Marta Kulpa

Anxiety and depression, cognitive coping strategies, and health locus of control in patients with digestive system cancer

Introduction Contemporary psycho-oncology focuses on the study of the psychological determinants of the functioning of cancer patients. Among the psychological factors that significantly affect the functioning of the patients are anxiety and depressive disorders. Aim To assess the psychological functioning of patients with digestive system cancer in the cancer-treating process and to develop guidelines for psychological care dedicated to this group of patients based on the results of the study. Material and methods A total of 69 patients aged 23 to 91 (average 56) years with digestive system cancer treated in the Gastroenterology Cancer Clinic in the Institute of Oncology in Warsaw were examined using HADS, Mini-MAC, and MHLC. The results were analysed using statistical tests and correlation analysis. Another 532 patients from other wards formed the reference group. Results Measured HLC, anxiety, and depression did not differ significantly from the overall patient population. The investigation of the relationships between anxiety and depression and mental adjustment to cancer showed a positive correlation between anxiety and depression and anxious preoccupation and hopelessness-helplessness, and negative correlation between anxiety and depression and fighting spirit. Conclusions The obtained research results on the correlation of anxiety and depression with health locus of control show that the lower the severity of anxiety and depression, the higher the severity of internal health locus of control. The results confirm the necessity of psychological support forcancer patients showing evidence of destructive attitudes and external health locus of control, so that the severity of anxiety-depressive disorders can indirectly be reduced.

Anxiety and depression and cognitive coping strategies and health locus of control in patients with ovary and uterus cancer during anticancer therapy

Aim of the study The crisis associated with cancer may contribute to the development of anxiety and depressive disorders. Contemporary psycho-oncology focuses on the psychological determinants of the cancer patients functioning to find which disease-coping strategies help the healing process, facilitate the establishment of a good therapeutic relationship and the process of adapting to difficult situations. Aim of the study was assess the psychological functioning of patients with cancer of reproductive organs in the cancer-treating process. The practical aim was to develop guidelines for psychological care dedicated to this group of patients. Material and methods The study was conducted in the Reproductive Organs Cancer Clinic in Institute of Oncology in Warsaw using a questionnaire consisting of: Demographic, Hospital Anxiety and Depression Scale (HADS), Multidimentional Health Locus of Control (MHLC), Cognitive Emotions Regulations Questionaire (CERQ). Results Seventy-eight patients aged 22 to 82 (average 54) were examined. Investigation of relationships between anxiety and depression and coping strategies showed: positive correlation of anxiety with self blame and rumination, positive correlation of anxiety and depression with catastrophizing, positive correlation of depression with blaming others, negative correlation of anxiety and depression with acceptance and positive refocusing, negative correlation of depression with refocus of planning and putting into perspective. Conclusions The results of this study indicate that there may be an indirect method of diagnosing anxiety and depression disorders in cancer patients by observing the coping strategies to cope with the difficult situation.

Quality of life in penile carcinoma patients – post-total penectomy

Introduction Total amputation, as a treatment for advanced penile cancer, significantly debilitates the patients quality of life and sexual function. The aim of the study was to assess the quality of life in patients who had undergone total penectomy. Material and methods The questionnaires EORTC QLQ C-30, SES, CMNI, and a modified IIEF-15 questionnaire, were sent to 11 patients. Results A total of 10 patients returned the questionnaires completed. The results of the overall quality of life, the median result in individual domains, as assessed by the EORT QLQ C-30 questionnaire, were clearly lower than the reference results. There were statistically significant differences in the results of the QLQ C-30, concerning the role-functioning domain in relation to age (p = 0.008) and education (p = 0.032), in the domain of emotional functioning in relation to education (p = 0.008) and in the domains of physical functioning in relation to the partner relationship (p = 0.032). A significant number of patients were sexually inactive. Sexual activity as defined by touching the area of the pubic symphysis at the scars of the penis, touching and fondling perianal areas or the scrotum and watching things/people that cause excitement was observed in 2/10, 1/10 and 2/10 of patients respectively. In 5/6 of these patients, partnership relationships did not deteriorate, including one patient for whom the relationship actually improved. Conclusions The results obtained indicate that total amputation of the penis significantly affects ones sex life and overall quality of life. However, this does not have negative implications in terms of partnership relations, self-assessment or the evaluation of masculinity.

