Depressive symptoms in advanced cancer. Part 2. Depression over time; the role of the palliative care professional

Objective: To investigate prevalence and predictors of postloss distress, depressive and anxiety symptoms, and quality of life among bereaved family caregivers of patients with advanced cancer. Methods: Prospective multicenter study. Family caregivers (N = 160, mean age 56.8 years, 66% female) completed validated outcome measures (Distress Thermometer, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire depression module 9-item scale, SF-8 Health Survey Questionnaire) 6 months after patient’s discharge or death at specialist inpatient palliative care ward. Results: Clinically relevant distress was observed in 82% with sadness (89%), exhaustion (74%), sleeping problems (68%), loneliness (53%), and sorrows (52%) being the most common distress-causing problems. Moderate/severe anxiety and depressive symptoms were observed in 27% and 35%, respectively. Compared to an adjusted norm sample, quality of life was significantly impaired with exception of “bodily pain” and physical component score. Preloss caregiving (odds ratio [OR] 2.195) and higher preloss distress (OR 1.345) predicted high postloss distress. Utilization of psychosocial support services (OR 2.936) and higher preloss anxiety symptoms (OR 1.292) predicted moderate/severe anxiety symptoms, lower preloss physical quality of life (OR 0.952), and higher preloss depressive symptoms (OR 1.115) predicted moderate/severe depressive symptoms. Conclusion: Preloss mental burden showed to be a consistent predictor for postloss burden and should be addressed during palliative care. Future research should examine specific caregiver-directed interventions during specialist palliative care.

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Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer

Journal of Clinical Oncology ◽

10.1200/jco.19.00013 ◽

2020 ◽

Vol 38 (9) ◽

pp. 915-925 ◽

Cited By ~ 6

Author(s):

Joseph A. Greer ◽

Allison J. Applebaum ◽

Juliet C. Jacobsen ◽

Jennifer S. Temel ◽

Vicki A. Jackson

Keyword(s):

Palliative Care ◽

Coping Strategies ◽

Advanced Cancer ◽

Physical Symptoms ◽

Early Palliative Care ◽

Beneficial Effects ◽

Symptoms Of Depression ◽

Home Based ◽

Oncology Care

Advanced cancer, with its considerable physical symptoms and psychosocial burdens, represents an existential threat and major stressor to patients and their caregivers. In response to such stress, patients and their caregivers use a variety of strategies to manage the disease and related symptoms, such as problem-focused, emotion-focused, meaning-focused, and spiritual/religious coping. The use of such coping strategies is associated with multiple outcomes, including quality of life, symptoms of depression and anxiety, illness understanding, and end-of-life care. Accumulating data demonstrate that early palliative care, integrated with oncology care, not only improves these key outcomes but also enhances coping in patients with advanced cancer. In addition, trials of home-based palliative care interventions have shown promise for improving the ways that patients and family caregivers cope together and manage problems as a dyad. In this article, we describe the nature and correlates of coping in this population, highlight the role of palliative care to promote effective coping strategies in patients and caregivers, and review evidence supporting the beneficial effects of palliative care on patient coping as well as the mechanisms by which improved coping is associated with better outcomes. We conclude with a discussion of the limitations of the state of science, future directions, and best practices on the basis of available evidence.

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Phase II Trial of Symptom Screening With Targeted Early Palliative Care for Patients With Advanced Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7803 ◽

2021 ◽

pp. 1-10

Author(s):

Camilla Zimmermann ◽

Ashley Pope ◽

Breffni Hannon ◽

Monika K. Krzyzanowska ◽

Gary Rodin ◽

...

