Fear of Cancer Recurrence Is Highly Prevalent and Linearly Associates With Anxiety and Depression in Chinese Breast Cancer Patients

Objective: To characterize the fear of cancer recurrence (FCR) and its relationship with anxiety and depression and quality of life (QoL) among Chinese breast cancer (BC) patients in China. Methods: Patients completed the questionnaires of QLQ-C30, QLQ-BR32 and HAD to assess FCR, QoL, anxiety and depression before radiotherapy. A cross-sectional analysis was performed. Chi-square and non-parametric tests and multivariate ordinal logistic regressions (mOLR) were utilized for reference analysis. Final covariates included age, BMI, TNM, surgery, chemotherapy, pain, and sleep disturbance. Results: From July 2015 to December 2016, 463 patients were prospectively enrolled. Their age mean (range) were 47 (19 - 89) years old. In total, 327 patients (70.6%) reported having FCR ‘a little bit’ (51.2%), ‘some’ (12.1%) and ‘very much’ (7.3%) in the past week. FCR severity ordered above (incl. ‘no’) was associated with anxiety score (median 1.5, 5.0, 7.0, 8.5 and level (‘abnormal’ rate 0%, 3.4%, 12.5%, 26.5%), depression score (median 2.0, 4.0, 6.0, 6.5) and level (‘abnormal’ rate 2.2%, 3.4%, 5.4%, 17.7%) (all p<0.001). mOLR showed that compared to ‘no’, three higher levels of FCR were associated with one level increase of anxiety with OR (p) as 1.983 (0.076), 4.291 (0.001), 8.282 (<0.001) and depression with OR (p) as 1.903 (0.062), 2.262 (0.065), 4.205 (0.004), respectively. FCR severity also was inversely associated with most QoL function scores (p<0.001). Conclusions: FCR was prevalent in Chinese BC patients and linearly associated with anxiety, depression and low QoL. It seems that a single-item question for FCR is a valid surrogate tool for distress screening in this population.

A qualitative study investigating Australian cancer service outpatients’ experience of distress screening and management: what is the personal relevance, acceptability and improvement opportunities from patient perspectives?

Purpose People diagnosed with cancer experience high distress levels throughout diagnosis, treatment, and survivorship. Untreated distress is associated with poor outcomes, including worsened quality of life and higher mortality rates. Distress screening facilitates need-based access to supportive care which can optimize patient outcomes. This qualitative interview study explored outpatients’ perceptions of a distress screening process implemented in an Australian cancer center. Methods Adult, English-speaking cancer outpatients were approached to participate in face-to-face or phone interviews after being screened by a clinic nurse using the distress thermometer (DT). The piloted semi-structured interview guide explored perceptions of the distress screening and management process, overall well-being, psychosocial support networks, and improvement opportunities for distress processes. Thematic analysis was used. Results Four key themes were identified in the 19 interviews conducted. Distress screening was found to be generally acceptable to participants and could be conducted by a variety of health professionals at varied time points. However, some participants found “distress” to be an ambiguous term. Despite many participants experiencing clinical distress (i.e., DT ≥ 4), few actioned referrals; some noted a preference to manage and prevent distress through informal support and well-being activities. Participants’ diverse coping styles, such as positivity, acceptance, and distancing, also factored into the perceived value of screening and referrals. Conclusion and implications Screening models only measuring severity of distress may not be sufficient to direct care referrals, as they do not consider patients’ varying coping strategies, external support networks, understanding of distress terminology, and motivations for accessing supportive care services.

Comparing the Different Manifestations of Postpartum Mental Disorders by Origin, among Immigrants and Native-Born in Israel According to Different Mental Scales

We conducted a prospective study, aimed to study whether the prevalence of mental disorders after birth differs by country of origin. Parturient mothers of Ethiopian origin, Former-USSR (FSU) origin, or nonimmigrant, native-Israeli origin (n = 974, all Jewish) were recruited in hospitals in Israel and were followed 6–8 weeks and one year after birth. General linear models were used to study the associations between origin and mental health, comparing Ethiopian and FSU origin with native-Israeli. Ethiopian and FSU mothers were more likely to report on somatic symptoms, compared with native-Israeli women. Ethiopian origin was negatively and significantly associated with anxiety in all three interviews (β = −1.281, β = −0.678 and β = −1.072, respectively; p < 0.05 in all). FSU origin was negatively associated with depression after birth (β = −0.709, p = 0.036), and negatively associated with anxiety after birth and one-year postpartum (β = −0.494, and β = −0.630, respectively). Stressful life events were significantly associated with all mental disorders in the three time points of interviews. Our findings suggest that immigrants tend to express higher mental distress with somatic symptoms. Additional tools are needed for mental distress screening among immigrants.

