Cancer

Background: It is stated that the communication and disease experiences of paediatric patients, especially paediatric oncology patients, with healthcare professionals are completely different from those of adults. Objective: The aim of this study was to determine the definitions of a good physician and good nurse provided by elementary school-age oncology patients. Research design: In this qualitative research, data were collected through semi-structured individual interviews. The data were evaluated thorough thematic analysis. Participants and research context: Eighteen children hospitalised due to cancer (...) in paediatric oncology and haematology clinics of a university hospital in Turkey. Ethical considerations: Permission to conduct the study was obtained from the Institution’s Ethics Committee. The objectives of this study were explained to the participants and families, and written consent was obtained from them. Also, participants were assured that necessary measures would be taken to protect their anonymity and confidentiality. Findings: The definitions of children were based on five main themes: interpersonal relationships, virtues, professional responsibility, security and individual characteristics. Conclusion: Children conveyed important messages to health professionals. They emphasised that a good physician and good nurse should communicate well, not only with themselves but also with their family. In addition, children were sensitive about health professionals who played with them and actively participated in the treatment by informing them about the disease. Meeting the expectations of children can be possible by improving the communication skills of physicians and nurses and by adding games and activities to the treatment and care plan. (shrink)

There is a lot of conceptual engineering going on in medical research. I substantiate this claim with two examples, the medical debate about cancer classification and about obesity as a disease I also argue that the proper target of conceptual engineering in medical research are experts’ conceptions. These are explicitly written down in documents and guidelines, and they bear on research and policies. In the second part of the chapter, I propose an externalist framework in which conceptions have both the (...) explanatory power of psychological concepts and that of semantic concepts. It is likely, however, that human activities and practices distinct from medical research, and regulated by different practices and epistemic rules, call for different targets for conceptual engineering. I conclude with indicating an open agenda of problems for philosophers of medicine interested in conceptual engineering. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Dying is DifficultClarice DouilleHayden had been a constant in my life since I was eight, as our families were close. He was a single dad who loved to talk and always had a smile on his face. He was obsessed with anything related to his kids and attended every school activity or sporting event.In 2015, Hayden was diagnosed with stage III colon cancer. He was adamant that he didn't (...) want to share any information about his condition with his kids, waiting several months until the eve of his first surgery before breaking the news to them. Hayden made the operation seem trivial and underplayed the severity of the chemotherapy treatments that would follow. Despite whatever he was feeling, he seemed committed to maintaining his happy demeanor, which was probably an effort to convince himself and others to feel better about the situation.Hayden survived his first operation and rounds of chemotherapy. And, over the next several years, he chose to undergo a regimen of additional aggressive treatments, submitting to surgery after surgery, as well as several more rounds of chemotherapy, followed by radiation treatments. I was already working as a home care aide, and because of the close relationship between our families, Hayden asked me to help as his caregiver, including running errands and babysitting for his younger kids. Hayden made it clear that he wanted his kids to remain ignorant of the progression of his condition so that they wouldn't worry and become anxious. It seemed he was motivated by his desire to preserve his young kids' happiness and innocence. In hindsight, I think this prevented his kids from being able to fully savor moments with their dad or prepare for the possibility of his death. I also think Hayden was trying to shelter himself from his own fear of mortality. And it was this fear that made Hayden a "difficult patient."Hayden suffered both physically and mentally, not only from his disease and treatment but also from his fear of mortality. I noticed how he tried to hide his suffering by shutting himself in his bedroom and making excuses when he wasn't eating. He often forgot to take his medications; he refused to use pill boxes and objected to reminders from others. The consequences often meant additional hospitalizations. I wish more palliative options had been introduced to him earlier in his disease course. I believe a palliative care team would have encouraged Hayden to think about and discuss death, helped him change his outlook for treatment and living with cancer, and most importantly, enabled him to better enjoy the remainder of his life with his kids.Nevertheless, I understood why Hayden was worried about his kids, and I could see how his recent personal experiences since his initial diagnosis might have contributed to his choice for the most aggressive treatments: his sister and both his parents had died, leaving no other relatives to care for his kids. He wanted to be there for his kids, yet the side effects of treatment made him so sick that he couldn't leave his bed. He couldn't even do the very activities that made him want to live.Hayden was an extremely social person, but when he found out his cancer was terminal, he [End Page E6] isolated himself from his loved ones for nearly six weeks. Even though I was likely the only person he was communicating with, as the person who helped him and his family, I often didn't see him for weeks at a time. He would text me requests, leave money on the front table, and ask me to drop off the items I purchased and then leave. Hayden's kids continued their daily routines, despite comments from them about his absence.In early August 2020, Hayden was admitted to the hospital. His doctor called the kids at home and told them that their dad would immediately be enrolled in hospice care. They were, as one might expect, shocked at this news. They knew their dad was sick and had been dealing with his cancer for years. But Hayden's health deteriorated slowly, and the kids hadn't known... (shrink)

