Barbara Muzzatti

Defining Hospital Anxiety and Depression Scale (HADS) structure by confirmatory factor analysis: a contribution to validation for oncological settings

BACKGROUND Despite its popularity, not a definitive word has yet been said about the latent structure of the Hospital Anxiety and Depression Scale (HADS). The present work is a contribution to this issue: statistically identifying the best tool structure helps in understanding which constructs the tool actually detects. PARTICIPANTS AND METHODS Five hundred and twelve Italian consecutive hospitalized cancer patients completed the HADS together with a form for the collection of personal and clinical data. Two confirmatory factor analyses (CFAs) were carried out to test the validity of both two- and one-factor models, whereas qualitative and quantitative (i.e. Akaike information criterion) indices were used to assess which model among them would fit better with the observed data. Finally, two multigroup CFAs were carried out to test the factorial invariance across gender and disease phase (diagnostic, therapeutic) of the best-fitting model. RESULTS Although both considered models provide a good fit to the observed data, the two-factor model is more adequate; it is invariant across gender and disease phase. CONCLUSIONS The present study gives evidence for using HADS to detect anxious and depressive states separately as originally suggested by its authors. Given that this work involved only Italian cancer inpatients, replications in different cultural/national contexts are recommended.

Assessing the body image: relevance, application and instruments for oncological settings

PurposeBody image is the sum of physical, cognitive, emotional, and relational elements that, when integrated, allow the development of a whole, healthy self-identity. Even though body image is normally studied in relation to eating disorders, it can also be influenced by other pathologies, including cancer. In oncology, an effective body image assessment is fundamental. The physical effects of cancer and cancer treatments are important and frequently irreversible also on a functional and emotional level; however, only few surveys have investigated body image in this peculiar context.MethodsAn extensive literature review was carried out in PubMed and PsycINFO. We considered articles published from 1990 to 2010.ResultsTwo hundred sixty-three papers matched the search criteria. Assessment methodologies included clinical interviews, self-report measures, questionnaires, symptom check lists, and graphic tests and projective techniques. After excluding the instruments that referred to eating disorders, validated only for adolescents, and/or projective and graphic tests, we found 81 articles with six questionnaires specifically dedicated to body image assessment in oncology.ConclusionsFrom our systematic review, we could identify six instruments specifically designed for assessing body image in the oncological area. In this paper, we discuss their general characteristics, psychometrics properties and the clinical implications, and body image relevance on the quality of life in cancer patients.

Assessing quality of life in long-term cancer survivors: a review of available tools

PurposeConsidering that the number of people with oncological history is constantly growing, and that cancer survivorship has very specific long-term and late (both medical and psychosocial) effects, it seems useful to have specific multidimensional instruments to measure quality of life (QoL). This contribution aims to describe the characteristics and psychometric properties of QoL assessment tools specifically designed for the condition of long-term cancer survivorship.MethodsWe queried the MEDLINE, PsycINFO, and CINAHL databases, which allowed us to identify the pertinent papers, classified by the QoL tool they refer to. We then extracted the characteristics and the psychometric properties from each study.ResultsFrom the initial 902 papers, 18 meet the selection criteria referring to eight QoL measurements. However, a multipart validation process in order to verify validity and reliability was only started for two of these tools.ConclusionsEven though clinical practice documents that long-term cancer survivors present with different symptoms and functional challenges compared to patients who are currently undergoing treatment as well as the general population, we still lack a quality of life tool that is specific for them, and that has verified psychometric properties. Even though some of the instruments we described are promising, it is necessary to continue their refinement.

Fatigue, quality of life, and mood states during chemotherapy in Italian cancer patients

AIMS AND BACKGROUND In cancer patients, fatigue interferes with the individuals functioning and quality of life (QoL). We investigated the association between fatigue and the main QoL dimensions and mood states as well as the main sociodemographic and clinical variables. METHODS A total of 105 inpatients undergoing chemotherapy were administered the Revised Piper Fatigue Scale and the EORTC QLQ-C30 and POMS questionnaires, along with a form for collecting personal and clinical data. RESULTS Compared with patients reporting lower fatigue levels, patients with higher levels showed worse functioning (P <0.001) in every QoL domain (i.e., physical, role, emotional, social, cognitive functioning, pain, and general health) as well as in the assessed mood states (depression-dejection, tension-anxiety, confusion-bewilderment). Moreover, both QoL and mood states in the subgroup reporting intermediate fatigue levels were worse than those of the subgroup with lower fatigue levels (P <0.02), except for emotional functioning, general health and QoL, and tension-anxiety. In addition, fatigue was significantly associated with gender, age, education, performance status, but not with marital status, survival rate of cancer type, and current chemotherapy cycle. CONCLUSIONS The associations observed between fatigue, the main QoL domains, and negative mood states call for further active interventions to prevent and reduce fatigue.

