Cytokines and depression in cancer patients and caregivers.

Objective:A better understanding of the biobehavioral mechanisms underlying depression in cancer is required to translate biomarker findings into clinical interventions. We tested for associations between cytokines and the somatic and psychological symptoms of depression in cancer patients and their healthy caregivers. Patients and methods:The GRID Hamilton Rating Scale for Depression (Ham-D) was administered to 61 cancer patients of mixed type and stage, 26 primary caregivers and 38 healthy controls. Concurrently, blood was drawn for multiplexed plasma assays of 15 cytokines. Multiple linear regression, adjusted for biobehavioral variables, identified cytokine associations with the psychological (Ham-Dep) and somatic (Ham-Som) subfactors of the Ham-D. Results:The Ham-Dep scores of cancer patients were similar to their caregivers, but their Ham-Som scores were significantly higher (twofold, p=0.016). Ham-Som was positively associated with IL-1ra (coefficient: 1.27, p≤0.001) in cancer patients, and negatively associated with IL-2 (coefficient: -0.68, p=0.018) in caregivers. Ham-Dep was negatively associated with IL-4 (coefficient: -0.67, p=0.004) in cancer patients and negatively associated with IL-17 (coefficient: -1.81, p=0.002) in caregivers. Conclusion:The differential severity of somatic symptoms of depression in cancer patients and caregivers and the unique cytokine associations identified with each group suggests the potential for targeted interventions based on phenomenology and biology. The clinical implication is that depressive symptoms in cancer patients can arise from biological stressors, which is an important message to help destigmatize the development of depression in cancer patients

Global psycho-oncology in low middle-income countries : Challenges and opportunities

Objectives This Special Issue of Psycho-Oncology is focused on challenges and opportunities in the provision of psychosocial care to patients in low and middle-income countries (LMICs). The aim is to highlight global disparities and inequity in the provision of evidence-based, culturally-sensitive and timely psychosocial care and to showcase the work of researchers and practitioners to address this gap. We hope that this Issue will help to advance the psychological and social dimensions of cancer care in all parts of the world. Methods The focus of the papers is on research and clinical innovations in LMICs that target the psychological, social and cultural dimensions of cancer and on interventions to improve or maintain the psychological well-being, social functioning and/or quality of life of those who are affected and their families. Results These papers draw attention to guidelines, resource needs, clinical service evaluation, emerging research and knowledge translation within LMICs that advance knowledge and implementation in the field of psycho-oncology. Conclusions Innovations and advances in psycho-oncology are emerging from LMICs to enhance the care of patients with cancer and their families in these regions and in all parts of the world. A sustained global initiative is now needed to ensure that guidelines for such care are routinely included in global, national and local cancer control plans and that essential resources and attention are directed to implement them

The Assessment of Mentalization: Measures for the Patient, the Therapist and the Interaction

Mentalization has been clearly defined in the literature as a relational concept and yet in surveys and transcript-based measures it is almost universally treated as an individual capacity. That approach has value but may not capture the emergent nature of mentalization, as it is jointly constructed within a relational context. We report here on a critical evaluation of measurement approaches commonly used to conceptualize and assess mentalization and argue for the value of conversation analysis (CA) as an alternative approach. A variety of approaches have been shown to have utility in assessing mentalization as an individual capacity. We illustrate how conversation analysis allows for an in-depth-analysis of mentalization as it is co-created across different contexts in real-life therapy sessions. This method of analysis shifts the focus from content to process. Conversation analysis is a potentially valuable tool to support training, to assess treatment integrity, and to improve outcomes with mentalization-based interventions

Factor structure of the Beck Hopelessness Scale in individuals with advanced cancer

Although the Beck Hopelessness Scale is often used with the seriously ill, its factor structure has been given relatively little consideration in this context. The factor structure of this scale was examined in a sample of 406 ambulatory patients with advanced lung or gastrointestinal cancer, using a sequential exploratory confirmatory factor analysis procedure. A two-factor model was consistent with the data: The first factor reflected a negative outlook and was labeled ‘negative expectations’; the second factor identified a sense of resignation and was labeled ‘loss of motivation.’ Implications regarding scoring of the scale in this population are discussed, as are implications of the two-factor structure for our understanding of hopelessness in individuals with advanced cancer.Social Sciences and Humanities Research Council (SSHRC

