Heidi As Donovan

Examining the relationship between multiple primary cancers and psychological distress: A systematic literature review.

214 Background: The incidence of multiple primary cancers (MPC) in cancer survivors is increasing. However, little is known about the psychological effects of MPCs on cancer survivors. The purpose of this systematic review was to synthesize the evidence regarding the impact of MPC on psychological distress in cancer survivors. METHODS Relevant studies were identified in PubMed database (up to June 2015). Non-English articles were excluded. Two independent evaluators reviewed articles for relevancy and data extraction. Data was organized and recorded using a coding log with exclusionary rationale, a PRISMA flow diagram, and a standardized table of evidence. Effect sizes (ES) were calculated using Cohens d to measure relationship magnitude and direction. RESULTS Of the 543 potentially relevant articles identified, four articles met criteria and were retained for analysis. Different quality of life (QOL) measures were used to assess psychological distress across studies, so ES were calculated for individual studies. There were consistently small but significant ES found for the impact of MPC on distress. When compared to survivors of a single cancer: one study found lower global QOL and higher total stress (ES, 0.1430 and 0.3653); one study reported that those with MPC were more likely to experience frequent mental distress and sleep problems (ES, 0.1404 and 0.2235); and one study found that those with MPC had lower global QOL and emotional function and greater anxiety and depressive symptoms (ES range, 0.1026 - 0.3215). Finally, the one study that evaluated suicidal ideation in survivors of childhood cancers did not find a higher incidence among those with MPC. CONCLUSIONS The ES noted in the four studies suggest a small but significant increase in psychological distress in survivors of MPC compared to survivors of a single cancer. Clinicians should be aware of this at-risk population when screening for distress in cancer survivors. Additional studies that control for care transition points known to increase distress are warranted to explore the impact of MPC on psychological distress over time. Additionally, as the science in this area grows, it will be necessary to reevaluate the literature.

Associations between peripheral neuropathy and nausea/vomiting in survivors of ovarian cancer: Evidence of persistent vagal neuropathies?

165 Background: Persistent numbness and tingling in extremities are reported by many ovarian cancer survivors and are widely recognized symptoms of chemotherapy-induced peripheral neuropathy. Minimal research has addressed the possibility that chemotherapy may also result in vagal neuropathy, with associated adverse effects on somatosensory input to the brain. We hypothesize that ovarian cancer survivors with persistent numbness and tingling, hallmark symptoms of peripheral neuropathy, will report higher levels of nausea and vomiting, consistent with vagal neuropathy. METHODS A secondary analysis was conducted with data from 713 respondents to a survey of randomly selected members of the National Ovarian Cancer Coalition with a history of ovarian cancer. A validated questionnaire was used to assess symptom severity (0-10) at it worst over the past week for 22 commonly reported symptoms. For the present study, analyses were limited to women reporting no evidence of disease following chemotherapy (n = 362) at a mean of 50.3 months post-treatment. The mean age of the sample was 53.1y; 71.7% were married; 54.5% were college graduates. The symptom experiences of women with persistent numbness and tingling , N/T, (n = 206) were statistically compared to those without numbness and tingling (n = 156) with age and time since treatment included as covariates. RESULTS Ovarian cancer survivors with N/T had significantly higher levels of nausea (p < 0.001) and vomiting (p < 0.001), as well as several other symptoms consistent with vagal neuropathy, compared to women without N/T. Sensitivity analysis indicated that among women with the highest N/T severity (7-10), nausea severity was nearly three times higher than among women with the lowest levels of N/T severity (1-3), p < 0.002. CONCLUSIONS Consistent with the study hypothesis, ovarian cancer survivors with persistent numbness and tingling also reported higher levels of nausea and vomiting. These results suggest the importance of new research efforts to examine vagal neuropathy in ovarian cancer survivors.