Journal Article Annotations
2018, 1st Quarter
Psycho-Oncology & Palliative Care
Annotations by Elie Isenberg-Grzeda, MD, and Carlos Fernandez-Robles, MD
- A screening algorithm for early detection of major depressive disorder in head and neckcancer patients post-treatment: longitudinal study
- Perceived employer-related barriers and facilitators for work participation of cancer survivors: a systematic review of employers’ and survivors’ perspectives
- Increased prescription rates of anxiolytics and hypnotics to survivors of cancer in childhood, adolescence, and young adulthood—a population-based study
PUBLICATION #1 — Psycho-Oncology & Palliative Care
A screening algorithm for early detection of major depressive disorder in head and neckcancer patients post-treatment: longitudinal study
Henry M, Rosberger Z, Ianovski LE, et al
Abstract: Psychooncology 2018 Mar 13 (Epub ahead of print)
Objective: The primary purpose of this study was to identify predictors of Major Depressive Disorder in head and neck cancer (HNC) patients in the immediate post-treatment period (i.e., at three months post-diagnosis), with a focus on previously unexamined historical and contextual factors.
Methods: Prospective longitudinal study of 223 consecutive adults (72% participation) newly diagnosed with a first occurrence of primary HNC, including validated psychometric measures, Structured Clinical Interviews for DSM Disorders, and medical chart reviews.
Results: The three-month period prevalence of Major Depressive Disorder was 20.4%; with point prevalences of 6.8% upon HNC diagnosis, 14.2% at three months, and 22.6% lifetime. Patients most susceptible to developing Major Depressive Disorder in the immediate post-treatment period: were diagnosed with advanced- rather than early-stage cancer (O.R.=4.94, p=0.04), received surgery only (O.R.=8.73, p=0.04), presented a lifetime history of Anxiety Disorder on SCID-I (O.R.=6.62; p=0.01), and indicated higher pre-treatment levels of anxiety on the HADS (O.R.=0.45, p=0.05).
Conclusions: Our results outline the predominant role of anxiety upon diagnosis as a precursor to post-treatment Major Depressive Disorder, suggesting the need for identification and prophylactic treatment of anxiety upon diagnosis in head and neck cancer patients. Further investigation into pathways by which pre-treatment anxiety predisposes to post-treatment Major Depressive Disorder in this population is warranted. On PubMed: Psychooncology 2018 Mar 13 (Epub ahead of print)
Type of study: 12-month prospective longitudinal study
The finding: Pre-treatment anxiety can predict post-treatment Major depression in patients with Head and Neck cancer.
Strength and weaknesses: The strengths of the study are its sample size, the broad number of contributing factors included in the design and the easy applicability to daily clinical practice; weakness lies on the unfortunate attrition of most severely ill patients and the type of sample which limits the ability to generalize to other populations.
Relevance: This study follows 233 patients diagnosed with first occurrence head and neck cancer for 12 months, and correlates different baseline metrics with the development of major depression. Findings showed that advanced disease, surgical treatment only and presence of anxiety disorder and high anxiety scores on HADS were predictors of major depression in this population. Additionally, it found that those suffering from depression also had a more mediocre quality of life. These findings can help clinicians promptly identify those patients at risk for MDD in this population and guide development of more effective screening mechanisms.
PUBLICATION #2 — Psycho-Oncology & Palliative Care
Perceived employer-related barriers and facilitators for work participation of cancer survivors: a systematic review of employers’ and survivors’ perspectives
Greidanus MA, de Boer AGEM, de Rijk AE, et al
Abstract: Psychooncology 2018; 27(3):725-733
Objective: To identify employer-related barriers and facilitators for work participation of cancer survivors from the perspective of both employers and cancer survivors, and to synthesise these perceived barriers and facilitators to understand their perceived consequences.
Methods: A systematic review of qualitative studies focusing on employers’ and cancer survivors’ perspectives on the work participation of cancer survivors was performed. Four databases (MEDLINE, EMBASE, PsycINFO, and Business Source Premier) were systematically searched, and the quality of studies included was assessed using the CASP checklist. Perceived barriers and facilitators were extracted and synthesised to conduct a content analysis.
Results: Five studies representing the employers’ perspectives and 47 studies representing the cancer survivors’ perspectives were included. Employers perceived barriers and facilitators related to support, communication, RTW policies, knowledge about cancer, balancing interests and roles, and attitude. Survivors perceived barriers and facilitators related to support, communication, work environment, discrimination, and perception of work ability. The synthesis found that the employers’ willingness to support can be understood by perceptions they have of the survivor, goals of the employer, and national or organizational policies. Employers require knowledge about cancer and RTW policies to be able to support survivors.
