Impact of Anticipated Awake Surgery on Psychooncological Distress in Brain Tumor Patients

BackgroundBrain tumor patients present high rates of distress, anxiety, and depression, in particular perioperatively. For resection of eloquent located cerebral lesions, awake surgery is the gold standard surgical method for the preservation of speech and motor function, which might be accompanied by increased psychological distress. The aim of the present study was to analyze if patients who are undergoing awake craniotomy suffer from increased prevalence or higher scores in distress, anxiety, or depression.MethodsPatients, who were electively admitted for brain tumor surgery at our neurooncological department, were perioperatively screened regarding distress, anxiety, and quality of life using three established self-assessment instruments (Hospital Anxiety and Depression Scale, distress thermometer, and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30-BN20). Screening results were correlated regarding operation technique (awake vs. general anesthesia). Retrospective statistical analyses for nominal variables were conducted using chi-square test. Metric variables were analyzed using the Kruskal–Wallis test, the Mann–Whitney U-test, and independent-samples t-tests.ResultsData from 54 patients (26 male and 28 female) aged 29 to 82 years were available for statistical analyses. A total of 37 patients received primary resection and 17 recurrent tumor resection. Awake surgery was performed in 35 patients. There was no significant difference in awake versus non-awake surgery patients regarding prevalence (of distress (p = 0.465), anxiety (p = 0.223), or depression (p = 0.882). Furthermore, awake surgery had no significant influence on distress thermometer score (p = 0.668), anxiety score (p = 0.682), or depression score (p = 0.630) as well as future uncertainty (p = 0.436) or global health status (p = 0.943). Additionally, analyses revealed that primary or recurrent surgery also did not have any significant influence on the prevalence or scoring of the evaluated items.ConclusionAnalyses of our cohort’s data suggest that planned awake surgery might not have a negative impact on patients concerning the prevalence and severity of manifestation of distress, anxiety, or depression in psychooncological screening. Patients undergoing recurrent surgery tend to demonstrate increased distress, although results were not significant.

Mental Health in der Covid-19-Pandemie – Beobachtungen unter Kopf-Hals-Tumorpatienten

ZUSAMMENFASSUNG Hintergrund In Krisenzeiten wie der Covid-19-Pandemie hat das individuelle Coping für jeden Tumorpatienten eine besondere Bedeutung zur Bewältigung ihrer spezifischen Belastungen. Material und Methode Wir haben in zwei Projekten Daten zu Mental Health für Patienten mit Kopf-Hals-Karzinomen erfasst: WHO-5, SpREUK, Distress-Thermometer zu Belastung. Vor der Pandemie inkludierten wir 113 Patienten, während des 1. Lockdowns 84 Patienten und während des 2. Lockdowns 86 Patienten. Ergebnisse Wir sehen während des 1. Lockdowns im Trend eine Abnahme der allgemeinen Krankheitslast gegenüber der Zeit vor Covid-19. Lebenszufriedenheit steigt, Copingstrategien wie Sinnsuche, Vertrauen und Reflexion der eigenen Situation werden aktiviert. Im zweiten Lockdown lassen diese Entwicklungen wieder nach, wobei insbesondere das per se nicht sehr große religiöse Vertrauen geschwunden zu sein scheint. Schlussfolgerung Tumorpatienten können Krisensituationen durch Coping besser überwinden. Spiritual Care kann gezielt diese Copingmuster unterstützen.

Predictive Value of the Distress Thermometer Score for Risk of Suicide in Patients with Cancer

Purpose: This study aimed to assess the association between the Distress Thermometer (DT) score and risk of suicide in patients with cancer. In addition, we aimed to determine the best cutoff score to predict patients at risk of suicide.Methods: From 2015 to 2016, we retrospectively collected data on patients with cancer. DT scores were collected, and the association between DT score and risk of suicide (suicide ideation or death ideation) was analyzed. Furthermore, receiver operating characteristic (ROC) analysis was performed to identify the appropriate cutoff score for predicting risk of suicide.Results: A total of 394 patients with cancer were included, and suicidal ideation was identified in 33 cases referred for psychological intervention. The DT scores of the patients with suicidal ideation were significantly higher than those of patients without suicidal ideation (6.30±2.11 vs. 4.29±1.72, p<0.05). In addition, the area under the ROC curve for predicting risk for suicide was 0.758. The cutoff DT score of 3 had the highest sensitivity of 1.00 to rule out suicidal ideation, while 9 had the highest specificity of 1.00 to rule in suicidal ideation. Moreover, the appropriate cutoff DT score to predict patients with suicidal ideation was 5, with a sensitivity of 0.52, specificity of .84, positive likelihood ratio of 3.24, and negative likelihood ratio of 0.58.Conclusion: The DT score may be a helpful clinical tool to evaluate emotional distress and risk of suicide in patients with cancer. Clinically, for DT scores greater than 5 in patients with cancer, the risk of suicide greatly increases. In view of the DT’s widespread use internationally by non-mental health clinicians in cancer to guide the need for specialist mental health interventions, it’s potential utility in also predicting suicide risk is of great interest.

Successful implementation of an ePRO remote monitoring system in patients receiving chemotherapy in a community oncology practice.

