Journal Article Annotations
2019, 1st Quarter
Elie Isenberg-Grzeda and Carlos Fernandez-Robles
- Factors associated with depression over time in head and neck cancer patients: a systematic review.
- Exercise Interventions and their Effect on Masculinity, Body Image, and Personal Identity in Prostate Cancer – A Systematic Qualitative Review.
- Quality of life versus Length of Life Considerations in Cancer Patients: A Systematic Literature Review.
PUBLICATION #1 — Psycho-oncology
Factors associated with depression over time in head and neck cancer patients: a systematic review.
Korsten LHA, Jansen F, de Haan BJF, Sent D, Cuijpers P, Leemans CR, Verdonck-de Leeuw IM
Abstract: Psychooncology. 2019 Mar 13. doi: 10.1002/pon.5058. Epub ahead of print
Objective: To systematically review the literature on factors associated with a clinical diagnosis of depression or symptoms of depression(depression) among head and neck cancer (HNC) patients.
Methods: The search was conducted in Pubmed, PsycINFO, and CINAHL. Studies were included if they investigated factors associatedwith depression among HNC patients, were of prospective or longitudinal nature, and English full-text was available. The search, data extraction, and quality assessment were performed by two authors. Based on the data extraction and quality assessment, the level of evidence was determined.
Results: In total, 35 studies were included: 21 on factors associated with depression at a single (later) time point, 10 on the course of depression, and 4 on both. In total, 77 socio-demographic, lifestyle, clinical, patient-reported outcome measures and inflammatory factorswere extracted. Regarding depression at a single time point, there was strong evidence that depression at an earlier time point was significantly associated. For all other factors evidence was inconclusive, although evidence suggests that age, marital status, education, ethnicity, hospital/region, sleep, smoking, alcohol, surgery, treatment, tumor location and recurrence are not important associated factors. Regarding the course of depression we found inconclusive evidence for all factors, although evidence suggests that gender, age, chemotherapy, pain, disease stage, treatment, tumor location are not important associated factors.
Conclusion: Depression at an earlier time point is significantly associated with depression later on. Several sociodemographic and clinical factors seem not to be important factors associated with depression. For other factors further research is warranted.
This article is protected by copyright. All rights reserved.
Keywords: depression; depressive symptoms; head and neck cancer; systematic review
PMID: 30865357 DOI: 10.1002/pon.5058
Type of study: Systematic review of the literature
The finding: In patients with Head and Neck Cancer (HNC), depression at an earlier time point is significantly associated with depression at a later time point. Sociodemographic factors (age, marital status, education, etc.) and clinical factors (the type of treatment, surgery) are not strongly associated. While three studies found that HNC-related symptoms (problems with senses and speech) were significantly associated with higher depression, the differences in methodology do not allow to draw a definite conclusion of this association. Likewise, studies examining biological factors (TNFα, IL6, CRP) did not show a significant association, yet the quality of these studies is low.
Strength and weaknesses:This is a systematic review of the literature that included 35 prospective/longitudinal nature studies looking at factors associated with the occurrence of depression in patients with HNC. Studies were categorized by the quality of the methodology using a 12 point rating scale, and further segmenting the evidence into strong, moderate and inconclusive depending on the quality of the studies supporting it. Furthermore, the manuscript does an excellent job on doing a more granulate analysis of the results by presenting them as different subcategories depending on the factors studied, including socio-demographic, lifestyle, and clinical and biological factors; and, also, making a differentiation between the timing of the occurrence of depression. These results are limited by the individual power of each study, the relatively small proportion of high methodological quality among the studies selected, and the heterogenicity of the tumor characteristics/staging, the tools used to measure depression.
Relevance: This study highlights the vulnerability of patients with early depressive symptoms to later struggles with depression during HNC care, therefore the importance of early screening. The lack of a definite association with other factors should caution providers from overlooking those patients with characteristics traditionally considered as protective.
PUBLICATION #2 — Psycho-oncology
Exercise Interventions and their Effect on Masculinity, Body Image, and Personal Identity in Prostate Cancer – A Systematic Qualitative Review.
Langelier DM, D’Silva A, Shank J, Grant C, Bridel W, Culos-Reed SN.
Abstract: Psychooncology. 2019 Jun;28(6):1184-1196. doi: 10.1002/pon.5060. Epub 2019 Apr 24
Objective: Men with prostate cancer face various body composition and psychosocial challenges following diagnosis. Movement-based interventions such as exercise may represent novel strategies to improve these important biopsychosocial changes. This systematic qualitative review aimed to examine the various exercise interventions and their effect on male perception of masculinity, body image, and personal identity.
Methods: A systematic search across nine electronic databases was conducted in July 2017 and repeated in August 2018. Eligible studies included qualitative works examining masculinity, body image, or personal identity within an exercise intervention. Thematic content analysis allowed for qualitative synthesis across numerous studies.
