PATHOPHYSIOLOGY OF ONCOLOGICAL PAIN: REVIEW OF LITERATURE

2020 ◽  
Vol 7 (1) ◽  
pp. 59-61
Author(s):  
Lucas Yago Souza Schmidt ◽  
Ana Flávia de Oliveira Castro ◽  
João Gabriel Lopes Siqueira ◽  
Dowglas Pereira De Oliveira ◽  
Welma Rezende Fuso De Assis

Despite the contributions to the diagnosis and treatment of cancer, the disease continues to present an adverse effect on patients' quality of life, with pain being a frequent complaint, with a prevalence varying from 50 to 53% in cancer patients at all stages and up to 70 % in cases of advanced disease. Cancer pain ismanifested by the primary site of cancer, metastasis, bone involvement, proximity to the nervous system, production of pain-promoting chemicals, and patient-related factors such as anxiety and depression. Because it is subjective, not palpable, and an individual experience and difficult to evaluate, requires for the health team educational support, knowledge and instruments that contribute to their understanding, being the elucidation of its biological mechanisms object of this literature review.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 739-739
Author(s):  
M. Carbo ◽  
L. Overbeeke ◽  
S. Arends ◽  
Y. Kamsma ◽  
F. Wink ◽  
...  

Background:Patients with axial spondyloarthritis (axSpA) who are more physically active experience less pain and better physical functioning.1Psychological factors such as anxiety and depression are associated with physical functioning and reduction of Quality of Life (QoL).2Furthermore, evasive coping strategies are commonly used in health-related coping.3However, as far as we know, no data is available regarding the influence of coping strategies, anxiety and depression on daily physical activity in axSpA.Objectives:To determine if coping strategies, anxiety and depression are associated with daily physical activity in patients with axSpA.Methods:Consecutive outpatients from the Groningen Leeuwarden AxSpA cohort (GLAS) participated in this study. Additionally to the standardized follow-up assessments, patients filled out the axSpA-Short Questionnaire to assess health-enhancing physical activity (axSpA-SQUASH), the Coping with Rheumatic Stressors (CORS) and the Hospital Anxiety and Depression Scale (HADS). Univariable and multivariable linear regression analyses were performed to explore associations of copings strategies, anxiety and depression, and patient- and disease related factors with daily physical activity. Additionally, patients were stratified into three tertiles of physical activity: low, intermediate and high. To identify group differences, Kruskal-Wallis test or Chi-Square test were used with post-hoc testing.Results:In total 85 patients were included; 59% were male, mean age was 49±14, median symptom duration 19.5 years (IQR 12.0-31.0), 71% were HLA-B27 positive and mean ASDAS was 2.1±1.0. Median axSpA-SQUASH total physical activity score was 9406.3 (IQR 5538.8–12081.3). Median scores of HADS-Anxiety (scale 7-28) and HADS-Depression (scale 7-28) were scores of 12 (IQR 10.0-14.0) and 10(IQR 9.0-12.5). The mostly frequently used coping strategie was comforting cognitions (for pain, range 9-36); median of 25.5 (IQR 22.0-28.0).Univariable analysis showed that lower daily physical activity was significantly associated with gender (female), higher disease activity (BASDAI), worse physical function (BASFI), worse quality of life (ASQoL), coping strategies ‘decreasing activities’ and ‘pacing’, higher depression score (HADS) and higher perceived influence of axSpA on general well-being. In multivariable analysis, only the coping strategy “decreasing activity” was independently associated with physical activity (β: -419.3, R2: 0.155, P<0.001). Additionally, patients in the highest physical activity tertile were significantly more often male, had higher working status, lower BASDAI and ASDAS, better BASFI and ASQoL and scored lower on the coping strategy “decreasing activities”.Conclusion:In this cross-sectional study in axSpA patients with established disease, multiple patient and disease related factors were associated with daily physical activity. The evasive coping strategy ‘decreasing activities’ was the only independently associated factor. These findings suggest that to improve daily physical activity in axSpA patients attention should be paid not only on targeting disease activity, but also to other patient and disease related aspects, especially coping strategies used.References:[1]Regel A et al.RMD Open. 2017;3(1):e000397.[2]Kilic G et al.Med (United States). 2014;93(29):e337.[3]Peláez-Ballestas I et al.Med (United States). 2015;94(10):e600.Acknowledgments:The authors would like to thank all patients who participated in the GLAS cohort.Disclosure of Interests:Marlies Carbo: None declared, Laura Overbeeke: None declared, Suzanne Arends Grant/research support from: Grant/research support from Pfizer, Yvo Kamsma: None declared, Freke Wink Consultant of: Abbvie, Janssen, Davy Paap: None declared, Anneke Spoorenberg: None declared