Systematyczny przegląd narzędzi pomiaru jakości umierania i śmierci

Aby odpowiedzieć na pytanie, czy współczesna medycyna może zapewnić „dobrą” śmierć, trzeba opracować i wdrożyć odpowiednie narzędzia pomiaru jakości umierania i śmierci. Niniejsza praca ma na celu zidentyfikowanie takich narzędzi oraz określenie ich jakości. Przeszukano bazy danych MEDLINE (1950–2008), Healthstar (1966–2008) oraz CINAHL (1982–2008) według słów kluczowych „jakość umierania/śmierci” oraz „»dobra«/ /»zła« śmierć”. Do analizy wybrano prace, które opisywały narzędzie pomiaru jakości umierania i śmierci lub miały na celu zmierzenie tej jakości. Kryteria oceny obejmowały: informację, czy narzędzie zostało oparte na wcześniejszych teoriach czy też zostało skonstruowane na potrzeby badania (ad hoc), obecność definicji jakości umierania i śmierci, empiryczną podstawę narzędzia, uwzględnienie licznych dziedzin i subiektywnego charakteru jakości umierania i śmierci oraz czułość w wykrywaniu zmian. Wymagane kryteria spełniło 18 narzędzi pomiaru. Sześć z nich opierało się na wcześniejszych teoriach, natomiast 12 zostało skonstruowanych na potrzeby badania. Mniej niż połowa miała określoną wyraźną definicję jakości umierania i śmierci, natomiast jeszcze mniej — model pojęciowy uwzględniający wielowymiarowe podejście i subiektywną ocenę. Czas trwania fazy umierania i śmierci wahał się w granicach od ostatnich miesięcy do ostatnich godzin życia. Z 6 poddanych analizie narzędzi, które oparto na wcześniejszych teoriach, najlepiej przebadany jest kwestionariusz Quality of Dying and Death questionnaire (QODD). Sposoby pomiaru jakości umierania i śmierci cechują się coraz większą dokładnością. Niezbędne są dalsze badania, które pozwolą lepiej zrozumieć czynniki wpływające na oceny jakości umierania i śmierci

Testing the Treatment Integrity of the Managing Cancer and Living Meaningfully Psychotherapeutic Intervention for Patients With Advanced Cancer

Introduction: The Managing Cancer and Living Meaningfully (CALM) therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention (SPI) in a randomized controlled trial (RCT). We investigated whether CALM was delivered as intended (therapists’ adherence); whether CALM therapists with less experience in psycho-oncological care show higher adherence scores; and whether potential overlapping treatment elements between CALM and SPI can be identified (treatment differentiation). Methods: Two trained and blinded raters assessed on 19 items four subscales of the Treatment Integrity Scale covering treatment domains of CALM (SC: Symptom Management and Communication with Health Care Providers; CSR: Changes in Self and Relationship with Others; SMP: Spiritual Well-being and Sense of Meaning and Purpose; FHM: Preparing for the Future, Sustaining Hope and Facing Mortality). A random sample of 150 audio recordings (75 CALM, 75 SPI) were rated on a threepoint Likert scale with 1 = “adherent to some extent,” 2 = “adherent to a sufficient extent,” 3 = “very adherent.” Results: All 19 treatment elements were applied, but in various frequencies. CALM therapists most frequently explored symptoms and/or relationship to health care providers (SC_1: n_applied = 62; 83%) and allowed expression of sadness and anxiety about the progression of disease (FHM_2: n_applied = 62; 83%). The exploration of CALM treatment element SC_1 was most frequently implemented in a satisfactory or excellent manner (n_sufficient or very adherent = 34; 45%), whereas the treatment element SMP_4: Therapist promotes acknowledgment that some life goals may no longer be achievable (n_sufficient or very adherent = 0; 0%) was not implemented in a satisfactory manner. In terms of treatment differentiation, no treatment elements could be identified which were applied significantly more often by CALM therapists than by SPI therapists. Conclusion: Results verify the application of CALM treatment domains. However, CALM therapists’ adherence scores indicated manual deviations. Furthermore, raters were not able to significantly distinguish CALM from SPI, implying that overlapping treatment elements were delivered to patients

The Relationship Between Postpartum Depression and Timely Child Vaccination: A Systematic Review

Background/Objective: Vaccines administered during early childhood rely on caregivers being aware, willing, and able to vaccinate their child. Postpartum depression (PPD) could adversely affect a parent’s ability to undertake such preventive care. This systematic review sought to examine the relationship between PPD and timely vaccination in children. Methods: We systematically searched eight databases (MEDLINE ALL, Embase, PsycINFO, CINAHL, LILACS, Web of Science, Sociological Abstracts, and Scopus) from database inception to September 2023. We also reviewed reference lists of included studies. We included primary studies that examined the association between PPD and child vaccination status between birth and 24 months. Two researchers independently extracted data and assessed study quality. Results: In total, 5504 records were screened for eligibility. Of the 50 articles included in full-text assessment, 12 met the eligibility criteria. Most studies (83%) were conducted in high-income countries, with a minority (17%) from lower-middle income countries (LMICs). The sample size of studies varied from <500 (33%) to >450,000 participants (17%). Overall, six studies (50%) found a relationship between maternal PPD and child vaccinations not completed on time, and six (50%) found no relationship. In most studies that were assessed to be of high-quality and found a relationship, the magnitude of the absolute risk was small. Conclusions: We detected significant heterogeneity among the included studies. Further high-quality research using standardized definitions is needed to determine whether parents with PPD may require tailored strategies and supports that consider their symptoms and specific barriers to vaccination

