Pok Ja Oh

Effects of Psychosocial Interventions on Cortisol and Immune Parameters in Patients with Cancer: A Meta-analysis

PURPOSE This study was done to evaluate the effects of psychosocial interventions on cortisol and immune response in adult patients with cancer. METHODS MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and domestic electronic databases were searched. Twenty controlled trials (11 randomized and 9 non-randomized trials) met the inclusion criteria with a total of 862 participants. Methodological quality was assessed using the Cochranes Risk of Bias for randomized studies and the Risk of Bias Assessment tool for non randomized studies. Data were analyzed using the RevMan 5.2.11 program of Cochrane library. RESULTS Overall, study quality was moderate to high. The weighted average effect size across studies was -0.32 (95% CI [-0.56, -0.07], p=.010, I²=45%) for cortisol concentration, -0.62 (95%CI [-0.96,-0.29], p<.001, I²=0%) for T lymphocyte (CD3) and -0.45 (95%CI [-0.74, -0.16], p=.003, I²=0%) for Th lymphocyte (CD4) numbers. Psychosocial interventions were not effective for Tc lymphocyte (CD4), NK cell, monocyte, and cytokine response. CONCLUSION Although these results provide only small evidence of successful immune modulation, they support the conclusion that psychosocial interventions can assist cancer patients in reducing emotional distress and improving immune response.

[Disturbance in ADL from Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Cancer Patients: The Mediating Effect of Psychological Distress].

Purpose: The purpose of this study was to examine the mediation of psychological distress in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life in order to provide a basis for planning nursing interventions to improve the quality of life in cancer patients. Methods: A purposive sample of 130 patients treated with chemotherapy were recruited in the cross-sectional survey design. Data were collected using self-report questionnaires. The instruments were the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). Results: The mean score for disturbance in ADL from chemotherapy induced peripheral neuropathy was 3.30. Overall quality of life was 2.48. The mean score was 1.04 for psychological distress. The prevalence was 35.4% for anxiety and 47.7% for depression. There were significant correlations among the three variables, disturbance in ADL from chemotherapy induced peripheral neuropathy, psychosocial distress, and quality of life. Psychosocial distress had a complete mediating effect (β= -.74, p ＜.001) in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life (Sobel test: Z= -6.11, p ＜.001). Conclusion: Based on the findings of this study, nursing intervention programs focusing on disturbance of ADL management, and decrease of psychological distress are highly recommended to improve quality of life in cancer patients.PURPOSE The purpose of this study was to examine the mediation of psychological distress in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life in order to provide a basis for planning nursing interventions to improve the quality of life in cancer patients. METHODS A purposive sample of 130 patients treated with chemotherapy were recruited in the cross-sectional survey design. Data were collected using self-report questionnaires. The instruments were the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS The mean score for disturbance in ADL from chemotherapy induced peripheral neuropathy was 3.30. Overall quality of life was 2.48. The mean score was 1.04 for psychological distress. The prevalence was 35.4% for anxiety and 47.7% for depression. There were significant correlations among the three variables, disturbance in ADL from chemotherapy induced peripheral neuropathy, psychosocial distress, and quality of life. Psychosocial distress had a complete mediating effect (β=-.74, p<.001) in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life (Sobel test: Z=-6.11, p<.001). CONCLUSION Based on the findings of this study, nursing intervention programs focusing on disturbance of ADL management, and decrease of psychological distress are highly recommended to improve quality of life in cancer patients.

[Effect of Cancer Symptoms and Fatigue on Chemotherapy-related Cognitive Impairment and Depression in People with Gastrointestinal Cancer].

PURPOSE The purpose of this study was to test a hypothetical model of chemotherapy-related cognitive impairment (CRCI) and depression in people with gastrointestinal cancer. METHODS A purposive sample of 198 patients undergoing chemotherapy was recruited from November 2014 to July 2015. The instruments were Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module. Data were analyzed using descriptive statistics, correlation, and path analysis. RESULTS CRCI was directly affected by cancer symptoms (β=.19, p=.004) and fatigue (β=.56, p<.001)(R²=47.2%). Depression was directly affected by fatigue (β=.48, p<.001) and CRCI (β=.27, p<.001). However, The impact of cancer symptoms on depression was confirmed through the mediating effect of CRCI. CONCLUSION Results indicate that in patients with gastrointestinal cancer undergoing chemotherapy along with the direct physiologic effects (fatigue, symptoms) of cancer treatment may have altered cognitive function leading to depression.

[Meta-analysis of psychosocial interventions to reduce pain in patients with cancer].