Author(s):  
Xuan Dung Ho

TÓM TẮT Giới thiệu: Các rối loạn về giấc ngủ: khó khăn khi đi vào giấc ngủ, duy trì giấc ngủ, chất lượng giấc ngủ kém, dậy sớm và ngủ ban ngày quá nhiều mà bệnh nhân ung thư phải trải qua thường xuyên nhưng thường hay bị bỏ sót và chưa được chú ý đến. Mục tiêu: Đánh giá chất lượng giấc ngủ và tìm hiểu các yếu tố liên quan đến chất lượng giấc ngủ ở bệnh nhân ung thư đang được điều trị tại bệnh viện trường đại học Y dược Huế. Phương pháp nghiên cứu: Phương pháp nghiên cứu cắt ngang trên 104 bệnh nhân ung thư tại Khoa Ung Bướu, bệnh viện trường Đại học Y dược Huế. Sử dụng thang đo PSQI và PHQ-ADS để đánh giá chất lượng giấc ngủ, và tình trạng trầm cảm lo âu ở bệnh nhân ung thư. Phân tích hồi quy đa biến tuyến tính dùng để kiểm định mối tương quan giữa chất lượng giấc ngủ và các yếu tố liên quan. Kết quả: Đối tượng nghiên cứu có độ tuổi trung bình 59,6 ± 11,7. Điểm PSQI trung bình chất lượng giấc ngủ là 10,6 ± 5,2. Phần lớn bệnh nhân có chất lượng giấc ngủ kém (79,8%); trong đó, 50% bệnh nhân gặp trở ngại lớn để đi vào giấc ngủ, có đến 46,2% chỉ ngủ được 5 giờ trong một đêm. Có mối liên quan có ý nghĩa thống kê giữa chất lượng giấc ngủ với giới tính và tình trạng trầm cảm, lo âu (p < 0,05). Kết luận: Bệnh nhân ung thư thường có chất lượng giấc ngủ kém. Điều này cho thấy giấc ngủ của bệnh nhân cần được quan tâm đúng mức và không nên bỏ sót trong quá trình chẩn đoán và điều trị. Từ khóa: Chất lượng giấc ngủ, bệnh nhân ung thư, trầm cảm lo âu. ABSTRACT QUALITY OF SLEEP AND RELATED FACTORS AMONG CANCER PATIENTS IN HUE UNIVERSITY HOSPITAL Introduction: Sleep disorders such as difficulty in falling asleep, maintaining sleep, poor sleep efficiency, early awakening and excessive daytime sleepiness are among the adverse effects that are experienced frequently but they are widely underdiagnosed. Therefore, addressing problems related to sleep among cancer patients could carry out better implications to improve quality of sleep, enhancing treatment outcomes. Aim: To evaluate quality of sleep and to detect associated factors of sleep quality among cancer patients. Methods: The cross-sectional study was conducted among 104 cancer patients treated at the Oncology Department, Hue University of Medicine and Pharmacy hospital. Sleep quality (Pittsburgh Sleep Quality Index), severity of anxiety and depression (Patient Health Questionnaire - Anxiety and Depression Scale) were accessed in the present study. Linear regression analysis was used to investigate the association between sleep quality and its related factors. Results: The mean age of study population was 59.6 ± 11.7. The average PSQI score was 10.6 ± 5.2. 79.8% cancer patients had poor sleep quality (PSQI score > 5). 50% patients had difficulty falling asleep and 46.2% patients reported sleep of < 5 hours per day. There were statistically associations between quality of sleep and gender, depression/anxiety (p < 0.05). Conclusion: The majority of cancer patients had poor sleep quality. This study points out that sleep is of great importance among cancer patients, which should not be neglected during the diagnosis and treatment procedure. Keyword: Quality of sleep, cancer patient, depression, anxiety.


