Journal Article Annotations
2018, 2nd Quarter
Annotations by Elie Isenberg-Grzeda, MD, and Carlos Fernandez-Robles, MD
Type of study: Cohort study
The finding: In a prospective cohort study sample of 2,739 Australasian women at increased familial risk for breast cancer, the authors found no statistically significant associations between psychosocial stress and breast cancer incidence.
Strength and weaknesses: The main strength of this study is that the authors addressed methodological issues of prior studies, which have included inadequate power and control of potential confounders, as well as failing to consider stressor severity and chronicity, social support and personality. In addition, the authors reported a very high response rate of 85%. The limitations include the fact that the authors did not evaluate for coping style, which may have been a confounding variable. In addition, the study may have been underpowered to detect a statistically significant relationship between chronic severe stress and breast cancer risk. Finally, the results may not necessarily be generalizable to non-breast cancer patients, or even those not at risk of familial breast cancer.
Relevance: Decades worth of messages aimed at cancer patients have emphasized the role of optimism, positive attitude, and stress reduction in the treatment or prevention of cancer, without a strong evidence base to substantiate the message. This, of course, can add to the guilt and self-blame of those diagnosed with cancer, having felt that they failed in some way. The results of this study are reassuring to healthcare providers treating breast cancer patients, since they add to the mounting evidence that the burden of stressors in the lives of breast cancer patients do not appear to increase the incidence of breast cancer. The authors note the importance of treating anxiety for other reasons.
Type of study: Prospective cohort study
The finding: Cognitive dysfunction may be prevalent in older patients with blood cancer and may have differential predictive value for survival.
Strengths: Adequate sample size, and use of Frailty scales. Homogeneity of the sample.
Weaknesses: Use of only two cognitive screening tools, in domains that can be particularly challenging to test. Despite the high prevalence, it may be underestimated given the skills required to reach a center the size of the one where the study was conducted. The characteristics of the patients and the intensity of the treatment may be higher given the center where the study was conducted, resulting in higher mortality than in community non-complicated cancer patients. Authors also highlight the probability of a self-selection bias.
Relevance: This study looked at the prevalence of cognitive impairment measured by Clock-in-a-Box test and five-word recall test, and correlation with frailty, in patients presenting for first-time evaluation of hematological malignancies at a large university affiliated cancer center. Additionally, it correlated scores with survival. The finding of high prevalence of cognitive disorders and association with frailty and poorer prognosis can help C-L psychiatrists look for these deficits early in treatment, and also advocate for routine screening proceedings, and implement early interventions geared at supporting these patients, that otherwise could be missed.
Type of study: Randomized controlled trial
The finding: Depression treatment in cancer patients improved quality of life, but there is no evidence that it has an impact on survival.
Strengths and duration: Sample size 642 patients, followed up to 5 years. The study design was adequate.
Weakness: Despite the large sample size it was estimated that small positive impact on survival could be missed. Given the limited nature of the study, participants could not be followed beyond the study conclusion, and long-term impact on survival could also be missed. Finally, the heterogenic nature of the sample does not allow to study disease-specific impact.
Relevance: This article presents the results of a randomized controlled study looking at the impact of SMaRT protocol for depression compared to usual care, and finds that while it helps improve quality of life, it does not have any impact on survival. This study will help consultation-liaison psychiatrists have more informed discussions with their patients about the importance and the role of depression treatment during cancer care.