Psychosomatic symptoms in patients suffering from morphea

Objective. To study the features of psychosomatic pathology in patients with morphea.Materials and methods. We used the Symptom Check List-90 Revised (SCL-90-R) to assess patterns of phychological signs in 95 patients suffering from morphea. The control group included 30 respondents without the skin pathology.Results. The patients with morphea revealed higher values in the Global Severity Index (GSI), Positive Symptom Distress Index (PSDI), Positive Symptoms Total (PST). The group of the patients with morphea showed higher distress levels according to the somatization, obsessive and compulsive disorders, depression, anxiety scales.Conclusion. Patients with morphea have a wider range of psychosomatic symptoms. The prevalent characteristics of psychosomatic changes are somatization, obsessive and compulsive disorders, depression, anxiety.

Self-Esteem as a Predictor of Mental Adjustment in Patients with Breast Cancer

This study aimed to explore the relationship between self-esteem and mental adjustment and examine the directional effects in patients with breast cancer using path modeling. This was a cross-sectional, descriptive, and correlational study. A total of 128 patients with breast cancer were selected through convenience sampling at a medical center in northern Taiwan. They completed a basic characteristics questionnaire, the Memorial Symptom Assessment Scale short form, the Rosenberg Self-Esteem Scale, and the mini-Mental Adjustment to Cancer Scale. Descriptive statistics, regression analysis, and path analysis were used to analyze the data. The results showed that higher self-esteem was associated with better mental adjustment (β = 0.9, 95% confidence interval 0.6~1.3, p < 0.001). Age, religious beliefs, employment, cancer stage, and symptom distress were correlated with mental adjustment. Path modeling demonstrated that self-esteem, cancer stage, performance status, and symptom distress directly affected mental adjustment in patients with breast cancer. These findings suggest that health professionals should evaluate self-esteem, performance status, and symptom distress in patients with breast cancer immediately upon admission. This can facilitate early implementation of relevant nursing interventions and, consequently, improve self-esteem and symptom distress and increase mental adjustment in these patients.

Relationship of symptom stress, care needs, social support, and meaning in life to quality of life in patients with heart failure from the acute to chronic stages: a longitudinal study

Background Patients with heart failure (HF) experience continuous changes in symptom distress, care needs, social support, and meaning in life from acute decompensation to chronic phases. The longitudinal relationship between these four factors and quality of life (QOL) was not fully explored. Aims To simultaneously investigate the relationship between all factors and QOL from hospitalization to 6 months after discharge, and the impact of the changes in these factors on QOL at different time points. Methods A longitudinal design with panel research (4 time points) was used. From January 2017 to December 2019, patients hospitalized due to acute decompensated HF were consecutively enrolled and followed up for 6 months. Patients were interviewed with questionnaires assessing symptom distress, care needs, social support, meaning in life and QOL at hospitalization and 1, 3 and 6 months after discharge. Results A total of 184 patients completed 6 months of follow-up. From baseline to 6 months, QOL continuously improved along with decreases in symptoms and care needs, but increases in social support and meaning in life. Better QOL was associated with younger age, higher education level, economic independence, less symptom distress and care needs, and stronger meaning in life (p < 0.05). Compared with hospitalization, decreases in care needs and increases in meaning in life at 1, 3 and 6 months were associated with an increase in physical QOL (p < 0.01). The decrease in care needs and increase in meaning in life at 3 months were associated with an increase in mental QOL (p < 0.05). The increase in social support at 6 months was associated with increases in both physical and mental QOL (p < 0.01). Changes in symptom distress were not correlated with changes in QOL from baseline to all time points. In the multivariable analysis, these findings were independent of age, educational level and economic status. Conclusions Although symptom distress is associated with QOL after acute decompensated HF, QOL cannot be improved only by improvement in symptoms. With differential duration of improvement in each factor, the integration of alleviation in care needs and strengthening in social support and meaning in life might provide additional benefits in QOL.

