Depression and anxiety among people living with and beyond cancer

Niedzwiedz, C. L. et al. | Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority | BMC Cancer | Volume 19, Article number: 943 (2019)

Abstract

Background

A cancer diagnosis can have a substantial impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. We argue that more research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. For background and to support our argument, we synthesise existing systematic reviews relating to cancer and common mental disorders, focusing on depression and anxiety.

We searched several electronic databases for relevant reviews on cancer, depression and anxiety from 2012 to 2019. Several areas are covered: factors that may contribute to the development of common mental disorders among people with cancer; the prevalence of depression and anxiety; and potential care and treatment options. We also make several recommendations for future research. Numerous individual, psychological, social and contextual factors potentially contribute to the development of depression and anxiety among people with cancer, as well as characteristics related to the cancer and treatment received. Compared to the general population, the prevalence of depression and anxiety is often found to be higher among people with cancer, but estimates vary due to several factors, such as the treatment setting, type of cancer and time since diagnosis. Overall, there are a lack of high-quality studies into the mental health of people with cancer following treatment and among long-term survivors, particularly for the less prevalent cancer types and younger people. Studies that focus on prevention are minimal and research covering low- and middle-income populations is limited.

Conclusion

Research is urgently needed into the possible impacts of long-term and late effects of cancer treatment on mental health and how these may be prevented, as increasing numbers of people live with and beyond cancer.

Full article at BMC Cancer

Mothers with advanced cancer experience psychological distress 

A research paper published in the journal Cancer publishes the findings of research that examined the mental health and well-being of over 200 mothers with advanced cancer. The women all had at least one child under the age of 18,  had metastatic cancer  via Science Daily 

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The researchers found that for mothers with stage IV cancer, parenting concerns contributed to their psychological distress. Associated with lower quality of life; the women scored higher in both depression and anxiety than the general population in the United States. The scientists also found a mother’s emotional well-being (these participants’ scores were lower than in other people with cancer in the United States) was linked with whether she had talked with her children about her illness and concerns about how her illness will financially impact her children.

The news item is available from Science Daily 

Abstract

BACKGROUND

Cancer is a leading cause of death among women of parenting age in the United States. Women living with advanced or incurable cancer who have dependent children experience high rates of depression and anxiety as well as unique parenting challenges. To the authors’ knowledge, few studies to date have examined the parenting factors associated with health‐related quality of life (HRQOL) in women with advanced cancer.

METHODS

The authors conducted a cross‐sectional, Web‐based survey of the psychosocial concerns of 224 women with a tumor‐node‐metastasis staging system of the AJCC stage IV solid tumor malignancy who had at least 1 child aged  less than 18 years. Participants completed validated measures of HRQOL (Functional Assessment of Cancer Therapy–General [FACT‐G]); depression and anxiety symptom severity; functional status; parenting concerns; and investigator‐designed questions to assess demographic, communication, and parenting characteristics. Multiple linear regression models were estimated to identify factors associated with FACT‐G total and subscale scores.

RESULTS

The mean FACT‐G score was 66 (standard deviation, 16). The mean Emotional Well‐Being subscale scores were particularly low (13; standard deviation, 5). In multivariable linear regression models, parenting variables explained nearly 40% of the HRQOL model variance. In the fully adjusted model, parenting concerns and the absence of parental prognostic communication with children both were found to be significantly associated with HRQOL scores. For each 1‐point increase in parenting concern severity, FACT‐G scores decreased by 4 points (P equal to .003).

CONCLUSIONS

Women with metastatic cancer who are parents of dependent children are at risk of high psychological distress and low HRQOL. Parenting factors may have a negative influence on HRQOL in this patient population. Cancer 2018. © 2018 American Cancer Society.

Full reference:

Park, E. M, et al |  Understanding health‐related quality of life in adult women with metastatic cancer who have dependent children |Cancer |ePub  https://doi.org/10.1002/cncr.31330

Supporting the emotional and mental health needs of people with cancer

The Mental Health Foundation | April 2018 | Supporting the emotional and mental health needs of people with cancer

The psychological impact of having cancer has been little researched. In response to this The Mental Health Foundation has conducted qualitative research with patients diagnosed with cancer in Scotland. Their research focused on the negative mental health impacts of cancer, how effective support can be delivered, the barriers to support and the unmet mental health support needs.