Cancer biologists ascribe normal functions to parts of cancer. Normal functions are activities that parts of systems are in some minimal sense supposed to perform. Cancer biologists’ finding normality within the abnormality of cancer pose difficulties for two main approaches to normal function. One approach claims that normal functions are activities that parts are selected for. However, some parts of cancers that have normal functions aren’t selected to perform them. The other approach claims that normal functions are part-activities typical for (...) the system and that contribute to survival/reproduction. However, cancers are too heterogeneous to establish what’s typical across a type. (shrink)

Cancer biology features the ascription of normal functions to parts of cancers. At least some ascriptions of function in cancer biology track local normality of parts within the global abnormality of the aberration to which those parts belong. That is, cancer biologists identify as functions activities that, in some sense, parts of cancers are supposed to perform, despite cancers themselves having no purpose. The present paper provides a theory to accommodate these normal function ascriptions—I call it the Modeling Account of (...) Normal Function (MA). MA comprises two claims. First, normal functions are activities whose performance by the function-bearing part contributes to the self-maintenance of the whole system and, thereby, results in the continued presence of that part. Second, MA holds that models of system-level activities that are (partly) constitutive of self-maintenance are improved by including a representation of the relevant function-bearing part and by making reference to the activity/activities that part performs which contribute(s) to those system-level activities. I contrast MA with two other accounts that seek to explicate the ascription of normal functions in biology, namely, the organizational account and the selected effects account. Both struggle to extend to cancer biology. However, I offer ecumenical readings which allow them to recover some ascriptions of normal function to parts of cancers. So, though I contend that MA excels in this respect, the purpose of this paper is served if it provides materials for bridging the gap between cancer biology, philosophy of cancer, and the literature on function. (shrink)

Since its initial publication in 2018, Professor Anya Plutynski’s Explaining Cancer: Finding Order in Disorder has garnered a great deal of accolades.1 In 2021, The London School of Economics and Political Science conferred Professor Plutynski the Lakatos Award, recognizing the book’s significant contribution to the philosophy of science. On the heels of its recent reissuing as a paperback, it is an ideal time to revisit this remarkable work.

Canguilhem’s take on the normal and the pathological offers an interesting insight to elaborate on a phenomenological account of illness and the medical encounter within the scope of Heidegger’s Daseinanalysis from Being and Time. Fredrik Svenaeus has drawn from the latter a definition of illness as an “unhomelike being in the world”. In this paper, I will elaborate on these concepts through the tale of Adriana, a cancer fighter that got diagnosed at age 26. Through her story, I will try (...) to illustrate Canguilhem’s main criticism against medicine's current state, as well as describe phenomenologically what it means to be ill, and what illness does to the patient's being-in-the-world. (shrink)

Lung cancer is a serious and deadly disease that affects the lungs, which are responsible for taking in oxygen and expelling carbon dioxide from the body. The disease can develop in any part of the lungs and is usually caused by smoking or exposure to certain chemicals. The main Objective: of this expert system is to provide an accurate diagnosis of lung cancer and the appropriate treatment options. In this paper, Methods: we present the design and implementation of an expert (...) system that can assist physicians in diagnosing lung cancer and determining the best course of treatment. The system provides an overview of the disease, its causes, symptoms, diagnosis, and treatment, along with relevant medical information. Results: The system was developed using the Clips expert system language and evaluated by medical professionals who found it to be an effective tool for diagnosing and treating lung cancer. Conclusion: The proposed expert system has the potential to improve patient outcomes and reduce healthcare costs associated with the treatment of lung cancer. (shrink)