Results: Six studies met eligibility criteria for inclusion. Four interventions used multimodal aerobic and resistance training, one incorporated aerobic exercise through football practice, and one utilized a home-based aerobic plus yoga program. Exercise was implicated to improve masculinity through creation of a safe community, allowed for refocusing on valued male traits, provided a source of distraction, and offered a means of establishing control over one’s illness. Exercise also facilitated a process of self-reflection secondary to changes in physique and helped to re-establish male self-efficacy.
Conclusions: Regardless of prostate cancer stage, treatment status, or prior androgen deprivation therapy exposure, both aerobic or aerobic and resistance training exerted positive effects on perceived feelings of masculinity, body image, and personal identity.
This article is protected by copyright. All rights reserved.
Keywords: Body Image; Cancer; Exercise; Masculinity; Movement; Oncology; Prostate Neoplasms; Qualitative; Review; Self-Concept
PMID: 30875710 DOI: 10.1002/pon.5060
On PubMed: Psychooncology. 2019 Jun;28(6):1184-1196. doi: 10.1002/pon.5060. Epub 2019 Apr 24.
Type of study:(http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401): Systematic Review.
The finding: In this systematic review focusing on the impact of exercise interventions on psychosocial domains of masculinity in men with prostate cancer, the authors identified 6 studies describing a total of 105 patients. Thematic analysis revealed that exercise programs fostered a shared sense of masculinity through community and safety, placed a focus on valued male traits, provided distraction, restored a sense of control, facilitated self-reflection, and helped redefine self-efficacy.
Strength and weaknesses: The authors used appropriate methodology for conducting systematic reviews, following PRISMA guidelines and using the AMSTAR critical appraisal tool. The main limitations related to the heterogeneity found among the studies with regards to defining the psychosocial domains and the multidimensional nature of ‘masculinity’. The sample size of 105 cases is small and specific questions about exercise type and differences between exercise prescriptions could not be answered.
Relevance: The benefits of exercise in cancer care are well known, yet adherence to exercise programs can be challenging. This study identifies core features of exercise that may appeal to and restore masculinity and identity among men with prostate cancer.
PUBLICATION #3 — Psycho-oncology
Quality of life versus Length of Life Considerations in Cancer Patients: A Systematic Literature Review.
Shrestha A, Martin C, Walters S, Collins K, Burton M, Wyld L.
Abstract: Psychooncology. 2019 Mar 5. doi: 10.1002/pon.5054. Epub ahead of print
Background: Patients with cancer face difficult decisions regarding treatment and the possibility of trading quality of life (QoL) for length of life (LoL). Little information is available regarding patients‘ preferences and attitudes towards their cancer treatment and the personal costs they are prepared to exchange to extend their life. The aim of this review is to determine the complex trade-offs and underpinning factors that make patients with cancer choose quality over quantity of life.
Methods: A systematic review of the literature was conducted using MeSH terms: cancer, longevity or length of life, quality of life, decision-making, trade off and health utility. Articles retrieved were published between 1942 to October 2018.
Results: Out of 4393 articles, 30 were included in this review. Older age, which may be linked to declining physical status, was associated with a preference for QoL over LoL. Younger patients were more likely to undergo aggressive treatment to increase survival years. Preference for QoL and LoL was not influenced by gender, education, religion, having children, marital status or type of cancer. Patients with better health valued LoL and inversely those with poorer physical status preferred QoL.
Conclusion: Baseline QoL and future expectations of life seem to be key determinants of preference for QoL versus LoL in cancerpatients. In-depth studies are required to understand these trade-offs and the compromises patients are willing to make regarding QoL or LoL, especially in older patients with naturally limited life expectancy.
This article is protected by copyright. All rights reserved.
Keywords: Cancer; Longevity; Quality of Life; decision-making; trade-off
PMID: 30838697 DOI: 10.1002/pon.5054
On PubMed: Psychooncology. 2019 Mar 5. doi: 10.1002/pon.5054. [Epub ahead of print]
Type of study: Systematic literature review
The finding: The finding: The baseline Quality of life and the probability of survival/better prognosis seem to be the key determinants of a patient’s preference in the trade-off of Quality of Life (QoL) and Length of Life (LoL). Younger patients tend to endure more toxic treatments in favor of LoL, while older patients opted for improving QoL, no other sociodemographic factor was strongly associated with either choice. The authors did not find a difference in preference among the different cancer types.
Strength and weaknesses:The article does an excellent job at establishing the definitions QoL and LoL, the metrics used and implications of the trade-offs between both, and the different factors that can affect the decision. Given the complexity of the topic, the authors provided an adequate methodology for their study selection. One of the weaknesses is that most of the studies don’t directly test the determinants that influence the decision-making process, instead focus on quantifying the patient’s choice. Also, the existing tools do not capture the psychosocial reasoning behind the decision. Also, most of the studies did not involve early-stage cancers, where sociodemographic and other clinical factors may play a more significant role on patient’s choices.
Relevance: This study is the first comprehensive review of studies looking at trade-offs between QoL and LoL in a cancer setting. It highlights the importance of measuring QoL and providing a correlation to life expectancy. Also brings to light some of the factors that influence decision making, and can help clinicians when caring for patients at these decisive moments.