PURPOSE The purpose of this study was to investigate the effects of psychosocial interventions on pain in cancer patients. METHODS Eight studies published between 1980 and 2012 in Korean and ten studies published between 2002 and 2012 in English met the inclusion criteria with a total of 1539 participants. Methodological quality assessed by Cochranes Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. The data were analyzed by the RevMan 5.2 program of Cochrane library. RESULTS Overall, study quality was moderate to high. Effect sizes were heterogeneous and subgroup analysis was done. Cognitive behavioral therapy (CBT) were effective for pain (ES= -0.35; 95% CI= -0.56, -0.13). Pain education studies measured with NRS and VAS were effective for pain (ES= -0.77; 95% CI= -1.01, -0.52). Publication bias was not detected. CONCLUSION This study support the use of psychosocial interventions administered to cancer patients for their pain management. However, more well-designed studies are needed.

Meta-analysis of psychosocial interventions on survival time in patients with cancer

Objective: This study was to evaluate the effects of psychosocial interventions on survival in adult patients with cancer. Method: MEDLINE via PubMed, Cochrane Library CENTRAL, CINAHL, and Korean electronic databases (September 2014) were searched. Methodological quality was assessed using Cochrane’s Risk of Bias for randomized studies. The RevMan 5.3 program of the Cochrane library was used for data analysis. Results: Fifteen randomized controlled trials met the inclusion criteria, with a total of 2940 participants. Overall, psychosocial interventions was not associated with better survival (HR = .83, 95% CI [.68, 1.10], p = .06, I2 = 64%). In subgroup analysis, based on six trials with 1448 subjects, psychoeducational interventions for cancer patients with non-metastatic at intervention implementation resulted in a 41% reduction in the risk of dying of cancer (HR = .59, 95% CI [.49, .71], p < .001, I2 = 0%). For psychoeducational intervention, significant survival benefit were found when health staff delivered the intervention and at a follow-up time of more than 10 years. Conclusions: Use of psychoeducational interventions for cancer patients at early stage appeared to have beneficial effects on survival, preferably for delivering of health staff. However, conduct of further psychosocial studies with adequate power will lead to better understanding of the effects of treatments on survival outcome.

[Chemotherapy-related Cognitive Impairment and Quality of Life in People with Colon Cancer: The Mediating Effect of Psychological Distress].

PURPOSE The purpose of this study was to test the mediating effect of psychological distress in the relationship between chemotherapy related cognitive impairment (CRCI) and quality of life (QOL) in people with cancer. METHODS A purposive sample of 130 patients undergoing chemotherapy was recruited for the cross-sectional survey design. Data were collected from November 2014 to June 2015. The instruments were K-MMSE (Korean Mini-Mental State Examination), Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). Data were analyzed using descriptive statistics, correlation, and multiple regression using Baron and Kenny steps for mediation. RESULTS The mean score for objective cognitive function was 27.95 and 69.32 for perceived cognitive decline. Overall quality of life was 91.74. The mean score was 17.52 for psychological distress. The prevalence was 56.2% for anxiety and 63.1% for depression, and 20.0% for CRCI. There were significant correlations among the variables, objective cognitive function and self-reported cognitive decline, psychological distress, and quality of life. Psychological distress was directly affected by CRCI. (R²=29%). QOL was directly affected by CRCI. Psychological distress and CRCI effected QOL (R²=43%). Psychological distress had a partial mediating effect (β=-.56, p<.001) in the relationship between self-reported cognitive decline and quality of life (Sobel test: Z=-5.08, p<.001). CONCLUSION Based on the findings of this study, nursing intervention programs focusing on managing cognitive decline, and decreasing psychological distress are highly recommended to improve quality of life in cancer patients.

Menopause Symptoms and Perceived Cognitive Decline in Menopausal Women: The Mediating Effect of Health Promotion Behavior

Purpose: The purpose of this study was to assess the relationship between menopausal symptoms and decline in cognitive functioning of menopausal women with mediating effects of health promoting behavior. Methods: Using a convenience sampling, 140 menopausal women were recruited for the cross-sectional survey. Data were collected by using the Menopause Rating Scale, Health Promoting Lifestyle Profile, Everyday Cognition, and Korean Mini-Mental State Examination. Results: The mean scores for menopausal symptoms, health promotion behavior, and subjective cognitive decline were 14.40, 153.79, and 67.40 respectively. Health promotion behavior was directly affected by menopausal symptom (R=8%). Cognitive decline was directly affected by menopausal symptom (R=11%). Menopausal symptom (β=.33, p<.001) and health promotion behavior (β=-.21, p=.014) were found to be predictive factors in subjective cognitive decline and explained 14%. Health promotion behavior had a partial mediating effect in the relationship between menopausal symptom and perceived cognitive decline (Sobel test: Z=2.05, p=.040). Conclusion: Based on the findings of this study, developing nursing intervention programs focusing on decreasing menopausal symptoms and encouraging health promotion behavior are recommended to improve cognitive decline in menopausal women.