Janet Ellis

Predictors of Referral for Specialized Psychosocial Oncology Care in Patients With Metastatic Cancer: The Contributions of Age, Distress, and Marital Status

PURPOSE This study examines the rate and prediction of referral for specialized psychosocial oncology care in 326 patients with metastatic GI or lung cancer. PATIENTS AND METHODS Referral information was abstracted from medical records and hospital databases. Patients completed measures of psychosocial and physical distress and functioning. RESULTS Routine referral occurred in 33% of patients, and in 42% and 44%, respectively, of those scoring high on measures of depression (Beck Depression Inventory [BDI]-II >or= 15) and hopelessness (Beck Hopelessness Scale >or= 8). Univariate analyses indicated that referral was associated with younger age, unmarried status, living alone, presence of more depressive symptoms, hopelessness, and attachment anxiety, and with less social support, self-esteem, and spiritual well-being (all P < .05). Among the significantly depressed (BDI-II >or= 15), 100% of those less than 40 years of age, but only 22% of those age 70 years or older were referred. Multivariate analyses indicated that referral was associated with younger age, unmarried status, and presence of more depressive symptoms. Moreover, increasing age was associated with a progressively lower likelihood of referral independent of the level of distress. CONCLUSION Routine referral of patients with metastatic cancer for psychosocial oncology care was predicted by presence of more severe depressive symptoms, younger age, and unmarried status. The rate of referral progressively declined with each decade of age, even among those with significant distress. These findings are consistent with some aspects of Andersens model of health care utilization. The extent to which referred patients represent those who are most likely to benefit deserves further investigation.

Wernicke-Korsakoff syndrome in patients with cancer: a systematic review

Wernicke-Korsakoff syndrome in patients with cancer is understudied. Much of what is known-that significant under-recognition and delays in treatment exist-comes from studies of alcohol misuse disorders or non-alcohol-related Wernicke-Korsakoff syndrome in patients. We investigated the frequency and associated features of cancer-related Wernicke-Korsakoff syndrome in the published literature. We included 90 articles reporting on 129 patients. Only 38 (30%) of 128 patients with data available exhibited the entire triad of classic features of Wernicke-Korsakoff syndrome: confusion, ataxia, and ophthalmoplegia or nystagmus. Diagnosis during life was missed altogether in 22 (17%) of 128 patients. The operational diagnostic criteria (at least two of the following: nutritional deficiency, ocular signs, cerebellar signs, and either altered mental status or mild memory impairment), which are considered more reliable than the classical triad, were used in only nine (7%) cases, yet 120 (94%) met the operational criteria for diagnosis at the time of presentation when applied retroactively. Complete recovery was reported in only 47 (36%) cases. Given that oncologists or haematologists accounted for only 17 (19%) first authors among the articles included, it is important that oncologists are aware of the risk factors for cancer-related Wernicke-Korsakoff syndrome, and that they are vigilant about diagnosing and treating the disease especially in the absence of alcohol misuse disorders.

Sexual health issues in cancer.

DOI:10.1097/SPC.0000000000000194 Although emotional and physical symptom screening in cancer is now a standard of care [1], systematic response to distress screening and evidence-based psychosocial interventions are often not fully integrated into care (Matthew, pp. 38–43). Sexual health and relationship needs in cancer are now widely recognized to be important (Matthew, pp. 38–43; Bober et al., pp. 44–54), but they lag even further behind; sexual health is not routinely assessed or addressed in cancer care (Matthew, pp. 38–43). Owing to these gaps in knowledge and practice, we included a section on sexual health in cancer in this quarter’s issue of Current Opinion in Supportive and Palliative Care. Our section includes several articles focusing on a variety of different topics but unified by the common thread of sexual health issues in cancer. The main goal in this section is to summarize the psychosexual issues experienced by men and women with cancer and the current evidence to help clinicians better assess and manage these difficulties. Given that knowledge, clinical assessment, level one interventions, access to specialized service, and research in sexual health issues in cancer need to be improved and expanded, it is hoped that this issue will help clinicians in their daily care of their patients with cancer. Four studies explore areas relevant to all people with cancer; relationship and fertility issues, sex and sexuality in the elderly, the palliative setting and lesbian, gay, bisexual, and transgender (LGBT), and a review of online interventions (Wittman, pp. 75–80; Benedict et al., pp. 87–94; Griebling, pp. 95–101; Wooten et al., pp. 81–86). Two studies explore women’s sexual health in cancer (Male et al., pp. 66–74; Bober et al., pp. 44–54). In turn, two studies explore men’s sexual health in cancer; Matthews (pp. 38–43) writes a comprehensive overview of the principles of sexual health treatments in men and Wassersug (pp. 55–65) uses clinical examples to illuminate men’s experience on androgen deprivation therapy after prostate cancer. All of us will have met at least one young adult cancer survivor who did not fully understand or receive fertility preservation counseling at the time of treatment, leading to immense distress and regret, and significant impact on the rest of their life. Supporting couples’ intimacy during cancer

Editorial, supportive care and psychological issues around cancer.

Since its beginnings in the mid 1970s [1], the field of psychosocial oncology has been devoted to the psychological, behavioral, social, and spiritual aspects of cancer care. Assessment of psychosocial domains is now routinely integrated into clinical care in all cancer centers and required to achie