Journal Article Annotations
2019, 1st Quarter
Elie Isenberg-Grzeda and Carlos Fernandez-Robles
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.
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.
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.