Recent years have seen an emergence of the field of comparative cancer genomics. However, the advancements in this field are held back by the hesitation to use knowledge obtained from human studies to study cancer in other animals, and vice versa. Since cancer is an ancient disease that arose with multicellularity, oncogenes and tumour‐suppressor genes are amongst the oldest gene classes, shared by most animal species. Acknowledging that other animals are, in terms of cancer genetics, ecology, and evolution, rather similar (...) to humans, creates huge potential for advancing the fields of human and animal oncology, but also biodiversity conservation. Also see the video abstract here: https://youtu.be/UFqyMx5HETY. (shrink)

It has not been established how to assess children’s and adolescents’ decision-making capacity (DMC) and there has been little discussion on the way their decision-making (DM). The purpose of this study was to examine actual situation and factors related to difficulties in explaining their disease to adolescent cancer patients or obtaining informed consent (IC). The cross-sectional questionnaire survey was conducted. Physicians who have been treating adolescent cancer patients for at least five years answered a self-administered questionnaire uniquely developed about clinical (...) difficulties in explaining, IC and factors related patient’s refusal of medical treatment (RMT). Descriptive statistics for each item and a polychoric correlation analysis of the problems and factors related to the explanation were conducted. As a result, fifty-six physicians were participated (rate of return: 39%). Explaining the disease and treatment to patients (83.9%), IC to patients (80.4%), and explaining the disease and treatment to parents (78.6%) was particularly problematic. Difficulties to provide support related with patient’s refusal of medical treatment and to explain disease and treatment for patient and parents were related to difficulties obtaining IC for the patient. Conclusion: There are clinically difficult to explain for the patient or parents and to obtain IC for the patient. It is necessary to establish a disease acceptance assessment tool for the adolescence generation so that it can be applied in the field. (shrink)

ObjectivePreviously Mindfulness-Based Swinging Technique 's immediate efficacy for overcoming psychological concerns has recently received empirical support, yet its longer-term efficacy needed to be evaluated among women with breast cancer. The objective of this study was to assess and report the efficacy of MBST intervention among breast cancer patients for hopelessness, anxiety, depression, self-efficacy, oxygen intensity, and heart rate-beats per minute at an 8-week period.MethodThe State-Trait Anxiety Inventory, The Emotion Thermometer, Hospital Anxiety and Depression Scale, Self-Efficacy for Managing Chronic Disease, and (...) Beck's Hopelessness Scale were used for assessing the intervention's outcome; 149 BC patients were randomly assigned into two groups. The participants in the control group received Cognitive Behavioural Therapy -Cognitive-Disputation for 20 min, and intervention group received MBST intervention. No additional psychological interventions were given between week-1 and week-8.ResultOutcomes of the 8-week post-treatment follow-up exhibited significantly higher improvements in all evaluated-measurements for CG, and some for IG with large effect size in the following: anxiety and depression levels. It increased self-efficacy for managing disease and hopefulness, and saturation levels measured by pulse-meter/oximeter.ConclusionsBoth CBT-CD and MBST have been found to be efficacious interventions to shorten the psychotherapy duration for reducing clinical anxiety and hopelessness as well as increase self-efficacy for BC women. This may have a distinct clinical importance for supporting BC patient's adherence-to-treatment since CBT-CD could be an alternative technique to MBST as a brief intervention. In future studies, the effectiveness of MBST through adapting to virtual reality and other online delivery methods should be examined. (shrink)

The emotional experience and the type of communication about cancer within the family are important factors for successful coping with pediatric oncology. The main purpose is to study mother’s and children’s emotional experiences concerning cancer, whether they communicate openly about the disease, and relationships between the type of communication and the different emotions expressed by the children. Fifty-two cancer patients aged 6–14 years and their mothers were interviewed in separate sessions about the two central themes of the study: emotional experiences (...) and type of communication. Analyses of response categories were performed to subsequently compare the age-groups and the mother–child responses. According to the results, mothers expressed emotions such as fear, sadness, or anxiety, while children report sadness, pain, but also happiness. Significant positive correlations were observed between mothers’ sadness and older children’s sadness, mothers’ anxiety and children’s fear, and mothers’ anxiety and children’s happiness. Regarding communication type, mothers tend to hide information about the disease from younger children and to provide direct information to the older children. Children usually prefer to communicate their concerns to parents; however, children whose mothers convey anxiety are more likely to prefer to communicate with others. These results support the idea that parents should talk honestly with their children, explaining their illness in an age-appropriate way, and encouraging them to share their emotional experiences. Further studies are needed from a developmental perspective to understand the disease management of children and families. (shrink)

Built-in decision thresholds for AI diagnostics are ethically problematic, as patients may differ in their attitudes about the risk of false-positive and false-negative results, which will require that clinicians assess patient values.