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The interviews identified the post-treatment phase a an especially volatile time for mental wellbeing.  To address the unmet need in terms of service provision for mental health during cancer and to strengthen existing programmes, they  make the following recommendations:

  1. There needs to be greater awareness by all service providers of the mental health impacts of cancer and the need to support emotional wellbeing and mental health
  2. The right support needs to be given at the right time
  3. Tailored, person-centred support needs to be offered at all stages of the cancer journey
  4. There must be more collaboration and communication between service providers
  5. Improve signposting for mental wellbeing services
  6. Provide clearer and more co-ordinated support pathways after treatment
  7. Improve the provision of support across Scotland
  8. More research is needed into how best to tackle social deprivation and co-morbed health inequalities
  9. More research and awareness is needed to design cancer and wellbeing support services that engage BME communities
  10. Ensure all people with cancer have access to some level of tumour support (The Mental Health Foundation)

    You can download the full document from The Mental Health Foundation 

Cancer mortality in patients with schizophrenia

Previous studies have reported conflicting results on the association between schizophrenia and cancer mortality | The British Journal of Psychiatry

Aims: To summarise available evidence and quantify the association between schizophrenia and cancer mortality using meta-analysis.

Method: We systematically searched literature in the PubMed and Embase databases. Risk estimates and 95% confidence intervals reported in individual studies were pooled using the DerSimonian–Laird random-effects model.

Results: We included 19 studies in the meta-analysis. Among them, 15 studies reported standardised mortality ratios (SMRs) comparing patients with schizophrenia with the general population, and the pooled SMR was 1.40 (95% CI 1.29–1.52, P<0.001). The other four studies reported hazard ratios (HRs) comparing individuals with schizophrenia with those without schizophrenia; the pooled HR was 1.51 (95% CI 1.13–2.03, P = 0.006).

Conclusions: Patients with schizophrenia are at a significantly increased risk of cancer mortality compared with the general population or individuals without schizophrenia.

Full reference: Zhuo, C. et al. (2017) Cancer mortality in patients with schizophrenia: systematic review and meta-analysis. The British Journal of Psychiatry. Published online: 8 June 2017.

Cancer as a stressful life event: Perceptions of children with cancer and their peers

Howard Sharp, K.M. Cancer. Published online: 4 May 2017

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Background: The medical traumatic stress model is commonly applied to childhood cancer, assuming that the diagnosis of cancer is a traumatic event. However, to the authors’ knowledge, little is known regarding what specifically children perceive as stressful about cancer or how it compares with other stressful events more often experienced by children.

 

Conclusions: Children do not necessarily view their cancer experience as their most stressful life event. The findings of the current study suggest that the diagnosis of cancer might be better viewed as a manageable stressor rather than a major trauma, and are consistent with the change in the fifth edition of the DSM to eliminate the diagnosis of a life-threatening illness as a qualifying trauma for PTSD.

Read the full abstract here

Effect of depression before breast cancer diagnosis on mortality

Liang, X. et al. Cancer | Published online: 7 April 2017

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Background: Few previous studies investigating depression before the diagnosis of breast cancer and breast cancer–specific mortality have examined depression measured at more than 1 time point. This study investigated the effect of depression (combining depressive symptoms alone with antidepressant use) measured at 2 time points before the diagnosis of breast cancer on all-cause mortality and breast cancer–specific mortality among older postmenopausal women.

Conclusions: Women with newly developed depression before the diagnosis of breast cancer had a modestly but significantly increased risk for death from any cause and for death from breast cancer at a late stage.

Read the full abstract here

Web-based stress management for newly diagnosed cancer patients (STREAM-1)

Grossert, A. et al. BMC Cancer. Published online: 3 November 2016

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Background: Being diagnosed with cancer causes major psychological distress, yet the majority of newly diagnosed cancer patients lack psychological support. Internet interventions overcome many barriers for seeking face-to-face support and allow for independence in time and place. We assess efficacy and feasibility of the first web-based stress management intervention (STREAM: STREss-Aktiv-Mindern) for newly diagnosed, German-speaking cancer patients.

Methods/design: In a prospective, wait-list controlled trial 120 newly diagnosed cancer patients will be included within 12 weeks of starting anti-cancer treatment and randomized between an immediate (intervention group) or delayed (control group) 8-week, web-based intervention. The intervention consists of eight modules with weekly written feedback by a psychologist (“minimal-contact”) based on well-established stress management manuals including downloadable audio-files and exercises. The aim of this study is to evaluate efficacy in terms of improvement in quality of life (FACT-F), as well as decrease in anxiety and depression (HADS), as compared to patients in the wait-list control group. A sample size of 120 patients allows demonstrating a clinically relevant difference of nine points in the FACT score after the intervention (T2) with a two-sided alpha of 0.05 and 80 % power. As this is the first online stress management intervention for German-speaking cancer patients, more descriptive outcomes are equally important to further refine the group of patients with the largest potential for benefit who then will be targeted more specifically in future trials. These descriptive endpoints include: patients’ characteristics (type of cancer, type of treatment, socio-demographic factors), dropout rate and dropout reasons, adherence and satisfaction with the program.

