Maria Antonietta Annunziata

DOES THE INFORMATION LEVEL OF CANCER PATIENTS CORRELATE WITH QUALITY OF LIFE? A PROSPECTIVE STUDY

Aims and background The aim of the study was to evaluate the impact of information level on quality of life in cancer patients previously studied for their information level. Patients and methods The information level was determined by means of a questionnaire that explored the degree of information on diagnosis and status of disease, the patients interpretation of his/her disease status, and his/her satisfaction with the information received. Quality of life was evaluated, some months after evaluation of the information level, by means of the Functional Living Index for Cancer (FLIC) and the State-Trait Anxiety Inventory (STAI 1-2). Results A total of 175 patients were studied. Information was adequate in 53.7% of patients. An adequate level of information was present more frequently among patients aged ≤65 years and in those patients followed at a cancer institute. There was no difference in the quality of life of adequately versus inadequately informed patients. Satisfaction with the information received influenced quality of life in both age groups. Objective clinical variables (active disease present and ongoing treatment) negatively affected quality of life in patients <65 years, whereas the subjective perception of the presence of disease was associated with a worse quality of life in older patients. Conclusions In the study, although the level of information did not affect the quality of life, satisfaction with the information was associated with a better quality of life. The finding stresses the importance of a sensible disclosure of diagnosis and prognosis.

Screening for distress in cancer patients: A multicenter, nationwide study in Italy

Routine screening for distress is internationally recommended as a necessary standard for good cancer care, given its high prevalence and negative consequences on quality of life. The objective of the current study was to contribute to the Italian validation of the Distress Thermometer (DT) to determine whether the single item DT compared favorably with referent criterion measures.

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.

Prospective, Multicenter, Randomized Trial of a New Organizational Modality for Providing Information and Support to Cancer Patients

PURPOSE No structured modality for providing information and support to patients in oncology wards has been validated in clinical trials. METHODS This is a pragmatic, two-arm, cluster randomized trial, with the oncology ward as random assignment unit. Centers were allocated to implement a Point of Information and Support (PIS) or to a control group. The PIS included a library for cancer patients and a specifically trained oncology nurse. End points, measured at patient level, were psychological distress and satisfaction with received information. Both intent-to-treat and per-protocol analyses considering clustering were performed. RESULTS Thirty-eight Italian cancer centers were randomly assigned, and 6 months after PIS creation, 3,286 unselected, consecutive cancer patients were surveyed (1,654 in the experimental group and 1,632 in the control group). Three thousand one hundred ninety-seven (97%) questionnaires were collected and deemed valid. Fifty-two percent of centers (11 of 21 centers) in the experimental arm did not implement the PIS in accordance with the protocol. Overall, 34% of patients showed moderate to severe psychological distress, and only 9% declared dissatisfaction. Intent-to-treat analysis did not yield significant differences. Although the per-protocol analysis did show a reduction in psychological distress (28.9% for functioning PIS v 33.3% for no PIS) and dissatisfaction (6.4% for functioning PIS v 9.3% for no PIS), differences did not reach significance. CONCLUSION This is the first cluster randomized trial aiming to demonstrate that a structured modality of providing information reduces psychological distress. We did not find this, but we believe results should be interpreted cautiously, particularly because of the low compliance with PIS implementation. Context analysis preceding such interventions is essential.

Cross-cultural adaptation and patients' judgments of a Question Prompt List for Italian-speaking cancer patients

BackgroundQuestion Prompt Lists (QPLs) have proven very effective in encouraging cancer patients to ask questions, allowing them to take up a more active role during visits with the oncologist. As no such tool has yet been validated for Italian-speaking users, we carried out the cross-cultural adaptation and evaluation of an existing Australian Question Prompt List.MethodsCross-cultural adaptation was performed in accordance with the five steps described by Guillemin and Beaton. Forward and back translations of the original tool were carried out, and the products discussed by an Expert Committee who agreed on a prefinal version of the Italian QPL, which was submitted to 30 volunteer patients for evaluation. They rated each questions adequacy of content, clarity of wording, usefulness, and generated anxiety, on a 3-point Likert scale. Based on the analysis of patient ratings, the final version of the Italian QPL was produced.ResultsFew discrepancies between the two back translations and the original version of the instrument were noted, indicating that the Italian translation (synthesis of the 2 forward translations) was substantially accurate. Most volunteer patients felt that the questionnaire was adequate, easy to understand and useful. Only a few minor criticisms were expressed. Certain questions on diagnosis and prognosis generated the highest level of anxiety. Patient comments and ratings on clarity highlighted the need to clarify common health care terms which are not widely used by the public (i.e. guideline, multidisciplinary team and clinical trial)ConclusionsThis cross-cultural adaptation has produced an Italian Question Prompt List that is now available for multi-center international studies and can be safely used with Italian-speaking cancer patients.

Is it better to transfer long-term cancer survivors to general practitioners or develop clinics for long-term survivors within the cancer centers?

TO THE EDITOR: The interesting work by Virgo et al highlights the importance and at the same time the problematic of long-term follow-up for cancer survivors. The limited experience and low interest of the general practitioner on the management of cancer patients in long-term care are major barriers to the transferability of long-term patients with cancer to their general physician, although is clear that the increasing number of cancer survivors are a limitation for the care from medical oncologist. As admitted by Virgo et al, one limitation of the study is that this was based mainly on breast and colon cancer survivors while the difference in patients with lymphoma could have been more evident. In our view, the problem not yet studied of the transfer of the patients from medical oncologist/hematologist to general practitioner is the willingness of patients with cancer to do that. In fact, the patients with cancer are usually reluctant to abandon the primary medical oncologist and to be transferred to their general practitioners. It should be important to have the point of view of organizations for patients with cancer on this matter. In our view, it would be much better, although more costly, to develop a cancer survivors clinic within the department of oncology of the major cancer hospitals with medical oncologist and psychologist working together, and transfer these patients to these new structures to give the best supportive care either medical and psychological to patients with cancer, also in association with other specialists, in particular cardiologists. In fact, it should not be forgotten that cardiovascular adverse effects are becoming increasingly important in long-term care of cancer survivors, in particular patients with breast cancer and lymphoma that may have received anthracyclines and/or radiotherapy. In our cancer center, the cancer clinic for long-term survivors is active with combined work of medical oncologist/hematologist and psychologist.

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.