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Adolescent and young adult (AYA) cancer patients may be at high risk of experiencing psychological distress because their diagnosis came during a key time of consolidation of identity and social growth. This study aimed (1) to examine the prevalence of psychological distress among AYA cancer patients within a year of diagnosis to long-term survivors and (2) to describe socio-demographic and cancer-related characteristics associated with psychological distress.
In a cross-sectional web-based survey, patients who scored 5 or more on the Kessler Psychological Distress Scale were assessed for significant psychological distress. Logistic regression examined whether demographics, clinical variables, and social support were associated with psychological distress.
A total of 206 young adult cancer patients participated. The median age at the survey was 34.5 years (range: 22–39 years), and 87.4% were female. The prevalence of psychological distress was 55.3%. Psychological distress among patients diagnosed within a year and long-term survivors (≥10 years since diagnosis) was significantly higher than patients 1–4 years since diagnosis. Pain, decrease in income after a cancer diagnosis, experience of negative change in work/school after a cancer diagnosis and poor social support were significantly associated with psychological distress.
Significance of results
Over half of young adult patients had significant psychological distress in Japan. Our findings potentially contribute to the intervention components for distress management among AYA cancer survivors.
Early integration of palliative and cancer care improves the quality of life and is facilitated by discussions about the end of life after cessation of active cancer treatment between patients with advanced cancer and their physicians. However, both patients and physicians find end-of-life discussions challenging. The aim of this study was to assess the need for a question prompt list (QPL) that encourages end-of-life discussions between patients with advanced cancer and their physicians.
Focus group interviews (FGIs) were conducted with 18 participants comprising 5 pancreatic cancer patients, 3 family caregivers, 4 bereaved family members, and 6 physicians. Three themes were discussed: question items that should be included in the QPL that encourages end-of-life discussions with patients, family caregivers, and physicians after cessation of active cancer treatment; when the QPL should be provided; and who should provide the QPL. Each interview was audio-recorded, and content analysis was performed.
The following 9 categories, with 57 question items, emerged from the FGIs: (1) preparing for the end of life, (2) treatment decision-making, (3) current and future quality of life, (4) current and future symptom management, (5) information on the transition to palliative care services, (6) coping with cancer, (7) caregivers’ role, (8) psychological care, and (9) continuity of cancer care. Participants felt that the physician in charge of the patient's care and other medical staff should provide the QPL early during active cancer treatment.
Significance of results
Data were collected to develop a QPL that encourages end-of-life discussions between patients with advanced cancer and their physicians.
The purpose of this study was to investigate the validity and reliability of the Japanese version of the Peace, Equanimity, and Acceptance in the Cancer Experience questionnaire (PEACE-J) and to evaluate the association between the PEACE subscales and Japanese patient characteristics.
A cross-sectional web-based survey was conducted among 412 patients with cancer. This survey assessed medical and demographic factors, such as the PEACE, the Coping Inventory for Stressful Situations (CISS), and the Functional Assessment of Chronic Illness Therapy — Spiritual well-being (FACIT-Sp). The forward–backward translation method was used to develop the PEACE-J. The validity of PEACE-J was evaluated by exploratory and confirmatory factor analysis, and correlation analysis between each subscale of PEACE and FACIT-Sp and CISS. The Cronbach's α and the item-total correlation of each subscale of the PEACE questionnaire were calculated to assess internal consistency reliability.
The factor analysis yielded two subscales corresponding to the original version: Cronbach's α coefficients were 0.84 and 0.86 for the Peaceful Acceptance of Illness subscale and the Struggle with Illness subscale, respectively. The PEACE subscales and the FACIT-Sp subscales and the CISS subscales were moderately associated with each other, including the Peaceful Acceptance to each subscale of FACIT (r = 0.22–0.55, p < 0.01); and the Peaceful Acceptance and the Struggle with Illness to CISS emotion-oriented coping (r = −0.36 and r = 0.45, p < 0.01, respectively). Married patients showed higher levels of peaceful acceptance than unmarried patients (p < 0.001). Poorer performance status, chemotherapy use, and recurrence or metastasis were significantly associated with higher levels of struggle with illness (p < 0.001).
Significance of results
This study indicated that the PEACE-J is a valid and reliable measure of the patient's sense of acceptance, calmness or equanimity, and peace, as well as their sense of struggle or desperation concerning their illness.
We previously reported that the nurse-assisted screening and psychiatric referral program (NASPRP) facilitated the psychiatric treatment of depressive patients, but the high refusal rate was a problem even though referral was recommended by the nurse to all positively screened patients. We modified the program so that the nurses could judge the final eligibility of referral using the result of the screening. This study assessed if the modified NASPRP led to more psychiatric referral of depressive patients.
