Francesca Romito

Informal caregiving for cancer patients

According to the recent worldwide estimation by the GLOBOCAN project, in total, 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008. The worldwide number of cancer survivors within 5 years of diagnosis has been estimated at be almost 28.8 million. Informal caregivers, such as family members and close friends, provide essential support to cancer patients. The authors of this report provide an overview of issues in the study of informal caregivers for cancer patients and long‐term survivors in the United States and Europe, characterizing the caregivers commonly studied; the resources currently available to them; and their unmet needs, their psychosocial outcomes, and the psychosocial interventions tailored to their special circumstances. A broad overview of the state of research and knowledge, both in Europe and the United States, and observations on the directions for future research are provided. Cancer 2013;119(11 suppl):2160‐9.

Quality of life, fatigue and depression in Italian long-term breast cancer survivors

Data from the European Cancer Registries show an increase in survival in the last decade: the 5-year age-standardised relative survival rate for breast cancer has reached 79 % for women diagnosed in 1995–1999 [1], which is higher from the 76 % for those diagnosed in 1990–1994 [2]. Nevertheless, most survivors experience adverse effects that can negatively affect their quality of life [3–5]. Risk factors for long-term cancer and treatment-related sequelae may differ by time from completion and type of treatment, age at diagnosis, comorbid conditions and biological factors as well as psychosocial or behavioural factors such as healthy or unhealthy lifestyle. All these aspects may affect both physical and psychological functioning [5]. Among physical late effects in breast cancer survivors (BCS), arm/shoulder complaints, cardiovascular disease, gonadal dysfunction and fatigue are the most common [6]. Fatigue is a distressing symptom in breast cancer patients both during treatments and during the survivorship phase. Long-term BCS tend on average to be more fatigued than the general population, but, until now, evidence of greater fatigue severity compared to healthy controls is mixed [7]. Incidence and prevalence rates for fatigue in long-term BCS range from 24 to 62 %, with most studies reporting rates of approximately 40 % [8–10]. In reality, both the diverse definitions of survivorship and the various fatigue measurement tools implied complicate the ability to make adequate data comparison and to draw clear conclusions on fatigue incidence and prevalence. Regarding psychological sequelae, it was found that in long-term BCS, depression is one of the most distressing and disabling symptoms, even more than anxiety and posttraumatic stress disorder [11]. In a recent US populationbased study [12], including 4,636 adult long-term survivors diagnosed five or more years earlier, the prevalence of significant psychological distress was found to be significantly higher compared to the healthy peers and similar data were also found in European studies [13, 14]. Fatigue and depression have been found to be closely related both in cancer patients and in cancer survivors [e.g. 15, 16]. The concept of health-related quality of life (HRQOL) includes aspects of physical and mental health as a subjective perception and is usually considered a valid indicator of the impact of health on peoples quality of life. In some previous studies on long-term BCS, it was surprisingly found that BCS reported better health compared to the general female population [17] even if reporting more frequent use of health care facilities [18]. When studying cancer late effects in cancer survivors, the intercultural variations across countries should also be mentioned: different cultures and health systems may contribute to diverse adaptation in the survivorship phase. For example, many European countries, such as France, Italy and the F. Romito (*) : C. Cormio :V. Mattioli Experimental Unit of Psychological Oncology, Department of Critical Area and Surgery, National Cancer Center “Giovanni Paolo II”, Via O. Flacco 65, 70126 Bari, Italy e-mail: francescaromito@yahoo.com

The Italian response to cancer survivorship research and practice: developing an evidence base for reform

IntroductionImprovement in cancer survival rates have increased longevity but have also revealed physical and psycho-social sequelae of long-term survivorship and raised many questions regarding how to assess, treat, and prevent these survival-related problems. The United States, Australia, and some northern European Union countries have already started to address these issues. Italy still needs to take up this challenge, taking into account its specific social and cultural background that shapes a different survivorship scenario.MethodsThis brief report summarizes the concept of cancer survivorship and the response to this emerging public health issue in Italy. Two current nationwide research programs on long-term cancer survivorship and post-cancer pain are described to provide readers with a perspective of how Italy is seeking to increase the understanding of the needs and problems of cancer survivors.Implications for cancer survivorsThe results of these nationwide research programs will provide an evidence base for reforming the national care plans to address the needs of the growing number of Italian people with a history of cancer. It is hoped that this description of Italy’s response to this public health challenge will offer some insight into how Italy is responding to the health and psychosocial needs of cancer survivors.

Psychological well-being and posttraumatic growth in caregivers of cancer patients

Introduction: Although research has shown that many cancer patients report positive life changes following cancer diagnosis, there are few data in the literature related to PTG in caregivers of cancer patients. However, the few studies available have shown that this kind of positive changes can also be experienced by family members. The aims of this study were to explore PTG in caregivers of cancer patients and to investigate correlations between the Posttraumatic growth, psychological status and QoL of caregivers and those of patients, taking into account also clinical and socio-demographic aspects. Methods: We enrolled 60 patient/caregiver pairs in the Department of Medical Oncology of the National Research Center “Giovanni Paolo II” in Bari. Both patients and caregivers were assessed using the following scales: Posttraumatic growth Inventory (PTGI); Hospital anxiety and depression scale; Short Form (36) Health Survey (SF-36); ECOG Performance Status. Clinical and socio-demographic data were collected. Results: Caregivers showed significantly higher scores than patients in the dimension of “personal strength.” Furthermore, we found a significantly close association between anxiety and depression of caregivers with those of patients. Younger caregivers were better than older ones in terms of physical activity, vitality, mental health, and social activities. Although the degree of relationship with the patient has no significant effect on the dependent variables of the study, it was found that caregivers with a degree of kinship more distant to the patient have less physical pain than the closest relatives. Conclusion: Results of the present study show that caregivers of cancer patients may experience post-traumatic growth as the result of their caregiver role. It would be interesting to investigate in future research which factor may mediate the presence of post-traumatic growth.

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety

Abstract Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.

Musica, canto ed espressione emozionale durante la chemioterapia. Fanno stare meglio?

Le pazienti oncologiche vivono elevati livelli di distress psicologico, in particolar modo durante le prime fasi di diagnosi e trattamento. Lo studio valuta l’efficacia di un intervento di terapie complementari, nel contenimento di ansia, depressione, rabbia e stress in pazienti oncologiche. 62 pazienti sono state randomizzate in gruppo sperimentale e di controllo. Il gruppo sperimentale ha partecipato ad una singola sessione di musicoterapia nella globalita dei linguaggi e holding psicologico in gruppo, durante l’infusione di chemioterapia ambulatoriale. Lo strumento di valutazione pre e post intervento e stato l’Emotional Thermometers Tool. Nel gruppo sperimentale i livelli di stress, ansia, depressione e rabbia, risultano ridotti in maniera significativa dopo l’intervento. Nel gruppo di controllo si riducono stress e ansia. La richiesta di aiuto risulta maggiormente soddisfatta nel gruppo sperimentale. L’intervento di gruppo di musicoterapia e holding psicologico si e dimostrato utile nel ridurre il distress emozionale durante l’infusione di chemioterapia. Andrebbe valutato l’impiego delle terapie complementari nei percorsi di umanizzazione.