Improving Communication Effectiveness in Oncology: The Role of Emotions

Through communication, physicians disclose to their interlocutors (who become patients) the course of their disease (with the diagnosis), and again through communication doctors announce the recovery from disease, or its progression, or the helplessness of medicine in coping with it. Communication in medicine has, then, very strong ethical and personal implications that inevitably include personal interpretations of life and suffering, as well as the establishment of a genuine doctor–patient relationship and listening to and recognizing the patients’ and one’s own emotions. Emotions represent an important aspect of the communicative task of physicians. In the present chapter (1) we will introduce the doctor–patient relationship as an element intrinsic to communication and its emotional aspects; (2) we will describe the principal emotions of patients along the disease course, as this is marked by various medical communications; (3) we will then focus on the subject of physicians’ emotions, and (4) list the principal strategies and resources that emotions (both doctors’ and patients’) will or should stimulate in physicians themselves. Increasing communication efficacy, improving the doctor–patient relationship, and adherence to therapy, as well as reaching greater well-being both in patients and in healthcare providers are the principal reasons that should encourage physicians to focus on this communicative-relational element and to look for occasions for specific training.

The Revised Piper Fatigue Scale (PFS-R) for Italian cancer patients: a validation study

BACKGROUND AND AIM Fatigue is one of the most frequently reported symptoms by cancer patients. In recent years, much effort has been directed to designing fatigue measures which are psychometrically appropriate as well as easily administered. Among these, the Revised Piper Fatigue Scale (PFS-R) is widely used in assessing fatigue in cancer patients and other populations. Despite its large utilization in different national contexts and with different populations, its structure appears to vary across cultures, suggesting the need for its validation before use. The main aim of the present work was to verify the validity (i.e., dimensional structure and construct validity) and reliability (i.e., internal consistency) of an Italian translation of the PFS-R to reassure Italian oncology practitioners about its appropriate usage in practice and research. METHODS AND STUDY DESIGN One-hundred ten Italian oncological inpatients were administered an Italian translation of the PFS-R together with a form for the collection of personal identification and clinical data and other fatigue and quality of life measures (POMS and EORTC QLQ-C30) already validated for Italy. RESULTS Principal component exploratory factor analysis revealed a four-factor structure quite similar to (although not overlapping) the original described by Piper and colleagues; all four factors proved to be reliable and to correlate with one another and with previous validated measures of fatigue and quality of life. Preliminary descriptive statistics were also provided for data comparisons. CONCLUSIONS Despite the discussed limitations, PFS-R seems a valid and reliable multidimensional fatigue measure also adequate in Italian oncological settings.

Emotional distress and needs in Italian cancer patients: Prevalence and associations with socio-demographic and clinical factors

AIMS AND BACKGROUND Since emotional distress is a relevant psycho-social component of an oncological disease experience, its study is useful in multidisciplinary patient cancer care. In the present research, emotional distress together with needs during hospitalization were recorded and their associations with several socio-demographic and clinical variables were verified. METHODS AND STUDY DESIGN Five hundred and forty-four consecutive oncological inpatients completed two self-assessment questionnaires concerning emotional distress and needs (i.e., Hospital Anxiety and Depression Scale, Needs Evaluation Questionnaire). RESULTS 27.4% and 20.8% of the enrolled patients were probable cases, respectively, for anxiety and depression; when possible cases were included the percentages raised to 52.5% and 39.3%, respectively. Furthermore, 11.9% and 20.2% of participants were simultaneously probable and possible cases for both conditions. Few differences in anxiety and depression according to socio-demographic and clinical variables were demonstrated, whereas needs seemed to be more frequently associated to them. Finally, needs also seemed to be associated with both anxiety and depression, with possible and probable cases for anxiety and depression displaying more needs than non-cases. CONCLUSIONS The implications for both the quality of care and disease adjustment by cancer patients are discussed together with study limitations.

Sopravvivere al cancro: una rassegna sulla Qualità di Vita nella cancer survivorship

Surviving after the cancer: a review of the Quality of Life of cancer survivors - Thanks to substantial medical progress, today the number of cancer survivors constantly increases. Thus, ever more frequently, patients and healthy professionals must treat a new condition: the cancer survivorship. This condition is peculiar for both its somatic (e.g. the late and long term effects of the treatments) and psychosocial (e.g. psychological distress, fear for a relapse, perceived social support) implications. The present paper is a review of the recent international literature about cancer survivorship; a condition still less known in Italy. First the definition of cancer survivorship is discussed and then cancer survivorship is addressed through a four point model of the concept of Quality of Life. In the last section, the authors will examine the expectation for future research, as well as the possible limitations, together with the practical implications of this topic.

Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives.

In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.

Cognitive functioning self-assessment scale (CFSS): Preliminary psychometric data

The cognitive functioning is included in the concept of quality of life. Many times well-being remains incomplete because of cognitive difficulties, that people are not always able to properly recognize and explain. Nonetheless, only few instruments, specifically thought for non-clinical neurologic populations, are available to measure them. The present study is an attempt at providing a self-report instrument – cognitive functioning self-assessment scale (CFSS) – to measure the individual cognitive functioning in general population. The CFSS is itemized into18 questions to which participants answer on a five-point scale. Two hundred and eighty-two patients in a General Practitioner study have filled-in the CFSS together with a clinical and socio-demographic data form. Explorative factor analysis, using principal component analysis, suggests the consideration ofthe CFSS as one-dimensional; internal reliability = 0.856. Non-parametric testshave shown that women report a worse cognitive functioning than men, while no differences emerged in relation to age, manual prevalence, presence of an illness or being in pharmacological treatment. Although further verifications are necessary, the CFSS seems to be a promising self-report cognitive functioning measure.