Journal Article Annotations
2022, 4th Quarter
Annotations by Christian Bjerre Real, MD, MMCI, Deepti Chopra, M.B.B.S., MPH, Daniel McFarland, MD, and Marie Tobin, MD
This narrative review utilizes current research to build a biobehavioral framework which speaks of the interrelatedness between cellular immunity dysfunction, psychosocial distress, and neurocognitive events in the context of CAR-T cell therapy. It also discusses current evidence on treatment strategies within such constructs both in the behavioral and pharmacological realms.
Strength and weaknesses:
Biobehavioral frameworks are generally useful in the field of psychosomatics, and especially so in emerging research areas (such as CAR-T Cell therapy), as it grounds our current understanding and suggests future research directions. The narrative nature of the review lacks a literature methodology which allows for selection bias.
C-L psychiatrists are increasingly involved in treating neuropsychiatric complications of CAR-T cell therapy. Deepening our understanding of the relationship among immune, affective, and neurocognitive phenomena supports better treatment plans and communication with primary teams.
The review evaluates various dimensions of telehealth programs in oncology using the RE-AIM framework to evaluate the feasibility of sustaining implementation of these programs. The authors identified 73 studies: one-third were randomized controlled trials, one-third were from heterogenous cancer sites, and a majority were recruited from hospital settings. They found a wide range of participation (10–100%), and approximately a third of the studies reported participant’s reason declining telehealth. Effectiveness of telehealth programs were assessed not only at the patient level but also at the system level. Patient outcomes primarily assessed quality of life (QOL) measures with 35% of studies noting significant improvement in QOL post telehealth intervention and 22% noting no difference. When compared to control (standard hospital care), QOL outcomes were not different. System level findings revealed 58% of studies found telehealth to be more cost effective whereas 16% found no difference, and the remaining 16% found telehealth to be more costly. Another system level finding was training staff in telehealth lowered rate of attrition and site-specific information regarding telehealth infrastructure was lacking in most studies.
Strength and weaknesses:
The paper is a comprehensive review that provides a platform for further assessment and development of telehealth in oncology settings. Authors highlight the various impacts of telehealth on patients, staff and organizational outcomes that may help clinicians tailor their practice or help administrators craft a more meaningful hybrid model of healthcare delivery. Knowledge of enablers and barriers can help guide future telehealth programs. Due to variability in studies—sample size, participation rate and location of hospital setting—some specific data cannot be easily generalized.
This review will help C-L psychiatrists and service leaders anticipate potential concerns in implementing, sustaining, or expanding telehealth programs in the post-COVID era.
This is a review of several proposed biological mechanisms underlying the relationship between cancer and depression. The paper highlights similarities between constitutional systemic homeostatic mechanisms in the initiation and propagation of cancer and the development of depression. The article is a comprehensive survey of these mechanisms generally showing the similarity in biological disruption in both cancer and depression. Particular attention is given to gut ‘dysbiosis’ and inflammation common to both diseases. Attention is also given to lifestyle interventions on symptom management in patients with cancer. The discussion on lifestyle management is a particularly unique aspect of this article as it is potentially actionable when considering the dysregulated biology and depressive symptoms in patients with cancer.
Strength and weaknesses:
Overall, this review article is a literature survey and provides a comprehensive assessment of underlying biological mechanisms to both cancer and depression. The article provides numerous thought-provoking and hypothesis-generating ideas based on extant literature and data. The topic is extremely broad, and one weakness of the article is its lack of an integrated synthesis of the material. The authors could do a better job of explaining what all the data ultimately mean for the field and how a researcher or clinician would might advance the field.
The C-L psychiatrist should be aware of the basic science underlying symptom management. The focus on lifestyle management, along with gut inflammation and circadian disruption should be considered in the management of depression in patients with cancer.