Conclusions: This review identified a plurality of and a large variety in perceived employer – related barriers and facilitators for work participation of cancer survivors, which can be understood to be related to both employers’ willingness and ability to support. There is a need for interventions targeting employers, with the aim of enhancing the sustainable work participation of cancer survivors.
On PubMed: Psychooncology 2018; 27(3):725-733
Type of study: Review of literature
The finding: Employers play an essential role in the return to work of cancer survivors, with communication, companies’ policies, knowledge of the cancer experience, balance of interests and employers’ attitudes exerting significant influence.
Strength and weaknesses: The strength of this study is its novelty of the idea/design, the use of multiple databases, and the inclusion of both, the survivor and the employer perspective. The limitations lay on the number of studies selected, the subjective nature of the material, the constraints imposed by the variability of work laws on is global applicability, and finally, the novel methodology used still pending validation.
Relevance: Return to work after cancer treatment is perceived a critical aspect of survivorship and improves quality of life. Cancer survivors face many physical limitations that may limit their ability to work and reduce their productivity. This review looks at the factors facilitating or impeding the reincorporation to the workforce of this patients from both perspectives and highlights areas where interventions (geared towards employers) can enhance work participation in cancer survivors.
PUBLICATION #3 — Psycho-Oncology & Palliative Care
Increased prescription rates of anxiolytics and hypnotics to survivors of cancer in childhood, adolescence, and young adulthood—a population-based study
Johannsdottir IM, Loge JH, Kiserud CE, Karlstad Ø, Skurtveit S
Abstract: Pediatr Blood Cancer 2018 Feb; 65(2)
Background: Survivors of cancer diagnosed in childhood, adolescence, or young adulthood (CAYACS) risk psychological morbidities later in life. The study compares prescription rates of anxiolytics and hypnotics among survivors to rates in age- and gender-matched controls.
Procedures: The population-based cohort included 5,341 cancer survivors, diagnosed ≤25 years of age during 1965-2000. For each survivor, three age- and gender-matched controls were randomly selected from the general population. Data were identified from the Norwegian Cancer and Population registries and linked to the Norwegian Prescription Database. A Cox proportional hazard model was applied to estimate hazard ratios (HRs) of prescriptions during 2004-2012 to the survivors with controls as referents.
Results: Survivors had an increased risk of being prescribed anxiolytics with crude rates of 16.9/1,000 person years compared to 11.8/1,000 person years in controls (HR 1.41; 95% confidence interval [CI] 1.29-1.54). The relative risk was highest for survivors of neuroblastomas (HR 2.62; 95% CI 1.11-6.16), bone tumors (HR 2.00; 95% CI 1.26-3.18), and central nervous system tumors (HR 1.90; 95% CI 1.40-2.51). The risk of being prescribed hypnotics was increased with crude rates of 20.8/1,000 person years compared to 14.3/1,000 person years in controls (HR 1.44; 95% CI 1.32-1.56). The relative risk was highest for survivors of gastrointestinal tumors (HR 1.80; 95% CI 1.04-3.10), leukemias (HR 1.78; 95% CI 1.32-2.38), and soft tissue cancers (HR 1.70; 95% CI 1.09-2.64).
Conclusions: Certain groups of CAYACS have an increased risk for being prescribed anxiolytics or hypnotics compared to controls. Diagnostic reasons for prescriptions are unknown, but the results indicate an increased emotional burden among these groups of survivors.
On PubMed: Pediatr Blood Cancer 2018 Feb; 65(2)
Type of study: Cohort study
The finding: Using a large Norwegian national database, the authors found that survivors of child, adolescent, and young adult cancer had higher rates of prescription of anxiolytics and hypnotics.
Strength and weaknesses: The main strength was the use of a national database, which allowed the authors to identify a large sample and match with age-matched controls. The main limitation is that because of the use of a database, the authors could only infer on the indications for hypnotic and anxiolytic prescription. The authors did not study non-pharmacologic interventions.
Relevance: It is well known that survivors of childhood, adolescent, and young adult cancers are at higher risk for psychological sequelae and difficulty with adjustment following their cancer. This study demonstrated that this population is prescribed anxiolytics and hypnotics at higher rates than the general population. Given the risks of anxiolytics and hypnotics, clinicians must be aware that this population represents a particularly high risk group, and efforts should be made to explore all treatment options—pharmacologic and nonpharmacologic—if or when survivors of childhood, adolescent, and young adult cancers present to clinical attention.