Journal Article Annotations
2020, 1st Quarter
Elie Isenberg-Grzeda and Carlos Fernandez-Robles
Also of interest:
Compared to other factors of significance, return to work self-efficacy was a strong predictor of return to work among previously employed patients undergoing chemotherapy for cancer.
Strength and weaknesses:
The strengths of this study lie on the inclusion of a wide variety of cancer patients, with different intents (one previous study looked at patients who at baseline took part on a Return to Work program). It also looked at a national register that ensured that all included patients would be followed to the conclusion of the study. Among the limitations was the use of instruments designed for different conditions, the potential of a selection bias given the large number of non-responders to the initial invitation to participate, and the resulting sample size. The authors also note that the studied group could have a pre-morbid functioning and higher socio-economic status as being employed at the time of cancer diagnosis was among the inclusion criteria, adding to the selection bias.
Return to work self-efficacy, an individual’s belief in his or her own ability to go back to work, has proven to be a strong predictor of actual return to work in both mental and musculoskeletal diseases. About half of cancer patients are in the working age, and as treatments improve, the rate of cancer survivors continues to increase. Returning to work is a crucial aspect of cancer survival, and patients often turn to their psychiatrists for help on the process. This study highlights that, contrary to other conditions, in oncology populations, a high Return to Work Self-Efficacy may be less of a significant predictor of a future return to work; and suggest that it is a more complex process. Previous studies suggest that many different factors (socioeconomic, health, illness, and work-related) influence the ability to return to work.
Type of study:
Prospective Longitudinal study
Both male and female patients with cancer with new-onset psychiatric disorders had a higher risk of mortality compared to patients with cancer who do not develop psychiatric disorders after their cancer diagnosis. This correlation was stronger among men and women with gastric cancer and women with breast cancer. The findings of this study suggest that prompt treatment (within 30-days of psychiatric diagnosis) leads to lower cancer-related mortality rates.
Strength and weaknesses:
This is a very well design examining a Nationwide claims database for eleven years, which allowed it to include a large number of cases. The design thoughtfully controlled for new-psychiatric disorders by allowing a one-year washout period and made efforts to identify psychiatric conditions secondary to medical conditions. Likewise, it included not only pharmacological treatments but also psychotherapy treatments. The limitations are also inherent to this type of research, as ICD codes documented for health insurance claims’ purposes. Diagnostic inaccuracies, uncaptured health-related behaviors, undocumented staging, and severity of cancer and psychiatric diagnosis, the use of psychiatric medications for non-psychiatric purposes can impact the validity of the results. Finally, while the team used a one-year washout period, they could not guarantee the absence of pre-existing psychiatric disorders not captured by the data studied.
This study strengths the current and growing evidence of the harmful impact of mental health disorders on cancer patients. A large body of evidence exists, documenting the fact that a diagnosis of mental illness is associated with poor oncological outcomes. This study focuses on the impact of new psychiatric diagnosis on mortality and suggests that early interventions can be course changing for these patients by lowering said mortality. This can be extremely useful to highlight the need for expanding mental health services in cancer centers, as well as increasing awareness among oncology providers and patients of the long term benefits of early detection and adequate referral to treatment.
Type of study
(http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401): Database observational study.
Am J Hosp Palliat Care. 2020 Feb 13:1049909120905789. doi: 10.1177/1049909120905789. (Epub ahead of print)
In a cohort of 386 Korean patients with advanced cancer, those with greater prognostic awareness tended to report worse quality of life measures, including emotional functioning, pain, existential well-being, and social support.
Strength and weaknesses:
Many studies looking at the association between illness understanding / prognostic awareness and emotional wellbeing have used cross-sectional study design. The current study employed a prospective cohort design which allows for more inference about the impact of prognostic awareness on wellbeing. The main limitation is that the findings may represent cultural bias and may not be generalizable to culturally diverse populations. In addition, the authors measured a 6-month follow-up period, so any inferences about longer-term impact of prognostic awareness cannot be deduced.
It is generally understood that prognostic awareness can help patients make treatment decisions among other important decisions. Western medicine, through the lens of patient autonomy, emphasizes patients’ right to know. While debate has occurred about whether prognostic conversations are more harmful or helpful to patients, studies have shown that prognostic awareness is generally welcomed by patients and associated with less psychological distress. In addition, fears that prognostic awareness may lead to depression, loss of hope, or decreased survival, have generally not been supported by the literature. This study reopens the question of whether prognostic awareness can negatively impact patients by its findings that prognostic awareness leads to worse quality of life on a number of subscales. While these findings mustn’t stop clinicians from providing prognostic information (to those patients who consent), it serves as an important reminder that delivering prognostic information must be done in a way that emphasizes supportiveness, sensitivity, and non-abandonment.
Type of study
(http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401):Type of study: Prospective cohort study
Annotation (unstructured): We previously (3rd quarter of 2018) highlighted an article demonstrating that bupropion might be effective for cancer-related fatigue. We now identified another study with similar, modest findings. In this double-blind randomized placebo-controlled clinical trial, 30 cancer patients suffering from fatigue were randomized to receive bupropion (75mg per day for 3 days, increased to 75 mg twice daily thereafter) or placebo. No differences in fatigue were noted at the end of the second week, but by 6 weeks, the bupropion group showed a mild improvement compared to placebo. This study, while subject to certain limitations, does add to the small literature on bupropion for cancer-related fatigue.
Type of study (http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401): RCT