Efficacy of a brief manualized intervention Managing Cancer and Living Meaningfully (CALM) adapted to German cancer care settings: study protocol for a randomized controlled trial

Background: Although psycho-oncological interventions have been shown to significantly reduce symptoms of anxiety and depression and enhance quality of life, a substantial number of patients with advanced cancer do not receive psycho-oncological interventions tailored to their individual situation. Given the lack of reliable data on the efficacy of psycho-oncological interventions in palliative care settings, we aim to examine the efficacy of a brief, manualized individual psychotherapy for patients with advanced cancer: Managing Cancer and Living Meaningfully (CALM). CALM aims to reduce depression and death anxiety, to strengthen communication with health care providers, and to enhance hope and meaning in life. We adapted the intervention for German cancer care settings. Methods/Design: We use a single-blinded randomized-controlled trial design with two treatment conditions: intervention group (IG, CALM) and control group (CG). Patients in the CG receive a usual non-manualized supportive psycho-oncological intervention (SPI). Patients are randomized between the IG and CG and assessed at baseline (t0), after three (t1) and after 6 months (t2). We include patients with a malignant solid tumor who have tumor stages of III or IV (UICC classification). Patients who are included in the study are at least 18 years old, speak German fluently, score greater than or equal to nine on the PHQ-9 or/and greater than or equal to five on the Distress Thermometer. It is further necessary that there is no evidence of severe cognitive impairments. We measure depression, anxiety, distress, quality of life, demoralization, symptom distress, fatigue as well as spiritual well-being, posttraumatic growth and close relationship experiences using validated questionnaires. We hypothesize that patients in the IG will show a significantly lower level of depression 6 months after baseline compared to patients in the CG. We further hypothesize a significant reduction in anxiety and fatigue as well as significant improvements in psychological and spiritual well-being, meaning and post-traumatic growth in the IG compared to CG 6 months after baseline. Discussion: Our study will contribute important statistical evidence on whether CALM can reduce depression and existential distress in a German sample of advanced and highly distressed cancer patients

Factors associated with cognitive impairment and cognitive concerns in patients with metastatic non-small cell lung cancer

BACKGROUND: Knowledge regarding cognitive problems in metastatic non-small cell lung cancer (mNSCLC) is limited. Such problems may include both patient-reported cognitive concerns and demonstrable cognitive impairment. Greater understanding of these outcomes is needed to inform rehabilitation strategies for these difficulties. We aimed to identify the frequency of cognitive problems and associated factors in patients with mNSCLC. METHODS: In this cross-sectional study, adults with mNSCLC completed validated neuropsychological tests and self-report questionnaires measuring cognitive concerns, neurobehavioral concerns, depression, demoralization, illness intrusiveness, self-esteem, and physical symptoms. Cognitive impairment (performance based) was defined according to International Cancer and Cognition Task Force criteria. Clinically significant cognitive concerns were defined by a score ≥1.5 SD below the normative mean on the Functional Assessment of Cancer Therapy-Cognitive Function Perceived Cognitive Impairment (FACT-Cog PCI). Univariate and multivariate logistic regression analyses were performed to identify associated factors. RESULTS: Of 238 patients approached, 77 participated (median age: 62 years; range: 37-82). Brain metastases were present in 41 patients (53%), and 23 (29%) received cranial irradiation. Cognitive impairment and cognitive concerns were present in 31 (40%) and 20 patients (26%), respectively. Cognitive impairment and cognitive concerns co-occurred in 10 patients (13%), but their severity was unrelated. Cognitive impairment was associated with cranial irradiation (odds ratio [OR] = 2.89; P = .04), whereas cognitive concerns were associated with greater illness intrusiveness (OR = 1.04; P = .03) and lower self-esteem (OR = 0.86; P = .03). CONCLUSIONS: Cognitive impairment and cognitive concerns are both common in patients with mNSCLC but are not necessarily related, and their risk factors differ. The association of illness intrusiveness and self-esteem with cognitive concerns can inform therapeutic interventions in this population