Author(s):  
Mai Nguyen Phuong

TÓM TẮT Giới thiệu: Các rối loạn về giấc ngủ: khó khăn khi đi vào giấc ngủ, duy trì giấc ngủ, chất lượng giấc ngủ kém, dậy sớm và ngủ ban ngày quá nhiều mà bệnh nhân ung thư phải trải qua thường xuyên nhưng thường hay bị bỏ sót và chưa được chú ý đến. Mục tiêu: Đánh giá chất lượng giấc ngủ và tìm hiểu các yếu tố liên quan đến chất lượng giấc ngủ ở bệnh nhân ung thư đang được điều trị tại bệnh viện trường đại học Y dược Huế. Phương pháp nghiên cứu: Phương pháp nghiên cứu cắt ngang trên 104 bệnh nhân ung thư tại Khoa Ung Bướu, bệnh viện trường Đại học Y dược Huế. Sử dụng thang đo PSQI và PHQ-ADS để đánh giá chất lượng giấc ngủ, và tình trạng trầm cảm lo âu ở bệnh nhân ung thư. Phân tích hồi quy đa biến tuyến tính dùng để kiểm định mối tương quan giữa chất lượng giấc ngủ và các yếu tố liên quan. Kết quả: Đối tượng nghiên cứu có độ tuổi trung bình 59,6 ± 11,7. Điểm PSQI trung bình chất lượng giấc ngủ là 10,6 ± 5,2. Phần lớn bệnh nhân có chất lượng giấc ngủ kém (79,8%); trong đó, 50% bệnh nhân gặp trở ngại lớn để đi vào giấc ngủ, có đến 46,2% chỉ ngủ được 5 giờ trong một đêm. Có mối liên quan có ý nghĩa thống kê giữa chất lượng giấc ngủ với giới tính và tình trạng trầm cảm, lo âu (p < 0,05). Kết luận: Bệnh nhân ung thư thường có chất lượng giấc ngủ kém. Điều này cho thấy giấc ngủ của bệnh nhân cần được quan tâm đúng mức và không nên bỏ sót trong quá trình chẩn đoán và điều trị. Từ khóa: Chất lượng giấc ngủ, bệnh nhân ung thư, trầm cảm lo âu. ABSTRACT QUALITY OF SLEEP AND RELATED FACTORS AMONG CANCER PATIENTS IN HUE UNIVERSITY HOSPITAL Introduction: Sleep disorders such as difficulty in falling asleep, maintaining sleep, poor sleep efficiency, early awakening and excessive daytime sleepiness are among the adverse effects that are experienced frequently but they are widely underdiagnosed. Therefore, addressing problems related to sleep among cancer patients could carry out better implications to improve quality of sleep, enhancing treatment outcomes. Aim: To evaluate quality of sleep and to detect associated factors of sleep quality among cancer patients. Methods: The cross-sectional study was conducted among 104 cancer patients treated at the Oncology Department, Hue University of Medicine and Pharmacy hospital. Sleep quality (Pittsburgh Sleep Quality Index), severity of anxiety and depression (Patient Health Questionnaire - Anxiety and Depression Scale) were accessed in the present study. Linear regression analysis was used to investigate the association between sleep quality and its related factors. Results: The mean age of study population was 59.6 ± 11.7. The average PSQI score was 10.6 ± 5.2. 79.8% cancer patients had poor sleep quality (PSQI score > 5). 50% patients had difficulty falling asleep and 46.2% patients reported sleep of < 5 hours per day. There were statistically associations between quality of sleep and gender, depression/anxiety (p < 0.05). Conclusion: The majority of cancer patients had poor sleep quality. This study points out that sleep is of great importance among cancer patients, which should not be neglected during the diagnosis and treatment procedure. Keyword: Quality of sleep, cancer patient, depression, anxiety.


2018 ◽  
Vol 53 (1) ◽  
pp. 1801270 ◽  
Author(s):  
David C. Currow ◽  
Magnus Ekström ◽  
Sandra Louw ◽  
Julie Hill ◽  
Belinda Fazekas ◽  
...  

Does sertraline provide symptomatic relief for chronic breathlessness in people with advanced disease whose underlying cause(s) are optimally treated?223 participants with chronic breathlessness (modified Medical Research Council breathlessness scale ≥2) who had optimal treatment of underlying cause(s) were randomised 1:1 to sertraline 25–100 mg (titrated upwards over 9 days) or placebo for 4 weeks. The primary outcome was the proportion who had an improvement in intensity of current breathlessness >15% from baseline on a 100-mm visual analogue scale.The proportion of people responding to sertraline was similar to placebo for current breathlessness on days 26–28 (OR 1.00, 95% CI 0.71–1.40) and for other measures of breathlessness. Quality of life in the sertraline arm had a higher likelihood of improving than in the placebo arm over the 4 weeks (OR 0.21, 95% CI 0.01–0.41; p=0.044). No differences in performance status, anxiety and depression, or survival were observed. Adverse event rates were similar between arms.Sertraline does not appear to provide any benefit over placebo in the symptomatic relief of chronic breathlessness in this patient population.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5296-5296
Author(s):  
Mirsa B. Hussain ◽  
Gangadharan P. Sarita ◽  
Nandakumar Devi ◽  
Bejoy C. Thomas ◽  
Krishnan Rita ◽  
...  

