Journal Article Annotations
2021, 4th Quarter
Annotations by Carlos Fernandez-Robles MD and Marie Tobin MD
December, 2021
Findings:
Fear of cancer recurrence (FCR) in caregivers of cancer survivors is prevalent and equal to or higher than that of the patient. Caregiver FCR is highest in younger caregivers and in caregivers of survivors with higher FCR. Caregiver FCR peaked approaching survivor follow up appointments. Elevated FCR in caregivers was associated with reduced quality of life and had a negative relationship with emotional and mental functioning
Strengths and limitations:
This systematic mixed studies review addresses an important but overlooked topic. It includes a long study period (1997-2021) and a large number of both quantitative and qualitative studies. The paper also reports on risk factors for FCR among caregivers. One limitation of the review is a lack of generalizability of the findings: a large number of the studies reported on male caregivers of women with breast cancer. In many of the studies measures of FCR lacked clinical cut-offs which allowed for characterization of statistical rather than clinical differences. Only three studies reported on interventions for FCR in caregivers; so, no conclusions about effective treatments can be made.
Relevance:
C-L psychiatrists are frequently involved in treating anxiety and depression in patients with cancer. Fear of cancer recurrence in cancer survivors is highly relevant to quality of life and emotional well-being. This study elucidates the importance of FCR among caregivers and provides a potential opportunity to develop interventions to improve the emotional and mental health of the survivor.
Findings:
This study is a comprehensive review of the mechanisms used to link patients with cancer to psychosocial supportive care services. The study found the greatest uptake rates with telephone outreach from supportive care programs; email outreach was the second most effective strategy. The lowest uptake was associated with a referral by a healthcare professional. Education of the referring healthcare professional followed by outreach from the psychosocial supportive care service resulted in a significant increase in uptake of services.
Strengths and Limitations:
Few studies explore effective ways to connect patients with cancer to psychosocial supportive care services. This study is an important contribution in this area. One weakness of the study is the lack of studies among patients with a variety of cancer types, ages, genders or ethnic or language backgrounds. Another limitation is that the study excluded studies based on hospital-based services, which are a frequent method of connecting patients with psychosocial services.
Relevance:
The importance of psychosocial supportive care services for the emotional and mental health of patients with cancer is widely recognized, and many countries have adopted guidelines for optimal provision of this care. Despite this consensus, many studies show a lack of uptake of psychosocial supportive care services—especially for underserved patients with the greatest needs. Identifying barriers to uptake of psychosocial supportive care services and characterization of the most effective linkage methods is highly relevant to the work of C-L psychiatrists.
Findings:
In this systematic review of 49 articles, the occurrence of psychological distress and psychiatric disorders in cancer patients is associated with higher healthcare utilization. Depression is associated with increased mental health, inpatient (e.g., hospitalization, inpatient healthcare use, intensive care admission), outpatient care use (i.e., emergency department visits, ambulatory visits, or general outpatient care use), and moderately associated with an increase in medication use. Anxiety symptoms were associated with increased outpatient care utilization. Both anxiety and depressive symptoms were negatively associated with return to work. The presence of a formal psychiatric disorder was moderately associated with an increased length of hospitalization.
There were two important findings for the psycho-oncology practitioner. First, fear of cancer recurrence was associated with increased primary care services use. Second, psychological symptoms were negatively related to oncology-related healthcare (i.e., oncology-related visits, mammography screening, and other screening practices).
Strengths and Limitations:
This well-designed review captures several sources of literature, uses thoughtful exclusion criteria, uses a recognized methodology, and had two reviewers establish the quality of the works included. Furthermore, this is the first review to include all psychological distress symptoms instead of limiting its scope to formal psychiatric disorders. Like many systematic reviews, it suffers from the included studies’ limitations. The authors point out that the absence of an association may result from limited power rather than the lack of one. Unfortunately, the included works’ heterogenicity limit role for a meta-analysis. Finally, the analysis is based primarily on research from North America and Dutch-speaking European countries; the suitability for other countries with different health systems may be limited.
Relevance:
Van Beek and colleagues’ paper compiles the economic and societal cost of psychological symptoms and psychiatric disorders during cancer. This should inform and help advance advocacy efforts on growing and developing mental health care in this population and extend or improve coverage for services. The result should positively impact non-billable problems such as fear of cancer recurrence; nowadays, a widely recognized issue lacking system incentives to conceive and increase interventions.
This systematic review looks at the unmet supportive care needs for patients with rare cancers. A large body of work exists identifying supportive care needs in many common cancers, i.e., breast, colon, so on. Identifying and addressing unmet needs across different populations helps achieve optimal well-being and improve outcomes in cancer care. The most significant needs among patients with infrequent cancers pertain to the healthcare system and information domains, followed by the psychological/physical, and last daily living domains. This finding contrasts with work in common cancers where the psychological/physical domain was the most prominent unmet needs.
Also importantly, rare cancer patients more often express at least one unmet need than common cancer patients. Unmet needs were primarily reported in the posttreatment phase. However, the authors point out that patients with rare cancers encounter difficulties early in their disease course, such as delayed and/or incorrect diagnosis, lack of disease-specific information, and limited access to clinical expertise, treatment options, and clinical research. This may indicate a lack of research in the diseases’ early phases.
Finally, the most frequently identified predictors were higher anxiety scores, younger age, and higher neuroticism.