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Patient Reported Outcomes ◽

Phase Ii Trial ◽

Symptom Control ◽

Satisfaction With Care ◽

Early Palliative Care ◽

Symptom Screening ◽

Patient Reported ◽

Over Time

Background: Routine early palliative care (EPC) improves quality of life (QoL) for patients with advanced cancer, but it may not be necessary for all patients. We assessed the feasibility of Symptom screening with Targeted Early Palliative care (STEP) in a phase II trial. Methods: Patients with advanced cancer were recruited from medical oncology clinics. Symptoms were screened at each visit using the Edmonton Symptom Assessment System-revised (ESAS-r); moderate to severe scores (screen-positive) triggered an email to a palliative care nurse, who called the patient and offered EPC. Patient-reported outcomes of QoL, depression, symptom control, and satisfaction with care were measured at baseline and at 2, 4, and 6 months. The primary aim was to determine feasibility, according to predefined criteria. Secondary aims were to assess whether STEP identified patients with worse patient-reported outcomes and whether screen-positive patients who accepted and received EPC had better outcomes over time than those who did not receive EPC. Results: In total, 116 patients were enrolled, of which 89 (77%) completed screening for ≥70% of visits. Of the 70 screen-positive patients, 39 (56%) received EPC during the 6-month study and 4 (6%) received EPC after the study end. Measure completion was 76% at 2 months, 68% at 4 months, and 63% at 6 months. Among screen-negative patients, QoL, depression, and symptom control were substantially better than for screen-positive patients at baseline (all P<.0001) and remained stable over time. Among screen-positive patients, mood and symptom control improved over time for those who accepted and received EPC and worsened for those who did not receive EPC (P<.01 for trend over time), with no difference in QoL or satisfaction with care. Conclusions: STEP is feasible in ambulatory patients with advanced cancer and distinguishes between patients who remain stable without EPC and those who benefit from targeted EPC. Acceptance of the triggered EPC visit should be encouraged. ClinicalTrials.gov identifier: NCT04044040.

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Prospective cohort study of patients with advanced cancer and their relatives on the experienced quality of care and life (eQuiPe study): a study protocol

BMC Palliative Care ◽

10.1186/s12904-020-00642-w ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Janneke van Roij ◽

◽

Myrte Zijlstra ◽

Laurien Ham ◽

Linda Brom ◽

...

Keyword(s):

Palliative Care ◽

Cohort Study ◽

Quality Of Care ◽

The Netherlands ◽

Advanced Cancer ◽

Number Of Patients ◽

Changes Over Time ◽

Prospective Longitudinal ◽

Over Time

Abstract Background Palliative care is becoming increasingly important because the number of patients with an incurable disease is growing and their survival is improving. Previous research tells us that early palliative care has the potential to improve quality of life (QoL) in patients with advanced cancer and their relatives. According to limited research on palliative care in the Netherlands, patients with advanced cancer and their relatives find current palliative care suboptimal. The aim of the eQuiPe study is to understand the experienced quality of care (QoC) and QoL of patients with advanced cancer and their relatives to further improve palliative care. Methods A prospective longitudinal observational cohort study is conducted among patients with advanced cancer and their relatives. Patients and relatives receive a questionnaire every 3 months regarding experienced QoC and QoL during the palliative trajectory. Bereaved relatives receive a final questionnaire 3 to 6 months after the patients’ death. Data from questionnaires are linked with detailed clinical data from the Netherlands Cancer Registry (NCR). By means of descriptive statistics we will examine the experienced QoC and QoL in our study population. Differences between subgroups and changes over time will be assessed while adjusting for confounding factors. Discussion This study will be the first to prospectively and longitudinally explore experienced QoC and QoL in patients with advanced cancer and their relatives simultaneously. This study will provide us with population-based information in patients with advanced cancer and their relatives including changes over time. Results from the study will inform us on how to further improve palliative care. Trial registration Trial NL6408 (NTR6584). Registered in Netherlands Trial Register on June 30, 2017.