Objective: Hashimoto’s thyroiditis is the most common autoimmune thyroid disease. Papillary thyroid cancer is the most common thyroid cancer. Whether Hashimoto’s thyroiditis is a predisposing factor for papillary thyroid cancer remains unclear. In this study, the frequency of papillary thyroid cancer was investigated in patients with Hashimoto’s thyroiditis who underwent total thyroidectomy. -/- Methods: In this study, 534 patients were screened retrospectively. Preoperative thyroid function tests, anti-thyroid antibodies, ultrasonography findings, fine-needle aspiration biopsies, and thyroidectomy pathology results were examined. According to (...) the pathology, 139 patients had Hashimoto’s thyroiditis. Patients with Hashimoto’s thyroiditis (group 1) and non-Hashimoto’s thyroiditis (group 2) were compared. -/- Results: Papillary thyroid cancer was found in 70 patients (50.4%) in group 1 and 156 patients (39.5%) in group 2 (P=.026). The odds ratio was 1.59 (95% CI; 1.07-2.34). There was no difference for sex, age, tumor size, microcarcinoma–macrocarcinoma distribution, subtype, number of tumor focus, lymph node metastasis, vessel invasion, and extrathyroidal spread. -/- Conclusion: We found more papillary thyroid cancer and less capsular invasion in patients with Hashimoto’s thyroiditis, but we did not find any differences between groups in terms of age, gender, tumor size, vascular invasion, and metastasis. According to these findings, Hashimoto’s thyroiditis may be a risk factor for papillary thyroid cancer. (shrink)

ObjectiveThe study aimed to assess the level of disease acceptance as well as the wellbeing and emotions that accompany cancer patients during the COVID-19 pandemic.Materials and MethodsThe study involved 1,000 patients of the oncology centers. The following questionnaires were used for the study: WHO-5–Well-Being Index, BDI–Beck Depression Inventory, disease acceptance scale, and proprietary multiple-choice questions regarding the impact of the epidemic situation on the respondents’ lives so far. The questionnaire study was conducted twice: in March-October 2020 and March-October 2021. The (...) differences between the given periods were statistically analyzed.ResultsAt the time of the study, the respondents felt mainly anxiety related to the possibility of contracting COVID-19, the possibility of infecting a loved one, or staying in quarantine. Anxiety was also caused by the vision of poorer access to health services. Along with the duration of the epidemic, the acceptance of neoplastic disease has decreased and the incidence of depressive symptoms has increased.ConclusionThe wellbeing of the respondents deteriorated significantly during the pandemic. The respondents, in their daily functioning, were mainly accompanied by anxiety. The risk of depression has increased and the acceptance of the disease has decreased significantly. (shrink)

It is not uncommon for families to wait in hopes of receiving test results that show a treatable mutation, such as in the case of lung cancer. Waiting for such test results can distract families from focusing on a patient’s current pain and suffering, especially when families experience heightened emotions and anticipatory grief. The substituted judgement standard can be helpful in resolving ethical dilemmas by encouraging families to think about what decision a patient would have made if competent, thus preventing (...) unnecessary pain and suffering. This case study sheds light on how the substituted judgement standard was used with a patient’s family and how the family’s hope for a treatable mutation affected their perception of the patient’s clinical condition. (shrink)

BackgroundAt the start of 2021, oncologists lacked the necessary scientific knowledge to adapt their clinical practices optimally when faced with cancer patients refusing or reluctant to be vaccinated against COVID-19, despite the marked vulnerability of these patients to severe, and even fatal forms of this new viral infectious disease. Oncologists at Foch Hospital were confronted with this phenomenon, which was observed worldwide, in both the general population and the population of cancer patients.MethodsBetween April and November 2021, the Ethics and Oncology (...) Departments of Foch Hospital decided to investigate this subject, through an empirical and interdisciplinary study in bioethics. Our scientific objective was to try to identify and resolve the principal bio-ethical issues, with a view to improving clinical practices in oncology during future major pandemics of this kind, from a highly specific bio-ethical standpoint. We used a mainly qualitative methodological approach based on questionnaires and interviews.ResultsIn April 2021, 29 cancer patients refused or were reluctant to be vaccinated. Seventeen of these patients said that making vaccination mandatory would have helped them to accept vaccination. In October 2021, only 10 cancer patients continued to maintain their refusal. One of the main reasons for the decrease in refusals was probably the introduction of the “pass sanitaire” in July 2021, which rendered vaccination indispensable for many activities. However, even this was not sufficient to convince these 10 cancer patients.ConclusionWe identified a key bio-ethical issue, which we then tried to resolve: vaccination policy. We characterized a major tension between “the recommendation of anti-COVID-19 vaccination” and “free will”, and the duty to “protect each other”. Mandatory vaccination, at least in France, could resolve this tension, with positive effects on quality of life, or survival, in cancer patients initially refusing or reluctant to be vaccinated, but only if collective and individual scales are clearly distinguished. (shrink)

