyses. Results: At baseline (T1), 15% had depression and 35% had increased inflammation followed by 18% with depression and 38% with increased inflammation 4.7 months later (T2). The odds ratio of depression in the presence of clinically significant inflammation was 4.8 at T1 and 5.3 at T2. Between time points, inflammation difference correlated with depression difference (r = −.26, p = .03). Significant depression at both time points was associated with a 4 fold risk of inferior survival while significant inflammation at any time point was associated with >3 fold risk of inferior survival. Conclusions: Depression and inflammation track together over time and have variable implications on survival. Persistent depression is particularly detrimental but incidental inflammation is more sensitive to predicting poor survival. These findings have implications for treating depression early in the lung cancer trajectory.

scholarly journals One Step Forward, Two Steps Back: Trends in Aggressive Inpatient Care at the End of Life for Patients With Stage IV Lung Cancer

2018 ◽  
Vol 14 (12) ◽  
pp. e746-e757 ◽  
Author(s):  
Chebli Mrad ◽  
Marwan S. Abougergi ◽  
Bobby Daly
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
Inpatient Care ◽  
Stage Iv ◽  
Cost Of Care ◽  
Metastatic Lung Cancer ◽  
Metastatic Lung ◽  
Aggressive Care ◽  
Stage Iv Lung Cancer ◽  
Hospital Characteristics

Background: Patients with metastatic lung cancer are treated with palliative intent. Aggressive care at the end of life is a marker of poor-quality care. National trends and factors related to aggressive inpatient care at the end of life for these patients have not been evaluated. Methods: Patients with stage IV lung cancer and a terminal hospitalization were identified in the National Inpatient Sample database between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive inpatient care at the end of life and multivariate logistic regression was performed to determine associations with patient and hospital characteristics. Results: A total of 412,946 patients met the inclusion criteria. From 1998 to 2014, the proportion of patients admitted to the intensive care unit (ICU) during the terminal hospitalization increased from 13.3% to 27.9% ( P < .001). The ICU stay translated into a higher mean total cost of care (+$18,461; 95% CI, $17,460 to $19,463). Promisingly, palliative care encounters for terminal hospitalizations also increased during this period from 8.7% to 53.0% ( P < .01) and were correlated with a decrease in aggressive care at the end of life. However, this did not offset the trend in increased ICU use; mean total costs for a terminal hospitalization increased from $14,000 to $19,500, adjusted for inflation. A multivariable model demonstrates variation by patient and hospital characteristics in aggressive care use. Conclusions: Among patients with metastatic lung cancer there has been a substantial increase in ICU use during terminal hospitalizations, resulting in high cost for the health care system.

Results of a pilot randomized controlled trial: A couple-based meditation intervention for patients with metastatic lung cancer and their partners.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 135-135
Author(s):  
Kathrin Milbury ◽  
Yisheng Li ◽  
Sania Durrani ◽  
Zhongxing X. Liao ◽  
Claire Chunyi Yang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Depressive Symptoms ◽  
Care Setting ◽  
Early Stage ◽  
Controlled Trial ◽  
Self Report ◽  
Metastatic Lung Cancer ◽  
Palliative Care Setting ◽  
Metastatic Lung

135 Background: Although mindfulness-based interventions have been widely examined in patients with early stage cancer, the feasibility and efficacy of these types of programs are largely unknown in the palliative care setting. We developed a couple-based intervention integrating meditation training with emotional disclosure exercises to target psychological distress in patients with metastatic lung cancer and their partners. Methods: Dyads completed baseline self-report measures and were then randomized to a couple-based meditation (CBM), a supportive-expressive (SE), or a waitlist control (WLC) group. Couples in the CBM and ES groups attended 4 weekly, 60 min. therapist-led sessions that were delivered via FaceTime. All groups were reassessed 1 month and 3 months later. Results: Seventy-five patients (51% female; mean age = 64 years) and their partners’ (52% female; mean age = 64 years) were randomized (63% consent rate) of which 79% completed the first and 65% completed the second follow-up assessments. Attrition was mainly due to patients’ death (44%). Although attendance was high in both groups (means: CBM = 3.12; SE = 3.08), dyads in the CBM group indicated greater benefit (P < .003) and usefulness (P < .05) of the sessions compared to those in the SE group. Compared with the WLC group, patients in the CBM group reported significantly lower depressive symptoms (P = .02; d = .49; CES-D means: CBM = 7.87; SE = 11.51; WLC = 12.76) and cancer specific distress (P = .05; d = .44; IES means: CBM = 12.40; SE = 16.34; WLC = 18.22). Similarly, compared with the WLC group, partners in the CBM group reported significantly lower depressive symptoms (P = .02; d = .58; means: CBM = 7.18; AC = 8.91; WLC = 11.62). For both patients and partners, there were no effects between SE and WLC groups. While small effects (d = .22-.42) in favor of the CBM group relative to the SE group were revealed, these differences were not significant. Conclusions: It seems to be feasible, acceptable and possibly efficacious to deliver dyadic interventions via FaceTime to couples coping with metastatic lung cancer. Mindfulness-based interventions may be of value to manage symptom burden in the palliative care setting. Clinical trial information: NCT02596490.

scholarly journals Prognosis in metastatic lung cancer: vitamin D deficiency and depression—a cross-sectional analysis

2020 ◽  
pp. bmjspcare-2020-002457
Author(s):  
Daniel C McFarland ◽  
Madalyn Fernbach ◽  
William S Breitbart ◽  
Christian Nelson
Keyword(s):  
Lung Cancer ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Depression Scale ◽  
Metastatic Lung Cancer ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Vitamin D Levels ◽  
Metastatic Lung ◽  
Sectional Analysis

BackgroundDepression and vitamin D deficiency are common in patients with lung cancer and have prognostic implications in cancer settings. However, their relationship and concomitant survival implications have not been evaluated in patients with metastatic lung cancer specifically. We hypothesised that vitamin D deficiency would be associated with depression and inferior cancer-related survival in patients receiving therapies for stage IV lung cancer.MethodsThis was a cross-sectional analysis of vitamin D, depression and lung cancer characteristics. Vitamin D levels were stratified by level (no deficiency ≥30 units, mild deficiency 20 to 29 units and moderate-to-severe <20 units). Depression was measured by the Hospital Anxiety and Depression Scale-Depression (HADS-D). Survival estimations were made using Cox proportional hazard model and Kaplan-Meier analyses.ResultsVitamin D deficiency was evident in almost half of the sample (n=98) and was associated with significant depression (HADS-D ≥8) (χ2=4.35, p<0.001) even when controlling for age, sex and inflammation (β=-0.21, p=0.03). Vitamin D deficiency and depression were associated with worse survival and showed evidence of an interaction effect (HR 1.5, p=0.04).ConclusionVitamin D deficiency is associated with depression in patients with metastatic lung cancer. Depression modulates the survival implications of vitamin D deficiency in this population. The role of vitamin D deficiency in cancer-related depression warrants further investigation since both are amenable to treatment. Psychological and nutritional prognostic considerations may help inform treatment paradigms that enhance quality of life and survival.

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