We retrospectively evaluated the annual change of the psychiatric referral proportion and compared the findings among the usual care term, the NASPRP term, and the modified NASPRP terms.
The referral proportions of the modified NASPRP terms were 4.4% and 3.9%. These were not significantly higher than the usual care term (2.5%), and significantly lower than the NASPRP term (11.5%).
Significant of results:
The modified NASPRP did not facilitate psychiatric treatment of depressive patients and another approach is needed.
Objective: Although depression is a prevalent and burdensome
psychiatric problem in end-of-life cancer patients, little is known about
its susceptibility to treatment, especially when patients reach very close
to the end of life. This study was conducted to evaluate response rate of
that end-of-life depression to psychiatric intervention and to assess the
feasibility of conventional evidence-based pharmacological therapy for
Methods: The medical records of 20 patients who were referred
to the psychiatry division for major depressive disorder and died within 3
months after the referral were reviewed. The Clinical Global
Impression–Improvement (CGI-I) Scale was used for each case, and
responders were defined as patients whose scores were much or very much
improved. All pharmacological treatments were extracted, and the doses of
the antidepressant prescribed were compared to their
evidence-based-defined therapeutic doses.
Results: Of the 20 patients, seven were responders, but no
response was achieved when the survival time was less than 3 weeks. Most
patients were treated with antidepressants, but the doses prescribed were
far less than the defined doses, especially the doses of the tricyclic
Significance of results: These results suggested that
patients' survival time largely determines susceptibility to
psychiatric treatment, and it is hard to achieve response in patients
whose survival time was less than about 1 month. Implementation of
conventional evidence-based pharmacological treatment is difficult,
especially with TCAs, and various antidepressants, which can be
administrated by other routes, are needed when oral intake is
Movement pattern of the Iriomote cat Prionailurus bengalensis iriomotensis was studied on Iriomote Island, Japan by radio-tracking. The influence of sex and reproductive status of cats on their daily movement distance (DMD), straight-line distance (SLD), daily movement range (DMR) and other relative indices of movements was estimated. DMD was longest in males (3.2 km) and shortest in females without kittens (1.9 km). Also, males moved faster than either females with or without kittens (0.34, 0.25 and 0.25 km/h, respectively). During the mating season, males moved faster and their DMRs were larger than during the rest of the year. The SLD/DMD ratio in males was similarly high in both seasons (0.29 and 0.33), which indicates that their daily routes were expanded over large areas year-round, possibly to maintain a continuous control over their home range. In contrast, SLD/DMD varied seasonally in breeding females. It was low (0.09) during the lactating period, when females returned repeatedly to the den with kittens and it became high (0.32) out of the breeding season. Breeding females moved equally long DMDs in both seasons, whereas non-breeding ones moved shorter distances during the breeding period. These differences may be related to seasonal changes of food abundance. Cats moved intensively, as indicated by long (812–1139 m) routes per km2 of their home range, and occasionally visited distant parts of their ranges in a short time (4–5 days). On the other hand, they showed a relatively slow increase of the patrolled area, from 10% to 36% of their home ranges, in the first and fifth day, respectively. Movement pattern of Iriomote cats showed no clear relation to active defence of home ranges.
Objective: Although surgery for early-stage non-small cell
lung cancer (NSCLC) is generally considered curative, the outcome is
still unsatisfactory, leaving patients faced with uncertainty and fear
of recurrence for a long time after surgery. The purpose of this study
was to clarify the course of patients' mental adjustment after
surgery for NSCLC and to identify predictors of long-term outcome.
Methods: A total of 205 patients completed a baseline
interview for patient characteristics at 1 month after curative
resection of NSCLC and for social support at 3 months, and the Mental
Adjustment to Cancer scale at 3 and 12 months. Univariate and
multivariate analyses were used to identify predictors of their
Results: The helplessness/hopelessness subscale score
improved slightly after curative resection (p < .001), but
the score on the fighting spirit subscale score was unchanged
(p = .659). Significant predictors of
helplessness/hopelessness at 12 months included
helplessness/hopelessness at 3 months and advanced disease stage,
and satisfaction with confidants. Significant predictors of fighting
spirit at 12 months included fighting spirit at 3 months existence of
Significance of results: The results suggested that mental
adjustment improved slightly after curative resection for NSCLC. They
also suggested the need to maintain continuity of psychosocial care
that provides social support, and that an approach that includes
careful attention to patients with advanced stage disease may be a
strategy for improving mental adjustment after surgery for NSCLC.
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