Fremonta Meyer

The Effect of EEG Biofeedback on Reducing Postcancer Cognitive Impairment

Background and hypotheses. Postcancer cognitive impairment (PCCI) is observed in a substantial number of breast cancer survivors, persisting for as long as 20 years in some subgroups. Although compensatory strategies are frequently suggested, no restorative interventions have yet been identified. This study examined the feasibility of EEG biofeedback (“neurofeedback”) and its potential effectiveness in reducing PCCI as well as the fatigue, sleep disturbance, and psychological symptoms that frequently accompany PCCI. Study design. This was a 6-month prospective study with a waitlist control period followed by an active intervention. Participants were female breast cancer survivors (n = 23), 6 to 60 months postchemotherapy, with self-reported cognitive impairment. Methods. Four self-report outcome measures (Functional Assessment of Cancer Therapy–Cognitive Function [FACT-Cog], Functional Assessment of Chronic Illness Therapy–Fatigue [FACIT-Fatigue], Pittsburgh Sleep Quality Index [PSQI], and Brief Symptom Inventory [BSI]-18) were administered 3 times during a 10-week waitlist control period, 3 times during a 10-week (20-session) neurofeedback training regimen, and once at 4 weeks postneurofeedback. Results. All 23 participants completed the study, demonstrating the feasibility of EEG biofeedback in this population. Initially, the sample demonstrated significant dysfunction on all measures compared with general population norms. Repeated-measures ANOVAs revealed strongly significant improvements (P < .001) on all 4 cognitive measures (perceived cognitive impairment, comments from others, perceived cognitive abilities, and impact on quality of life [QOL]), the fatigue scale, and the 4 psychological scales (somatization, depression, anxiety and global severity index) as well as on 3 of 8 sleep scales (quality, daytime dysfunction, and global). Two of the other sleep scales (latency and disturbance) were significant at P < .01, and 1 (use of medication) at P < .05; 2 were not significant. Improvements were generally linear across the course of training, and were maintained at the follow-up testing. At the follow-up testing, the sample no longer differed significantly from normative populations on 3 of the 4 FACT-Cog measures (impairment, impact on QOL, and comments), FACIT-Fatigue, PSQI sleep quality and habitual efficiency, or any of the BSI-18 measures of psychological disturbance. Conclusions. Data from this limited study suggest that EEG biofeedback has potential for reducing the negative cognitive and emotional sequelae of cancer treatment as well as improving fatigue and sleep patterns.

Models of Care for Co-occurring Mental and Medical Disorders

In this article we review practice models for treating common mental disorders in primary care. Novel treatment approaches by primary care providers and specialty providers, including collaborative care and telepsychiatric models, show considerable promise. An understanding of remaining barriers to improved care suggests several possible solutions and future directions for outpatient psychosomatic medicine.

Patterns of psychiatric medication use among nationally representative long‐term cancer survivors and controls

Investigations of long‐term cancer survivors (LTCS) indicate that this population is not appreciably different from cancer‐naive peers with respect to several neuropsychiatric domains. The current study sought to determine whether differences in psychiatric medication use might help to explain the negative findings.

Male breast cancer networking and telephone support group: a model for supporting a unique population

Breast cancer is diagnosed in 2000 men and nearly 200,000 women in the USA annually [1]. Ninety-nine percent of breast cancers are diagnosed in women in this country, so the clinical, research, and advocacy efforts around breast cancer have been primarily focused on women [2]. Treatment decisions for men are extrapolated from data in women because there has never been a successful randomized clinical trial that studied male breast cancer specifically, mostly due to the comparative rarity of male patients. Even large referral centers in the USA usually see fewer than 50 male patients with new breast cancers annually. Pink ribbons and T-shirts have successfully increased breast cancer awareness and helped to raise money for breast cancer research, but also serve as visual reminders that breast cancer is seen as a women’s disease. The strong association between breast cancer and female gender may cause distress for men with the disease. Furthermore, aspects of their clinical care such as questionnaires asking about menstrual functioning and clinical trials that exclude males may heighten these feelings. Online or in-clinic educational materials about management of breast cancer treatment side effects (e.g., vaginal dryness) may not be applicable to them. An online survey of 42 male breast cancer survivors revealed inferior quality of life scores in the participating male breast cancer survivors than would have been expected in the general population of men [3]. Both hot flashes and sexual dysfunction were also noted as common in this population. Optimal symptom management strategies are uncertain, and it can be difficult for men to find other male patients who can advise them on what to expect during and after breast cancer treatment. Group structure and participation

Possibly impossible patients: management of difficult behavior in oncology outpatients.

Angry, threatening, or otherwise disruptive behavior by patients can interfere with necessary oncologic treatment, sometimes to the point of rendering continued care impossible. We offer oncology clinicians guidance in dealing with difficult outpatients by discussing the differential diagnosis and multidisciplinary management of treatment-disrupting behavior in the ambulatory oncology setting.We review the existing literature on dealing with difficult patients and present clinical experience at a comprehensive cancer center where a formalized, institutional process for responding to disruptive outpatients has been developed.A structured, multidisciplinary approach to deal with difficult behavior in oncology outpatients can improve care and staff morale. Staff using this approach can identify causes of treatment-disrupting behavior, develop and implement appropriate behavior plans, facilitate communication, address mental health issues, and ensure that decisions to terminate a relationship with a patient are ethical, clinically justified, and supported by due process.In the future, clinical recommendations and institutional guidelines for dealing with difficult patients should be evaluated with more structured, quantitative research.

Course and predictors of post‐traumatic stress disorder in a cohort of psychologically distressed patients with cancer: A 4‐year follow‐up study

Scant evidence exists on the long‐term course of cancer‐related post‐traumatic stress disorder (PTSD). This is among the few studies worldwide, and the first in the South‐East Asian region, to prospectively evaluate PTSD in patients with cancer using gold‐standard clinical interviews. The objective of the study was to assess the course and predictors of PTSD in adult patients with cancer in a South‐East Asian population.

The role of psychosomatic medicine in global health care.

This article reviews the principles and skills involved with psychosomatic medicine and their potential ability to improve global health care. New awareness of the escalating global public health impact of noncommunicable diseases, including chronic medical conditions and mental disorders, has stimulated interest in determining how best to organize health services. Home to the biopsychosocial model, the field of psychosomatic medicine is well-suited to inform such efforts by virtue of its emphasis on cross-disciplinary collaboration and specialized knowledge at the interface of medicine and psychiatry that takes into account individual and contextual influences on health. Consistent with the principles of psychosomatic medicine, promising strategies to improve global health care include integrating mental health care into primary care, applying the chronic care model in programs aimed at enhancing disease self-management, and using innovative models such as Internet-based therapy and telemedicine to increase access to quality care.

Retrospective review of serotonergic medication tolerability in patients with neuroendocrine tumors with biochemically proven carcinoid syndrome.

Patients with carcinoid tumors frequently could benefit from the pharmacologic treatment of depression and anxiety. However, many prescribers avoid serotonergic medications due to the theoretical risk of exacerbating carcinoid syndrome.

Advanced cancer as a risk for major depressive episodes.

Major depression adversely affects health communication, quality of life, and survival in patients with advanced cancer. Prior research provides limited insight into how patients with advanced cancer differ from the general population in risk for developing a major depressive episode (MDE). This study aims to determine whether advanced cancer poses distinct risks for initial and recurrent MDEs.

Associations between cognitive impairment in advanced cancer patients and psychiatric disorders in their caregivers

This study examined whether cognitive impairment in advanced cancer patients is associated with a heightened frequency of psychiatric disorders in their primary caregivers.