Journal Article Annotations
2017, 2nd Quarter
Annotations by Elie Isenberg-Grzeda, MD, and Carlos Fernandez-Robles, MD
The finding: The authors studied the relationship of patient’s perceptions of their own illness prognosis and treatment and quality of life, depression and anxiety and coping strategies, using standardized tools in a cohort of patients with incurable lung and non-colorectal cancer. They found a substantial proportion of patients reported inaccurate prognostic understanding of their illness. Patients who self-reported as terminally ill, and those who did not identify their oncologist’s goals of treatment as being “to cure my cancer” had worse quality of life and higher depression and anxiety scores. Among those with adequate understanding of their prognosis and treatment, use of adapting coping strategies such as positive reframing, active coping, acceptance, and seeking emotional support had comparatively better quality of life and depression than who used less effective strategies such as behavioral disengagement.
Strength and weaknesses: Strengths of this study include the size of the sample, relevance of the topic, and the adequate instruments used. The authors discuss several weaknesses including a relatively homogenous sample which can limit the generalization of the findings to more diverse populations, and the lack of information about patient-clinician communication. Finally, the cross-sectional design limits the understanding of how the relationships between the variables change overtime.
Relevance: Enhanced patient-physician communication is important during all stages of disease. Better understanding of prognosis and treatment plan allows patients to make adequate and informed decisions about their care and personal life. This study shines light on the relationship between prognostic awareness and quality of life and mood, and at the same time the findings point to supporting patients and promoting certain coping strategies can significantly improve outcomes in these delicate groups of patients.
The finding: This retrospective chart review looked at the results of urine drug screens (UDS) of patients diagnosed with cancer followed at ambulatory oncology and palliative care clinics, who displayed aberrant behaviors with controlled substances or past history of chemical coping. They identified 150 patients with active cancer and 54 with no evidence of active disease. Eighty two percent of the patients had inappropriate UDS results. Thirteen percent had presence of cannabinoids, 46% had non-prescribed opiods, benzodiazepines, cocaine or heroin and 39% had inappropriately negative UDS raising concern for drug diversion.
Strength and weaknesses: The careful denotation between active and non-active cancer patients, as well as the use of mass spectrometry in the UDS analysis, which reduced the number of false positives, are among the strengths of this study. The limitations of the study are linked to its retrospective nature and the relatively small sample size. The high prevalence of inappropriate UDS may had been influenced by the complexity of patients requiring palliative care.
Relevance: Substance use disorder and drug diversion are major public health problems, and oncology care is at no lower risks for it. Lack of clear guidelines to prescribe and monitor controlled substances in this population increases vulnerability to aberrant behaviors. This study points at a high prevalence of these occurrences, both misuse of substances and drug diversion, and highlights the potential role of implementing harm reduction approaches in this population similar to those currently used in non-cancer populations.
The finding: This secondary data analysis reported findings of 292 patients with hepatobiliary or pancreatic cancers included in a previous prospective study. Using data from self-reported measures of sleep and depression, the authors found a high prevalence of sleep disturbance as well as a correlation between short sleep duration and depression. Exploring any relationships between sleep duration and mortality, the authors found a u-shaped curve representing greater mortality with short and long durations of sleep.
Strength and weaknesses: The strengths of the study include the large sample size, as well as the fact that the authors took into account the role that depression may have in affecting both mortality and sleep. The main limitations are the sole use of self-reported measures and the sample being limited to hepatobiliary and pancreatic cancer patients.
Relevance: While the relationships between sleep, depression, and mortality have been well-studied in the general population, very few studies have examined this in cancer patients. This is the first study to report a relationship between sleep duration and mortality in cancer patients, and if the findings can be replicated, may have implications for cancer care treatment.