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Emotion Regulation in Context: Social Connectedness Moderates Concurrent and Prospective Associations With Depressive Symptoms

Journal of Social and Clinical Psychology ◽

10.1521/jscp.2019.38.7.605 ◽

2019 ◽

Vol 38 (7) ◽

pp. 605-626 ◽

Cited By ~ 1

Author(s):

Brett Marroquín ◽

Jennifer De Rutte ◽

Casey L. May ◽

Blair E. Wisco

Keyword(s):

Emotion Regulation ◽

Depressive Symptoms ◽

Social Factors ◽

Experiential Avoidance ◽

Social Connectedness ◽

Strategy Use ◽

Cross Sectional ◽

Healthy Functioning ◽

Over Time

Introduction: Emotion regulation in healthy functioning and in depression is typically examined as an intrapersonal phenomenon, but growing evidence suggests social factors affect individuals' strategy use and effectiveness. We examined whether the role of emotion regulation in depression—concurrently and over four weeks—depends on social connectedness, predicting that higher social connectedness would dilute effects of one's own strategy use regardless of specific strategy. Methods: Young adult participants (n = 187) completed measures of perceived social connectedness, depressive symptoms, two avoidant emotion regulation strategies (ruminative brooding and experiential avoidance), and two approach-oriented strategies (positive reappraisal and planning), and depressive symptoms again four weeks later (n = 166). Results: Cross-sectional associations of emotion regulation with symptoms were moderated by social connectedness: effects of both avoidant and approach strategies were weaker among more connected individuals. Prospectively, social connectedness moderated effects of approach strategies, but not avoidant strategies. Among more socially connected individuals, using approach strategies—which are typically adaptive—was associated with higher symptoms over time. Discussion: Results partially replicate previous research and support the role of social factors as important contexts of intraper-sonal emotion regulation and dysregulation in depression. Findings suggest that social resources can dilute intrapersonal effects regardless of strategy type—more in the shorter term than in the longer term—and can even lead seemingly adaptive strategies to backfire over time. Implications for research integrating emotion regulation, relationships, and depressive psychopathology are discussed.

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Opportunities for improved end-of-life (EOL) care for adult patients with advanced cancer: Results of a longitudinal assessment of care provided by Quality Oncology Practice Initiative (QOPI) participants.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9537 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9537-9537

Author(s):

David W. Dougherty ◽

Pamela Kadlubek ◽

Trang Pham ◽

Craig Earle ◽

Jennifer Malin ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Advanced Cancer ◽

Care Quality ◽

Adult Patients ◽

Trend Test ◽

Chemotherapy Administration ◽

Hospice And Palliative Care ◽

Eol Care ◽

Over Time

9537 Background: End of life care of patients with advanced cancer has received recent attention because of evidence of widespread variation in utilization of aggressive therapies and interventions and possible suboptimal use of palliative care and hospice services. QOPI, the ASCO sponsored quality assessment program, has been available to all United States physician members since January 2006 and has assessed EOL care since its inception. The current analysis explores whether the increased national focus on EOL and increased availability of palliative care and hospice services has resulted in improvements in EOL care as reported by QOPI participants. Methods: Data was aggregated across all EOL care quality measures for 9 sequential semi-annual QOPI collection periods from 2008 through 2012. Trends were analyzed among rates of eligible patients related to hospice enrollment and timing of enrollment, palliative care referrals, discussions about hospice and palliative care, and chemotherapy administration at the end of life. The Cochran-Armitage trend test was performed to determine the significance of trends and differences in measure performance over time. Results: From Fall 2008 to Fall 2012, the rate of hospice enrollment for appropriate patients improved by 7.4% [51.8% to 59.2%; p<0.0001] and the rate of hospice enrollment or palliative care referral improved by 5.6% [63.3% to 68.9%; p<0.0001]. Modest improvements were seen in the rates of hospice enrollment more than 3 and 7 days before death [2.8%, 2.6%], discussion of hospice or palliative care with patients not referred for these services within the last 2 months of life [2.7% increase; 19% to 21.7%], and chemotherapy administration within the last 2 weeks of life [2.4% improvement from 13.7% to 11.3%]. Conclusions: Despite modest increases in the rate of hospice enrollment and palliative care referrals over time, EOL care for adult patients with cancer associated with QOPI practices remains suboptimal. Opportunities exist to increase more meaningful participation in hospice and palliative care and to reduce exposure to chemotherapy near death.

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Methylation Related to Perceived Parenting in Adolescents and its Association to Depressive Symptoms Two Years Later

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.203 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S307-S307

Author(s):

E. Van Assche ◽

E. Vangeel ◽

K. Freson ◽

K. Van Leeuwen ◽

K. Verschueren ◽

...