Abstract Introduction: The deteriorating effects of chemotherapy on cancer patients are well documented, as is the need and impact of psychosocial interventions in improving quality of life (QOL). In India, cancer centres have a very high patient load and providing quality treatment and achieving good survival is still the first priority. Published studies from India on QOL in cancer patients are far and few, current ongoing studies are even fewer. The present study is on effect of chemotherapy on QOL, and prevalence of psychological morbidity in the Indian context. Patients and Methods: The study sample consisted of 117 cancer patients undergoing chemotherapy with curative intent as single modality or as part of the multi modality regimen. Nearly 30% of the sample had lymphoproliferative disease, 17% had haematological malignancies, 45% had solid tumours, and the rest had multiple myeloma. The assessments were carried out using the Distress Inventory for cancer version 2 (DIC V2), Functional Assessment of Cancer Therapy-General (FACT-G), and the Hospital Anxiety and Depression scales (HADS). Results: Older patients (&gt;=47 years) had significantly greater spiritual distress, and difficulties in activities of daily living, but had better emotional well being compared to younger patients (&lt;47 years). Patients from lower income strata had significantly greater distress levels and poorer QOL than those in the upper income category. Those with advanced disease had significantly poorer scores on most of the QOL subscales. More than 20% of the patients were found to have significant psychological morbidity ranging from mood disturbances (12%), to anxiety (3%) and depression (5%). Though chemotherapy did not significantly influence anxiety and depression, it was noted that male patients had significantly higher depression rates than females. Conclusions: The study was intended to measure the existence of psychological morbidity within the cancer patients. Older patients, those from lower incomes groups, and those with advanced disease had significantly greater levels of distress and significantly poorer QOL scores. Depression rates were significantly higher in male patients than in female patients. This shows the need to have psychiatric assessment and intervention among patients undergoing cancer chemotherapy.


2014 ◽  
Vol 41 (5) ◽  
pp. 887-896 ◽  
Author(s):  
Emily McDonough ◽  
Renise Ayearst ◽  
Lihi Eder ◽  
Vinod Chandran ◽  
Cheryl F. Rosen ◽  
...  

Objective.(1) To determine the prevalence of depression and anxiety in patients with psoriatic arthritis (PsA) and to identify associated demographic and disease-related factors. (2) To determine whether there is a difference in the prevalence of depression and anxiety between patients with PsA and those with psoriasis without PsA (PsC).Methods.Consecutive patients attending PsA and dermatology clinics were assessed for depression and anxiety using the Hospital Anxiety and Depression Scale. Patients underwent a clinical assessment according to a standard protocol and completed questionnaires assessing their health and quality of life. T tests, ANOVA, and univariate and multivariate models were used to compare depression and anxiety prevalence between patient cohorts and to determine factors associated with depression and anxiety.Results.We assessed 306 patients with PsA and 135 with PsC. There were significantly more men in the PsA group (61.4% vs 48% with PsC) and they were more likely to be unemployed. The prevalence of both anxiety and depression was higher in patients with PsA (36.6% and 22.2%, respectively) compared to those with PsC (24.4% and 9.6%; p = 0.012, 0.002). Depression and/or anxiety were associated with unemployment, female sex, and higher actively inflamed joint count as well as disability, pain, and fatigue. In the multivariate reduced model, employment was protective for depression (OR 0.36) and a 1-unit increase on the fatigue severity scale was associated with an increased risk of depression (OR 1.5).Conclusion.The rate of depression and anxiety is significantly higher in patients with PsA than in those with PsC. Depression and anxiety are associated with disease-related factors.


2020 ◽  
Author(s):  
Arfan Ahmed ◽  
Nashva ALi ◽  
Sarah Aziz ◽  
Alaa A Abd-Alrazaq ◽  
Asmaa Hassan ◽  
...  