Psychological Distress and Its Predictors Among Hospital Admitted COVID-19 Patients

Objective Limited evidence is available on the psychological distress among patients hospitalized with COVID -19. We assessed (a) the incidence of psychological distress, posttraumatic symptoms and substance use among patients hospitalized with COVID-19, (b) perceived stress, coping, and social support experienced by distressed and non-distressed patients and the predictors of psychological distress. Method Ours was a hospital-based cross-sectional study, conducted in a Union Territory of India. Patients were assessed (August – September, 2020) at the time of admission (within two days) with standardized instruments (N=250). Results More than 19 percent of respondents had experienced significant psychological distress (probable cases) and nearly 9% reported post traumatic stress symptoms. The cases and non-cases differ in terms of active coping (5.51±0.87 v/s 5.06±1.06; t=3.10, p<0.01), emotional support (5.21±0.87 v/s 4.86±0.79; t=2.57, p<0.01), behavioural disengagement (5.18±0.92 v/s 4.55±1.15; t=3.56, p<0.001), venting (5.42±0.96 v/s 4.80±1.24; t=3.30, p<0.01), acceptance (5.75±1.24 v/s 5.29±1.50; t=2.23, p<0.05), religion (5.43±1.41 v/s 6.06±1.46; t=-2.76, p<0.01) and self-blame (5.65±1.00 v/s 4.82±1.39; t=3.95, p<0.001). Symptoms of post-traumatic stress (OR: 2.058; 95% CI: 1.49-2.84) was the only significant predictor of the psychological distress. Conclusions Nearly one in five hospitalized patients with COVID-19 experience psychological distress. Screening and treatment for trauma and psychological distress should be made an integral component of care for patients with COVID-19

Association of treatment type with patient-reported quality of life in cancer distress screening.

178 Background: Routine distress screening is recommended for all patients with cancer. In 2015, Stanford Cancer Center implemented such screening using a modified PROMIS-GH questionnaire. With the recent growth of oncology drugs, novel medications have been perceived as better tolerated than chemotherapy. We analyzed patient reported quality of life with global mental health (GMH) and global physical health (GPH) scores for different medication classes. Methods: Patients who completed a questionnaire at our center between 6/1/2015 and 12/31/2020 were included. Medications were classified as chemotherapy, targeted therapy, endocrine therapy, or immunotherapy using guidance from SEER.Rx ontology. Baseline (B) and treatment (Tx) questionnaires were completed before any treatment initiation of each medication type and within 3 months of each treatment, respectively. GPH and GMH scores were calculated using PROMIS T-scores stratified by medication type for B and Tx questionnaires. We analyzed for differences based on demographics and diagnoses. Clinically significant differences were defined as a 3-point difference in T-scores, which then prompted statistical comparison with t-tests to compare the B and Tx scores to each other and to the US population mean of 50. Results: We analyzed 28,180 questionnaires from 11,644 patients (59% women, median age 64; 23% stage I and II, 12% stage III, 23% stage IV, 51% missing). B and Tx mean GMH scores did not differ clinically compared to the US mean or to each other (baseline: 49.03 +/- 9.16, post: 48.5 +/- 9.1). However, both mean GPH scores were statistically and clinically lower (baseline: 44.2+/- 10.38, post: 42.4 +/- 10.1,) compared to the US mean (p < 0.001). Changes in scores by treatment category are shown in the table below. There was a statistically significant difference in post-treatment GPH scores for chemo-immunotherapy patients when compared to both corresponding baseline scores (p < 0.001) and post treatment chemotherapy alone scores (p < 0.001). There was no clinically significant difference in scores when stratified by age, sex, primary language, insurance, disease stage or type. Conclusions: In this large retrospective study, we found that patients being treated for cancer did not report worse GMH scores compared to the US mean population, but do report lower GPH scores. While most scores varied little relative to other treatment types, those receiving chemo-immunotherapy had lower GPH scores when comparing baseline to treatment and to the US mean, warranting further investigation, given increasing use.[Table: see text]

Piloting the REDUCE score to decrease acute care utilization.