Modern diagnostic and treatment regimens are needed to achieve the best cancer and quality of life control

Penile cancer is a very rare disease, with incidence and mortality of 0.3% and 0.2% in Poland, respectively [1]. In 2010, 232 new cases were diagnosed (standardized rate 0.8/105) and 89 patients died from the disease (standardized rate 0.2/105). Most new cases and deaths were observed in men aged over 50, with a slight improvement in one– and five–year survival rates in the last 10 years [1]. The clinical symptoms of penile cancer are highly diverse (from erythematous plaques and indurations to more verrucous and exophytic lesions that may coalesce into an irregularly shaped mass). The initial abnormal changes may be difficult to recognize, both for the patient and the physician, particularly if the lesion is accompanied by phimosis. The risk factors of penile cancer include phimosis, lack of circumcision, chronic inflammatory conditions (poor hygiene), multiple sexual partners, history of smoking, HPV and HIV infections [2]. Psychological problems are still the most important reasons for the delay in reporting to the doctor. Shame, embarrassment, reluctance to undress in front of the doctor, and the threat of losing the attribute of masculinity associated with a potential surgical treatment are significant barriers to an early contact with the doctor. Despite a large effort made to build a health–conscious society and raising awareness of the relationship between risk factors and diseases, e.g. bladder cancer and smoking, there seems to be a great need for discussion in the community about cancer of the penis, as well as testicular cancer. Most likely, a leading role in the education and diagnosis should be played by urologists, who are perfectly familiar with the natural course of these rare cancers. Another important aspect to consider is the quality of life (QoL) of patients during the treatment process. Health related quality of life is defined as a subjective assessment of ones position in life made during the illness and treatment, which is not the same as health [3]. QoL is a functional effect of the disease and its treatment, as experienced by the patient. Psychooncology considers QoL, in addition to the survival rate, to be a main factor defining the quality of cancer diagnostic and care. The authors of the study “Metastatic penile carcinoma – an update on the current diagnosis and treatment options” published in this issue of CEJU, accurately show what modern effective diagnostics should look like [4]. Careful medical history taking and physical examination, the use of appropriate diagnostic techniques, e.g. 18F–FDG–PET/CT or dynamic sentinel node biopsy (DSNB) in selected patients is crucial for the correct clinical staging. The choice of a therapeutic method for penile cancer patients depends on the clinical and pathological stage. The scope of the treatment may range from conservative management (topical cream), the use of minimally invasive techniques (e.g. laser, Mohs procedure) to different types of surgical procedures (from partial to total penectomy). Depending on the extent of damage to the penis, we observe a negative impact on the sexual function, psychological well–being, the quality of life, and the occurrence of possible post–traumatic stress disorder [5]. Because the majority of patients will have a long 5– and 10–year disease specific survival, the mutilating treatment of the penis should be limited to a minimum [6]. Unfortunately, there are no available standardized tools or interventional pathways to properly measure and identify the psychological and sexual dysfunction in this group of patients. Well–designed multicentre studies are needed to enable the identification of patients who require intervention [7]. Chemotherapy is becoming an important part of multimodality treatment of penile cancer. Yet, as underlined in the article of Barski et al. [4], experience with chemotherapy in this particular malignancy is limited due to small and inhomogeneous groups of patients included in clinical analyses. Cytotoxic treatment is used in neoadjuvant, adjuvant or metastatic setting [8]. Neoadjuvant chemotherapy is supposed to downstage the tumor to enable surgical resection and prevent microscopic spread; this usually refers to bulky unresectable inguinal lymph nodes or pelvic lymph nodes involvement. The most effective chemotherapy regimen is still under debate but cisplatin is clearly considered the cornerstone of the treatment. Recently, four cycles of TIP (paclitaxel, ifosfamide, cisplatin) have been recommended by many authors as the optimal regimen in patients fit for cisplatin (overall response rate 50%, stable disease 30%, progressive disease 20%) [9]. Another triplet, TPF (paclitaxel, cisplatin, 5–fluorouracil) has been advocated by others. Combination treatment offers a higher response rate at the cost of significant or even unacceptable toxicity. Although supported by less evidence, adjuvant chemotherapy is recommended in resected pN2–N3 patients. Disseminated disease is unfortunately incurable and chemotherapy in this setting is aimed to modestly prolong survival and time to progression or alleviate disease–related symptoms. Yet, the prognosis remains poor. The most common regimens include: PF (cisplatin, 5–fluorouracil), TIP (paclitaxel, ifosfamide, cisplatin), PG (cisplatin, gemcitabine) or cisplatin with irinotecan [8]. In most analyses, partial remission can be achieved in 20–33% of patients. Due to older age and comorbidities (kidney insufficiency, cardiovascular diseases, inability to tolerate long intravenous hydration) many patients are unfit for cisplatin. Such patients can be challenged with paclitaxel–carboplatin doublet or monotherapy (paclitaxel, methotrexate). It should be stressed that regimens containing bleomycin should now be avoided in view of a high risk of lung toxicity in this patient population (older age, present or former smokers, often compromised lung capacity). Barski at al. agree that more high–volume multicenter trials are urgently needed to better understand the role of chemotherapy in penile cancer patients and to improve the level of evidence available [4]. The following issues may be of further interest in this disease: Chemoradiotherapy with cisplatin, as it proved active in other squamous cell carcinomas, e.g. cervical cancer or head and neck tumors; Direct comparison of different regimens; Epidermal growth factor receptor (EGFR)–targeted therapy, e.g. cetuximab, already approved in head and neck carcinomas [10]. The paper of Barski et al. [4] fully summarizes the role of proper diagnosis (clinical examinations imaging and invasive diagnostics) as well as treatment (surgical and chemotherapy) in penile cancer patients and outlines the issues for the future.