BACKGROUND Anxiety and depression rates are at an all-time high along with other mental health disorders. Smartphone-based mental health chatbots or conversational agents can aid psychiatrists and replace some of the costly human based interaction and represent a unique opportunity to expand the availability and quality of mental health services and treatment. Regular up-to-date reviews will allow medics and individuals to recommend or use anxiety and depression related smartphone based chatbots with greater confidence. OBJECTIVE Assess the quality and characteristics of chatbots for anxiety and depression available on Android and iOS systems. METHODS A search was performed in the App Store and Google Play Store following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol to identify existing chatbots for anxiety and depression. Eligibility of the chatbots was assessed by two individuals based on predefined eligibility criteria. Meta-data of the included chatbots and their characteristics were extracted from their description and upon installation by 2 reviewers. Finally, chatbots quality information was assessed by following the mHONcode principles. RESULTS Although around 1000 anxiety and depression related chatbots exist, only a few (n=11) contained actual chatbots that could provide the user a real substitute for a human-human based interaction, even with today's Artificial Intelligence advancements, only one of these chatbots had voice as an input/output modality. Of the selected apps that contained chatbots all were clearly built with a therapeutic human substitute goal in mind. The majority had high user ratings and downloads highlighting the popularity of such chatbots and their promising future within the realm of anxiety and depression. CONCLUSIONS Anxiety and depression chatbot apps have the potential to increase the capacity of mental health self-care providing much needed assistance to professionals. In the current covid-19 pandemic, chatbots can also serve as a conversational companion with the potential of combating loneliness, especially in lockdowns where there is a lack of social interaction. Due to the ubiquitous nature of chatbots users can access them on-demand at the touch of a screen on ones’ smartphone. Self-care interventions are known to be effective and exist in various forms and some can be made available as chatbot features, such as assessment, mood tracking, medicine tracking, or simply providing conversation in times of loneliness.


2019 ◽  
Vol 47 (7) ◽  
pp. 1-11
Author(s):  
Victoria A. Farrow ◽  
Anthony Ahrens ◽  
Kathleen C. Gunthert ◽  
Jay Schulkin

We assessed neuroticism, perceived stress, and work-related factors among obstetrician-gynecologists (ob-gyns), and examined the relationships between these variables. Surveys were sent to 500 physician members of the American College of Obstetricians and Gynecologists and we received 287 (57.4%) completed responses. Analyses included descriptive statistics and linear regressions. Ob-gyns reported high levels of perceived stress. After controlling for neuroticism, variables that significantly predicted stress levels included average hours worked, perception of working too many hours, colleague support for work–home balance, isolation due to gender/cultural differences, and perception of workplace control. Because these work-related factors are linked to stress even when controlling for neuroticism, administrators and physicians may consider whether any of these factors are modifiable to mitigate physician stress. This in turn may affect physicians' own health and the quality of care patients receive.


BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e051554
Author(s):  
Pascal Richard David Clephas ◽  
Sanne Elisabeth Hoeks ◽  
Marialena Trivella ◽  
Christian S Guay ◽  
Preet Mohinder Singh ◽  
...  

IntroductionChronic post-surgical pain (CPSP) after lung or pleural surgery is a common complication and associated with a decrease in quality of life, long-term use of pain medication and substantial economic costs. An abundant number of primary prognostic factor studies are published each year, but findings are often inconsistent, methods heterogeneous and the methodological quality questionable. Systematic reviews and meta-analyses are therefore needed to summarise the evidence.Methods and analysisThe reporting of this protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. We will include retrospective and prospective studies with a follow-up of at least 3 months reporting patient-related factors and surgery-related factors for any adult population. Randomised controlled trials will be included if they report on prognostic factors for CPSP after lung or pleural surgery. We will exclude case series, case reports, literature reviews, studies that do not report results for lung or pleural surgery separately and studies that modified the treatment or prognostic factor based on pain during the observation period. MEDLINE, Scopus, Web of Science, Embase, Cochrane, CINAHL, Google Scholar and relevant literature reviews will be searched. Independent pairs of two reviewers will assess studies in two stages based on the PICOTS criteria. We will use the Quality in Prognostic Studies tool for the quality assessment and the CHARMS-PF checklist for the data extraction of the included studies. The analyses will all be conducted separately for each identified prognostic factor. We will analyse adjusted and unadjusted estimated measures separately. When possible, evidence will be summarised with a meta-analysis and otherwise narratively. We will quantify heterogeneity by calculating the Q and I2 statistics. The heterogeneity will be further explored with meta-regression and subgroup analyses based on clinical knowledge. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guideline 28.Ethics and disseminationEthical approval will not be necessary, as all data are already in the public domain. Results will be published in a peer-reviewed scientific journal.PROSPERO registration numberCRD42021227888.


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