Lockdown measures in response to the COVID-19 pandemic involve placing huge burdens on some members of society for the sake of benefiting other members of society. How should we decide when these policies are permissible? Many writers propose we should address this question using cost-benefit analysis, a broadly consequentialist approach. We argue for an alternative non-consequentialist approach, grounded in contractualist moral theorising. The first section sets up key issues in the ethics of lockdown, and sketches the apparent appeal of addressing (...) these problems in a CBA frame. The second section argues that CBA fundamentally distorts the normative landscape in two ways: first, in principle, it allows very many morally trivial preferences—say, for a coffee—might outweigh morally weighty life-and-death concerns; second, it is insensitive to the core moral distinction between victims and vectors of disease. The third section sketches our non-consequentialist alternative, grounded in Thomas Scanlon’s contractualist moral theory. On this account, the ethics of self-defence implies a strong default presumption in favour of a highly restrictive, universal lockdown policy: we then ask whether there are alternatives to such a policy which are justifiable to all affected parties, paying particular attention to the complaints of those most burdened by policy. In the fourth section, we defend our contractualist approach against the charge that it is impractical or counterintuitive, noting that actual CBAs face similar, or worse, challenges. (shrink)

The coronavirus disease 2019 pandemic had a negative psychological impact on the population at scale, yet it is possible that vulnerable patient populations may experience a heavier burden with increased feelings of anxiety and distress. Cancer patients have to trade-off between the fear of exposing themselves to the virus and the need to continue life-saving medical procedures. The present study investigated the prevalence of generalized anxiety and post-traumatic stress symptoms in a population of Italian cancer patients and healthy participants in (...) the months following the COVID-19 outbreak. Using standardized measures of PTSS and generalized anxiety, we found that patients experienced higher levels of adverse mental health outcomes. Several variables were found to negatively affect PTSS and anxiety in this population, including the younger age of respondents, having children, and the impossibility to attend regular medical check-ups. These findings stress the importance of maintaining a clear and regular communication with patients throughout future waves of the pandemic and ensure continuity of care in this vulnerable population. Furthermore, this study indicates the need to establish psychological interventions aimed at patients with cancer, targeting especially younger generations who are more likely to experience adverse psychological outcomes. (shrink)

BackgroundThe impact of a cancer diagnosis may be traumatic, depending on the psychological resources used by patients. Appropriate coping strategies are related to better adaptation to the disease, with coping flexibility, corresponding to the ability to replace ineffective coping strategies, demonstrated to be highly related with self-efficacy to handle trauma. The Perceived Ability to Cope with Trauma scale is a self-rated questionnaire that assesses the perceived ability to cope with potentially traumatic events, providing a measure of coping flexibility. The current (...) study aimed at examining the psychometric properties of the PACT Scale in Portuguese patients with breast cancer.MethodsThe study included 172 patients recently diagnosed with early breast cancer. Participants completed a Portuguese version of the PACT scale, and instruments of self-efficacy for coping with cancer, of quality of life, and of psychological distress that were used as convergent and divergent measures, thus assessing construct validity. A confirmatory factor analysis was performed to test the factor structure of the Portuguese version of PACT scale and reliabilities were examined.ResultsResults from the CFA confirmed the two-factor structure, consistent with the original Forward and Trauma focus subscales. The two subscales demonstrated high internal consistencies. Convergent and divergent validities were confirmed: the PACT scale was related to high self-efficacy to cope with cancer, to high perceived quality of life, and to low psychological distress.DiscussionOverall, the current results support and replicate the psychometric properties of the PACT scale. The scale was found to be a valid and reliable self-reported measure to assess Portuguese breast cancer patients regarding beliefs about their capabilities in managing the potentially traumatic sequelae of cancer. The PACT is a simple and brief measure of coping flexibility to trauma, with potential relevance for application in clinical and research settings. (shrink)