252 Background: Emergency department visits and hospitalizations are common in patients with cancer, with nearly three quarters of patients with advanced disease hospitalized at least once in the year after their diagnosis. Efforts to prospectively identify patients at highest risk for this acute care utilization (ACU) are needed. While many risk scoring systems have been developed for this purpose, few have been effectively integrated into clinical practice. We piloted a prospective risk assessment tool using a quality improvement framework. Methods: We utilized our previously published REDUCE score (Reducing ED Utilization in the Cancer Experience) to pilot clinical interventions to reduce ACU using PDSA cycles. Cycle 1 included a chart review and targeted outreach by a nurse navigator to high risk patients identified by REDUCE. Outreach resulted in communication of patient needs to the care team, which may or may not have resulted in additional interventions. Cycle 2 involved initial identification by REDUCE followed by further assessment with a distress screening. Those who were high risk and had high distress (score ≥4) were discussed by an interdisciplinary team (including supportive medicine physicians, social work, nurses, nurse practitioners) to determine an appropriate intervention. Results: Of the patients in Cycle 1 (N = 138), 26.1% had ACU after outreach by a nurse navigator, while in Cycle 2 (N = 169) 7.1% had ACU after the intervention determined by the interdisciplinary team. The average distress score among all patients in Cycle 2 was 6.0 and the REDUCE score was 2.87, while the subset of patients who experienced ACU had an average distress score of 6.4 and a REDUCE score of 3.22. Conclusions: The REDUCE score may be a valuable tool to assist in identifying patients at risk for ACU. We found that combining the risk score with a biopsychosocial screening tool and multidisciplinary team discussion may prove more valuable than the risk score alone, with Cycle 2 findings suggesting that there is a directional correlation between REDUCE score and distress screening results. More work is needed to understand the relative impact of the REDUCE score and the biopsychosocial screening and team discussion on decreasing ACU.

Association of telemedicine use with disparities in cancer distress screening for patients with limited English proficiency.

147 Background: Distress has a significant impact on the quality of life for patients with cancer, however, implementation of such screening is variable. There is limited data in this area for patients who have limited English proficiency (LEP). Given data suggesting worsening disparities in medical care with telemedicine use, we evaluated the completion of distress screening and interpreter use for LEP patients with telemedicine. Methods: We analyzed assigned (complete and incomplete) questionnaires from 10/2019-3/2021 at Stanford Cancer Center (n = 181,105). We defined LEP as a patient electronic health record (EHR) demographic listing either a non-English preferred language or a request for an interpreter. We defined telemedicine as any video or phone visit. Data was analyzed with Fisher's test for differences. Given limitations in EHR data, we conducted a validation subset chart review for LEP patients in Thoracic and Gastrointestinal (GI) oncology which have the two highest % of LEP patients (n = 177 patients). The subset list was obtained for the above timeframe from the interpreter services group. We analyzed EHR notes from visit day for written mention of professional vs family interpreter use. Results: Overall, 14% of our cohort had LEP, highest prevalence in the Thoracic (21%) and GI groups (16%), with a total of 48 languages represented (Spanish, Mandarin & Vietnamese as the 3 most common). There was a significant difference in the English and Non-English groups in overall completion rates of the screening questionnaire (62% in English population vs 49% for LEP, p < 0.001). Completion rates for telemedicine vs. in person visits were overall higher for both English (78.9% vs. 55%, p < 0.001) and LEP (65.1% vs. 43.7%, p < 0.001) groups respectively. The overall screening completion rate for all visits was 57%, with a 62% completion rate with telemedicine and 51% completion with in-person visits (p = 0.2). In the LEP validation subset, there were 18 languages represented with the similar distribution as the larger cohort. Of all clinical notes reviewed, 48.8% included written mention of professional interpreter use, while 25.5% noted interpretation by a family member. There was no difference in professional interpreter use between visit types (̃50%), but with higher rate of family interpretation with telemedicine (35%) vs with in person visits (21%) (p = 0.04). Conclusions: Patients who have some level of limited English proficiency complete distress screening questionnaires less frequently compared to English speaking patients, which highlights the need to improve access to distress screening and supportive care. However, we found similar completion rates with in person vs telemedicine visits, with a signal for increased use of family members as interpreter with telemedicine. This warrants further analysis of the family role and patient understanding during these virtual visits.

Psychological Distress Screening for Depression, Anxiety and Stress among Medical Ward Patients in Hospital Tapah, Malaysia: A Cross-Sectional Study Using The Depression, Anxiety and Stress Scale (DASS-21)

Objectives: The mental health (MH) issue has emerged as one of the great public health concerns worldwide, and its prevalence is escalating substantially among Malaysians. An individual’s daily living, physical health, and relationships can be hard-hit by an MH disorder. The present study aimed to (i) estimate the probable psychological distress in warded adult patients at Hospital Tapah, Malaysia, and (ii) investigate the key antecedents intrinsically linked to depression, anxiety, and stress that may precipitate psychological distress symptoms.Material and Methods: This study was a cross-sectional questionnaire-based study involving 191 participants sampled from the warded adult patients at Hospital Tapah. The psychological distress was assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). Data were analysed by logistic regression using SPSS 16.0.Results: Anxiety (34.0%) was detected as the highest prevalence of probable psychological distress by a wide margin, trailed by stress (16.8%) and depression (15.2%). Race, Orang Asli (native people) and mental health awareness were associated with the depression. Respondents who exercised regularly, were employed, non-smokers, non-alcoholic drinkers, and without mental health awareness were at risk of anxiety. Income was found to be significantly associated with stress. Conclusion: This study detected a two-fold increase in the risk of anxiety compared to stress and depression. Further studies should be conducted to identify the factors related to the high DASS-21 scores in detail.