Discussion: New technologies open new opportunities: minimal-contact psychological interventions are becoming standard of care in several psychological disorders, where their efficacy is often comparable to face-to-face interventions. With our study we open this field to the population of newly diagnosed cancer patients. We will not only assess clinical efficacy but also further refine the target population who has the most potential to benefit. An internet-based minimal-contact stress management program might be an attractive, time- and cost-effective way to effectively deliver psychological support to newly diagnosed cancer patients and an opportunity to include those who currently are not reached by conventional support.

Read the full article here

Vitamin D and patients with palliative cancer

Björkhem-Bergman, L. & Bergman, P. (2016) BMJ Supportive & Palliative Care. 6:287-291

dandelion-1557110_960_720Vitamin D is a hormone that is synthesised in the skin in the presence of sunlight. Sufficient vitamin D levels are important—not only for a healthy skeleton—but also for a healthy immune system. Many patients with cancer have insufficient vitamin D levels, and low vitamin D levels are associated with increased ‘all-cause mortality’ and especially mortality due to cancer. Low vitamin D levels have also been associated with increased risk of infections, increased pain, depressive disorders and impaired quality of life.

We review the role of vitamin D in the immune system, in relation to cancer disease, pain and depression. We have recently performed an observational study in 100 patients with palliative cancer in Sweden. The main result was that low vitamin D levels were associated with higher opioid dose, that is, more pain. We also describe a case report where vitamin D supplementation resulted in radically decreased opioid dose, less pain and better well-being.

Vitamin D supplementation is not connected with any adverse side effects and is easy to administrate. Thus, we hypothesise that vitamin D-supplementation to patients with palliative cancer might be beneficial and could improve their well-being, decrease pain and reduce susceptibility to infections. However, more clinical studies in this field are needed before firm conclusions can be drawn.

Read the full article here

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Lo, C. et al. BMJ Supportive & Palliative Care. Published Online First: 19 January 2016

Background: Managing Cancer And Living Meaningfully (CALM) is a brief individual psychotherapy for patients with advanced cancer. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b pilot, which introduces procedures for randomisation and improved rigour in preparation for a phase 3 randomised controlled trial (RCT).

Aims: To test trial methodology and assess feasibility of a confirmatory RCT.

Design: A parallel-arm RCT (intervention vs usual care) with 3 and 6-month follow-ups. Assessment of feasibility included rates of consent, randomisation, attrition, intervention non-compliance and usual care contamination. Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9). Secondary outcomes: major depressive disorder (MDD), generalised anxiety, death anxiety, spiritual well-being, attachment anxiety and avoidance, self-esteem, experiential avoidance, quality of life and post-traumatic growth. Bayesian conjugate analysis was used in this low-powered setting.

Setting/participants: 60 adult patients with advanced cancer from the Princess Margaret Cancer Centre.

Results: Rate of consent was 32%, randomisation 78%, attrition 25%, non-compliance 37% and contamination 17%. There was support for potential treatment effects on: PHQ-9, OR=1.48, 95% Credible Interval (CRI.95) (0.65, 3.38); MDD, OR=1.56, CRI.95 (0.50, 4.84); attachment anxiety, OR=1.72, CRI.95 (0.73, 4.03); and attachment avoidance, OR=1.58, CRI.95 (0.67, 3.71). There was no support for effects on the seven remaining secondary outcomes.

Conclusions: A phase 3 CALM RCT is feasible and should aim to detect effect sizes of d=0.40, with greater attention to issues of compliance and contamination.

Read the full article here

Review explores cancer screening, prevention, and treatment in people with mental illness

A new report calls attention to cancer in people with mental illness, suggesting that healthcare system and societal factors are just as critical as individual lifestyle factors– linked to smoking and obesity–that lead to health disparities among this group.

Reports indicate that nearly one in five adults (18.6%) suffered some form of any mental illness in the last year, and almost 10 million U.S. adults (4.1% of the population) had a serious mental illness (such as schizophrenia or bipolar disorder) in the past year. Despite the high prevalence of mental illness among adults, widespread recognition of the significant health disparities experienced by this population has occurred only in the last decade. People with mental illness die decades earlier compared with the general population, with most of the disparity the result of preventable and treatable chronic conditions, including cancer.

Find the original article here: Lara C. Weinstein, et al. Cancer screening, prevention, and treatment in people with mental illness. CA: A Cancer Journal for Clinicians, 2015

Read the full commentary here