1526 Background: Remote symptom monitoring of patients receiving cancer treatment has been shown to improve patient outcomes in the research setting. However, there is little evidence that this technology can be implemented and scaled in the real world with the same benefits. Methods: Highlands Oncology Group (HOG) is a 19 physician medical oncology group in Northwest Arkansas. Beginning in June 2020, HOG offered patients receiving parenteral cancer therapy enrollment onto Expain: an EMR-integrated, electronic patient-reported outcomes (ePRO) system which enables remote symptom monitoring during systemic cancer therapy. Patients reported distress and symptoms using the NCCN Distress Thermometer and Problem List instrument. The practice prospectively defined patient reporting intervals based on disease and treatment protocol, as well as thresholds for each symptom that would trigger a nursing notification. Following clinical review, nurses initiated interventions including a telephone call, urgent office visit, or referral to an emergency room when necessary. Results: From June 2020 – January 2021, HOG treated 1261 patients with IV chemotherapy. 769 patients were offered enrollment and 569 (73.9%) were successfully enrolled onto the ePRO system. At the time of enrollment 419 (73.6%) of enrolled patients were in an Oncology Care Model (OCM) episode. Common reasons for declined enrollment were: low symptom burden, non-English speaker, and approaching the end of treatment. Of enrolled patients, the most common tumor types were: gastrointestinal (21.8%), breast (17.5%), and thoracic (16.1%). Patients reported using Expain’s mobile app (89.1%) or Interactive Voice Response interface (IVR, 10.1%) with the following frequency: once a month (12%), twice a month (30%), 3 reports a month (35%), and 4 reports or more (23%); Of patients successfully enrolled 52.72% were still reporting after 3 months. The most common reasons specified for opting-out were: death, hospice admission, and completion of the treatment course. 50% of reports exceeded the practice-defined threshold for a nursing notification. The nurses initiated a follow-up call in response to 78.8% of notifications, and of these calls, 21.2% resulted in an urgent office evaluation. The most common problems triggering an office evaluation were: high NCCN Distress Thermometer score (17.1%), fatigue (16.1%), pain (11.5%), nausea (9.4%), and dyspnea (4.5%). Conclusions: ePRO-based remote monitoring of patients receiving parenteral cancer therapy in routine clinical care is feasible. Patient enrollment and retention are high across all tumor types. Symptoms reported by patients were concordant with previous publications, and a small percent (7% of reports) required an acute office visit. It is expected that office intervention will reduce the use of ER and inpatient services.

Distress Thermometer in breast cancer: systematic review and meta-analysis

ObjectiveThis meta-analysis aimed to reach a summarised estimate of distress prevalence screened by Distress Thermometer (DT) among patients with breast cancer and compare different pooled prevalence estimated between different subgroups.MethodsTwo independent interviewers conducted a systematic search from PubMed, EMBASE, Ovid and Cochrane Library and checked related reviews and meta-analyses for eligible studies. The studies that identified distress of patients with breast cancer with DT were included. After extracting demographic characteristics and distress prevalence, the pooled analysis and the forest plot were completed by using STATA V.12.0 software. We conducted a subgroup analysis based on demographic and methodological characteristics of the studies. The publication bias was estimated by funnel plot.ResultsSeventeen studies describing 3870 patients with breast cancer were included in this meta-analysis. The distress prevalence of patients with breast cancer varied from 25.3% to 71.7% among these studies. The pooled distress prevalence was 50% (95% CI 49% to 52%) for the overall sample. The pooled distress prevalence rates in DT ≥7, DT ≥5 and DT ≥4 subgroups were 37% (95% CI 35% to 40%), 45% (95% CI 40% to 49%) and 62% (95% CI 60% to 65%), respectively. The distress prevalence had statistically significant differences between subgroups, which were differentiated by the initial time of distress identified, papers’ publication time, patients’ average age and country. There was no publication bias among the included studies.ConclusionThe distress prevalence was high among patients with breast cancer. Routine and timely screening of distress for patients with breast cancer is of great significance in oncology management.

Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study

Background In different cancer entities, several studies have shown the adverse effects of cancer on mental health, psychological well-being and the increased risk of high emotional distress in cancer patients. This study aims to analyze psychosocial distress levels and their relationship between sociodemographic parameters and selected items on the Distress Thermometer (DT) Problem List in head and neck squamous cell carcinoma (HNSCC) patients. Patients and methods We assessed a total of 120 HNSCC patients using the Distress Thermometer (DT) Problem List. Distress scores (DTS) of 90 patients were available. A DTS of ≥ 5 on the visual analogue scale represents clinically relevant distress. Data analysis consisted of descriptive statistics, comparison of mean values for different DTS subcategories and correlation between DTS scores and parameters of tumor classification, sociodemographic variables and selected problems. Results Distress was present in 57.7% of the sample, with a total of 52 patients with a DTS ≥ 5. The mean DTS was 4.7 (SD 2.4). Patients with newly diagnosed HNSCC had significantly higher DTS. Distress levels were significantly associated with sadness, general worries, anxiety, nervousness, sleeping disorders, mouth sores and fever. Out of the total sample, 6 patients and out of these 6 individuals, 5 patients with a DTS ≥ 5 requested referrals to psycho-oncological service. Conclusion High distress levels were common in HNSCC patients but only few patients desired psycho-oncological care. Addressing patients’ supportive care needs in routine clinical practice is essential to meet unmet needs of HNSCC patients and thus improve cancer care.