Narrative analysis is well established as a means of examining the subjective experience of those who suffer chronic illness and cancer. In a study of perceptions of the outcomes of treatment of cancer of the colon, we have been struck by the consistency with which patients record three particular observations of their subjective experience: the immediate impact of the cancer diagnosis and a persisting identification as a cancer patient, regardless of the time since treatment and of the presence or absence (...) of persistent or recurrent disease; a state of variable alienation from social familiars, expressed as an inability to communicate the nature of the experience of the illness, its diagnosis and treatment; and a persistent sense of boundedness, an awareness of limits to space, empowerment and available time. These subjectivities were experienced in varying degree by all patients in our study. Individual responses to these experiences were complex and variable. The experiences are best understood under the rubric of a category we call “liminality”. We believe that all cancer patients enter and experience liminality as a process which begins with the first manifestations of their malignancy. An initial acute phase of liminality is marked by disorientation, a sense of loss and of loss of control, and a sense of uncertainty. An adaptive, enduring phase of suspended liminality supervenes, in which each patient constructs and reconstructs meaning for their experience by means of narrative. This phase persists, probably for the rest of the cancer patient’s life. The experience of liminality is firmly grounded in the changing and experiencing body that houses both the disease and the self. Insights into the nature of the experience can be gained from the Existentialist philosophers and from the history of attitudes to death. Understanding liminality helps us to understand what it is that patients with cancer seek from the system to which they turn for help. Its explication should therefore be important for those who provide health care, those who educate health care workers and those concerned to study and use outcomes as administrative and policy making instruments. (shrink)

BackgroundParents affected by cancer are confronted with challenges such as communicating with their children about the disease and dealing with changes in their parental role. Providing appropriate information could support affected parents and their children. Still, high-quality and information booklets are rare. Therefore, we developed an information booklet for affected families. The study aims are: investigating the acceptability and usability of the information booklet, determining parental information needs, and collating suggestions for implementation. Finally, we adapted the booklet according to the (...) findings.MethodsWe interviewed five experts in psychosocial care of parental cancer and nine affected parents using a semi-structured interview guideline. Participants received the developed booklet after giving the consent to participate. Interviews on acceptability and usability of the booklet and information needs were conducted about 1 week after receiving the booklet. The interviews were analyzed using structuring content analysis.Results Experts and parents reported that the information booklet addresses the experiences of affected families and that the content combination makes it useful in an unprecedented way indicating both acceptance and usability. Following dimensions were identified as information needs: communication, support offers, children’s disease understanding and needs, organization of family life, competence in parenting, and sources of additional information material. The booklet should be handed out personally by, e.g., healthcare professionals and might be accompanied by a personal counseling. Minor adaptations on language and content were conducted based on the findings.ConclusionIndicated acceptance and usability of the developed information booklet for parents with cancer suggest a low-threshold, basic support for affected families and health professionals. The diverse parental information needs are covered. The long-term effects of the booklet, e.g., on the use of psychosocial support offers, parental self-efficacy and psychological distress will be quantitatively investigated. (shrink)

IntroductionThe present study aims at analysing how social support received and provided by parents of children, adolescents and young adults (AYA) diagnosed with cancer, as well as their sociodemographic and clinical variables, affect those parents’ stress levels and life and family satisfaction.Materials and MethodsA total of 112 parents of children and AYAs who had been diagnosed with cancer and who received treatment in Malaga participated in the study. In the study, participated all parents who voluntarily agreed to fulfil the questionnaire. (...) The main inclusion criterion was that their child had cancer. Instruments used were Questionnaire on the Frequency of and Satisfaction with Social Support (QFSSS), Paediatric Inventory for Parents (PIP), Life Satisfaction Scale and Family Satisfaction Scale.ResultsIn the mean difference analyses, male parents showed 3.38 (SD = 0.56) in social support received and female parents showedM = 3.08 (SD = 0.72). Conversely, in social support provided, female parents showed 3.22 and male parents showedM = 3.55 (p = 0.020). Significant differences were also found in family satisfaction, where female parents (M = 3.64) feel more satisfied than male parents (M = 3.06;p = 0.027). Parents of children aged between 0 and 14 years (M = 3.06) feel more stress than those parents of children aged 15–21 (M = 2.61;p = 0.021). The correlation analysis shows that there is a negative and significant relation between stress levels experienced by parents when facing different situations related to the child’s disease and both types of support, receivedr = −0.411,p < 0.001 and providedr = −0.282,p < 0.01. There is also a positive and significant relation between life satisfaction and social support receivedr = 0.292,p < 0.01, and social support providedr = 0.409,p < 0.001. There is a positive and significant relation between family satisfaction and social support receivedr = 0.330,p < 0.01, in the same way as with social support providedr = 0.222,p < 0.05. The regression analysis related to stress levels of parents indicates that social support received predicts levels of stress significantlyp < 0.001, with the variable of number of children being the one that showed to be significantp < 0.05. Social support provided showed the most significant resultsp = 0.001, meaning that social support provided increased life satisfaction. Social support received explains family satisfaction (p = 0.50), as it increases the family satisfaction of parents of children with cancer.DiscussionAnalysing social support received and provided, as well as sociodemographic and clinical variables, allowed us to broaden the knowledge on the effect social support has on stress levels, life satisfaction and family satisfaction in parents of children and AYAs diagnosed with cancer. This may have relevant practical implications for the design of interventions that would improve parents’ lives. (shrink)