636 Patient-reported distress with immunotherapy-based first-line treatment for mNSCLC: a real-world evidence study

BackgroundThere are limited published real-world data about patient-reported outcomes with immunotherapies (IO) in metastatic non-small cell lung cancer (mNSCLC). We describe the patient experience with first-line IO-based treatments vs. chemotherapy in this setting.MethodsWe conducted a retrospective chart review of adult patients with mNSCLC treated at Duke University from March 2015-June 2020. At each visit, patients self-reported their distress level and sources of distress using the NCCN Distress Thermometer (DT) tool, consisting of an 11-point ordinal scale reporting overall distress and a 39-item Problem List (PL). We abstracted demographic, clinical, distress, response data (by investigator assessment), then analyzed these data using descriptive statistics and generalized estimating equations accounting for clustering of clinic visits within participants and generalized linear models accounting for study exposure time.Results152 patients were analyzed in four groups: single agent immunotherapy (IO alone, n=40), dual immunotherapy (IO+IO, n=27), chemo-immunotherapy (IO+Chemo, n=46), and chemotherapy alone (n=39). Patients were followed for up to 1 year or earliest of: death, last contact, or 2nd line therapy start. Participants' mean age was 65.7 years. In all patients, overall distress was worst before treatment start (figure 1), and the odds of actionable distress (DT score >4) decreased over time by 10% per month (OR=0.901, 95% CI:0.813, 0.998, p=0.045). There were no significant differences in actionable distress across treatment groups. Symptom distress remained high over time, while other sources of distress (practical, family, and emotional) decreased. The most frequent sources of symptom distress were fatigue (90% of patients ever reported, 40% of all DTs), pain (75% of patients, 30% of DTs), and breathing (68% of patients, 22% of DTs) (figure 2). Treatment with chemotherapy alone yielded the fewest tumor responses (50%) and lowest clinical benefit rate (74.4%) compared to any IO therapy. Unplanned healthcare utilization was significantly different across treatment groups; IO+IO resulted in the lowest utilization rate (0.57, 95% CI:0.36, 0.90), while chemotherapy yielded the highest (1.46, 95% CI:1.00,2.12). Palliative care was utilized in 40% of patients; among those with actionable distress at any time (n=113; 74%), 53% (n=60) had a palliative care visit.ConclusionsThis single-center, real-world evidence study demonstrates that patients with mNSCLC experience significant distress prior to starting first-line treatment, with persistent symptom distress over time. Furthermore, IO treatment is associated with reduced healthcare utilization compared to chemotherapy. Increased utilization of integrated palliative care services may improve the patient experience of mNSCLC treatment, especially for management of symptom distress.Ethics ApprovalThis clinical study involves retrospective analyses of data extracted from medical charts and was approved by Duke University School of Medicine Institutional Review Board (IRB#106013).ConsentAs there was no prospective enrollment of subjects, consent was obtained through a Waiver or Alteration of Consent and Authorization and Decedent Research Notification of the Health Insurance Portability and Accountability Act (HIPAA) 1996.Abstract 636 Figure 1Overall distress thermometer scores over timeAbstract 636 Figure 2Most frequently reported problems by treatment type

Relationship Between Symptom Distress and Fatigue Characteristics in Patients with Gastric Cancer During 1 Month after Gastrectomy

This study’s purpose was to describe changes in symptom distress and fatigue characteristics identifying which symptoms significantly impacted fatigue characteristics of patients with Gastric Cancer (GC) within 1 month after gastrectomy. A prospective longitudinal study was conducted. Patients with GC who were scheduled for gastrectomy were recruited from surgical outpatient clinics and surgery wards in northern Taiwan. Data were collected using a set of questionnaires before (T0) and 7 (T1) and 28 days (T2) after gastrectomy. Over all, 86 patients experienced mild levels of fatigue and symptom distress. The changes in worst fatigue and fatigue interference were greatest at T1. Anxiety had a significant negative effect on both worst fatigue and fatigue interference. Dry mouth, pain, and body image had significant deleterious effects on worst fatigue. The co-occurring symptoms affecting fatigue for patients with GC in the acute phase after gastrectomy should be actively assessed to ensure optimal fatigue management.

A service evaluation of short-term mentalisation based treatment for personality disorder

Background People with personality disorder experience long waiting times for access to psychological treatments, resulting from a limited availability of long-term psychotherapies and a paucity of evidence-based brief interventions. Mentalisation-based treatment (MBT) is an efficacious therapeutic modality for personality disorder, but little is known about its viability as a short-term treatment. Aims We aimed to evaluate mental health, client satisfaction and psychological functioning outcomes before and after a 10-week group MBT programme as part of a stepped-care out-patient personality disorder service. Method We examined routinely collected pre–post treatment outcomes from 176 individuals (73% female) aged 20–63 years, attending a dedicated out-patient personality disorder service, who completed MBT treatment. Participants completed assessments examining mentalising capacity, client satisfaction, emotional reactivity, psychiatric symptom distress and social functioning. Results Post-MBT outcomes suggested increased mentalising capacity (mean difference 5.1, 95% CI 3.4–6.8, P < 0.001) and increased client satisfaction with care (mean difference 4.3, 95% CI 3.3–5.2, P < 0.001). Post-MBT emotional reactivity (mean difference −6.3, 95% CI −8.4 to −4.3, P < 0.001), psychiatric symptom distress (mean difference −5.2, 95% CI −6.8 to −3.7, P < 0.001) and impaired social functioning (mean difference −0.7, 95% CI −1.2 to −0.3, P = 0.002) were significantly lower than pre-treatment. Improved mentalising capacity predicted improvements in emotional reactivity (β = −0.56, P < 0.001) and social functioning (β = −0.35, P < 0.001). Conclusions Short-term MBT as a low-intensity treatment for personality disorder was associated with positive pre–post treatment changes in social and psychological functioning. MBT as deployed in this out-patient service expands access to personality disorder treatment.