Keyword(s):

Depressive Symptoms ◽

Linear Regression Analysis ◽

Depression Scale ◽

Well Being ◽

Epidemiologic Studies ◽

Depression Score ◽

Perceived Parenting ◽

Competing Interest ◽

Over Time

IntroductionAdolescents’ well being is affected by their parenting situation and can influence their well being over time. We present an exploratory study with an Illumina 450 k array, comparing methylation in adolescents, based on perceived parenting at T0, and how methylation can interact with parenting in explaining depressive symptoms two years later (T2).ObjectivesIdentify differentially methylated regions (DMRs) associated with perceived parenting at T0 and investigate their association with depressive symptoms two years later.AimsAn exploratory analysis evaluating the association between methylation and depressive symptoms longitudinally.MethodsFrom two extreme parenting clusters: perceived supportive, and punishing neglecting, we randomly selected 44 adolescents (MAge = 14 at T0; 48%boys). The CES-D scale (Center for Epidemiologic Studies Depression Scale) assessed depressive symptoms. DMRs were identified based on the parenting clusters (DMRcate and comb-p) using llumina Infinium HumanMethylation 450 BeadChip data. Associations between the most significant CpG for each DMR and the depression score at T2, were calculated using linear regression analysis.ResultsWe identified 17 DMRs, but only cg13306335 in PEX10 was associated with depressive symptoms at T2 (P = 0.0014, Bonferroni (17 tests): P < 0.0029). Additionally, an interaction between parenting at T0 and PEX10 methylation (T0) in explaining depressive symptoms (T2) can be suggested (P = 0.014).ConclusionsWe show that methylation at PEX10's most significant CpG is correlated with depressive symptoms at T2, these exploratory results also suggest a possible interaction between parenting and PEX10 methylation at T0 in association with depressive symptoms at T2. Validation in a larger sample is needed to support the role of methylation and its interactions in depression over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Abstract WP463: Moderator Role of Preparedness on the Association Between Depression and Quality of Life in Stroke Survivor-Caregiver Dyads

Stroke ◽

10.1161/str.51.suppl_1.wp463 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Gianluca Pucciarelli ◽

Karen S Lyons ◽

Silvio Simeone ◽

Rosaria Alvaro ◽

Christopher S Lee ◽

...

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Hierarchical Linear Modeling ◽

Longitudinal Design ◽

Stroke Survivor ◽

Linear Modeling ◽

Rehabilitation Period ◽

Over Time

Background: Although several studies have clearly shown that depressive symptoms in stroke survivors and caregivers decreases their quality of life (QOL), previous research has not yet analyzed the role of potential moderators in the relationship between the above two variables. Aims: To examine the moderating effect of caregiver preparedness between depressive symptoms and QOL in stroke survivor and caregiver dyads. Methods: Longitudinal design with 222 stroke survivor-caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivor and caregiver QOL dimensions (physical, psychological, social and environmental), depression and preparedness. Hierarchical Linear Modeling was used to test four longitudinal dyadic moderation models (one for each QOL domain). Results: Survivors (50% males) and caregivers (65% females) were 70.8 (SD=11.9) and 52.5 (SD=13.1) years old, respectively. Controlling for baseline covariates, caregiver preparedness significantly moderated the association between survivor depressive symptoms and survivor psychological (B = 0.56, p < .01) and environmental (B = 0.58, p < .01) QOL at baseline and social QOL over time (B = 0.24, p < .05). In each case, higher levels of caregiver preparedness were protective and buffered the influence of survivor depressive symptoms on survivor QOL. Similarly, caregiver preparedness significantly moderated the association between caregiver depressive symptoms and caregiver physical (B = 0.25, p < .01) and environmental (B = 0.18, p < .05) QOL over time. Conclusions: Caregiver preparedness is a positive variable for both members of the dyad and the paper highlights the importance of implementing tailored intervention which could improve caregivers’ preparedness already during the rehabilitation period.

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