"The author tells a history of the study of cancer-causing viruses from the early twentieth century to the development of an HPV vaccine for cervical cancer in 2006. He profiles the "cancer virus hunters" who made breakthroughs in tumor virology"--.

Introduction: In 2020, according to the Global Cancer Observatory, nearly 10 million people died of cancer. Amongst all cancers, breast cancer had the highest number of new cases and lung cancer had the highest number of deaths. Even though the literatures suggest a possible connection between psychological factors and cancer risk, their association throughout studies remains inconclusive. The present systematic review studied the connection between psychological factors and the risk of breast and lung cancer, prior to a cancer diagnosis. The (...) psychological factors of trauma, grief, and depression were studied.Methods: The current systematic review was carried out across multiple databases in two phases, an initial exploratory research in June 2020, refined with a second electronic research in December 2020. The inclusion criteria included studies describing the association between trauma, posttraumatic stress disorder, grief, and depression with breast and lung cancer risk. The psychological data collection must have been carried out prior to a confirmed breast or lung cancer diagnosis, and accessed through self-report measures, questionnaires, clinical interviews, or clinical diagnoses. Study reports had to contain information about the incidence of cancer and effect size. The exclusion criteria were studies in which psychological factors were collected after cancer diagnosis.Results and Conclusion: A total of 26 studies were included. Although non-consensual, the findings from the present systematic review suggest that, in addition to the known risk factors, psychological factors may play an important role in the etiology of both breast and lung cancer. To include psychological factors as a variable that affects cancer development may be fundamental to opening new avenues for prevention and intervention.Systematic Review Registration: [www.ClinicalTrials.gov], identifier [CRD42020209161]. (shrink)

Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors with persistent postsurgical pain over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture outcomes were vertical (...) spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open, eyes open relaxed and eyes closed. Assessments were made before and after the Qigong training. The association between categorical variables was measured by Cramer’s V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs. (shrink)

Objective:Prior research examining sexual and intimacy concerns among metastatic breast cancer patients and their intimate partners is limited. In this qualitative study, we explored MBC patients’ and partners’ experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences.Methods:We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with (...) intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software.Results:Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: the heavy disease/treatment burden leads to significant, long-term sexual concerns and consequent heightened emotional distress for both patients and partners ; viewing the relationship as having “an expiration date” influences patients’ and partners’ concerns related to sex/intimacy and complicates coping efforts; and information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences.Conclusion:Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients’ and partners’ perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients’ health and quality of life. (shrink)

IntroductionThe aim of the present study is to carry out a multidimensional analysis on the relation between satisfaction with social support received, resilience and optimism in cancer patients and their quality of life.Materials and MethodsData were gathered through questionnaires fulfilled by 142 cancer patients. Data relate to sociodemographic, health, quality of life, social support, resilience and optimism.ResultsSatisfaction with the sources and types of support, resilience and optimism relates positively with quality of life. Predictive models show that informational support from friends (...) is the variable that most increases patients’ general health, while emotional support from the partner is the one that best improves how patients cope with the disease. In the same line, emotional support from the partner, together with informational support from family are the ones that most contribute to reduce patients’ symptoms. Resilience improves general health and functioning, and reduces symptoms. