Journal Article Annotations
2022, 1st Quarter
Annotations by Carlos Fernandez Robles, MD,MBA and Marie Tobin, MD
The odds of 5-year survival for breast cancer patients treated at institutions with low-mid and mid-high integrative oncology programming were three times and 48% higher, respective-ly, compared to care at institutions with low commitment to integrative oncology services. Provid-ing access to and funding for integrative oncology services confers a survival advantage comparable to being treated at an academic medical or an NCCN- designated center.
Strength and weaknesses:
This study benefits from a complex but well-reasoned and -explained methodology. The work can be reproduced and guide researchers seeking to answer similar ques-tions; statistical tools address potential multicollinearity or overfitting. It is nonetheless a retro-spective study with potential for misjudgement and recall bias. Also, while data came from a large sample, the authors substantially reduced the sample, and the resulting size is relatively low for all variables included in the predictive model; however, the authors used SMOTE to address the low event rate among sample patients.
Evidence supports the role of integrative approaches in helping oncological patients manage side effects, improving patient-reported outcomes, and contributing to overall survival. While there has been an increase in its availability across cancer centers, institutional support re-mains variable, and providers often struggle to grow services to adequately meet the larger onco-logical population’s needs. The findings of this study help psychosocial oncology providers make a case for increasing integrative services at institutions where little efforts exist for funding and in-vesting in increasing awareness of these services. Furthermore, these findings outline core services more commonly adopted by institutions with better survival scores: exercise counselling, nutri-tional services, psycho-oncology support, chaplain assistance, and patient support groups. Four es-sential areas where efforts can help cross the threshold into mid-low involvement include 1) raising awareness, 2) facilitating access, 3.) covering costs, and 4) supporting on-site staffing for these ser-vices.
Thirty-five percent of patients with indolent hematological malignancies have unmet supportive care needs during the “watch and wait” period of their care. Psychological and health needs account for most of these. Younger patients with pre-existing psychiatric disorders and limited coping skills are at most risk. Also, higher distress, anxiety and depression, and lower quality of life correlated strongly with higher reports of unmet needs.
Strength and weaknesses:
This study benefits from a robust sample size that accurately represents the intended study population. It used validated and commonly used instruments to assess psychological variables. However, the authors disclosed a lower-than-expected response rate and noted the possibility of underrepresented distress, as 10% of the pool of patients declined participation given their potential for “too much distress .” Finally, the cross-sectional design does not provide information on longitudinal outcomes.
Indolent hematological malignancy accounts for twenty-two percent of new hematological diagnoses. Many of these patients have unmet psychological and physical needs, even as these patients usually have fewer medical appointments and receive less attention because of their disease’s “inactive” state. This study can help C-L psychiatrists, particularly psycho-oncologists, design strategies that detect and address needs for these patients—particularly those patients whose characteristics render increased vulnerability.
In this study the authors use the Delphi technique to engage 30 expert panellists to establish consensus around clinical and research recommendations and priorities for opioid use in cancer-related pain. Experts were drawn from diverse backgrounds across the US and Canada. Forty-three high priority clinical recommendations and eight research priorities were identified. These recommendations provide guidelines for healthcare providers, administrators, educators, and policy makers.
Strength and weaknesses:
This study employed a structured consensus development process to engage expert panellists from diverse backgrounds and across two continents. The design is well-described, and panellists came from diverse backgrounds. The study addresses an increasingly important societal and healthcare challenge: that of the opioid crisis. Specifically, the study focuses on opioid safety defined as the prevention, identification, and management of opioid related harm; much of the work to date on opioid-related harm has focused on chronic non-cancer pain, but increasingly patients who live with cancer need long-term opioid treatment and these guidelines apply to that population as well. The final recommendations (clinical and research) are clearly outlined in tables. The study does have some limitations: fewer than 50% of identified expert panellists contacted agreed to participate, leading to possible bias.
C-L psychiatrists are frequently involved in co-managing patients living with cancer, many of whom are on long-term opioid treatment. Furthermore, C-L psychiatrists are often consulted on patients hospitalized after an opioid overdose. It is the responsibility of all healthcare providers to work collaboratively to foster opioid safety regardless of circumstances. This study elucidates important clinical guidelines to meet this goal.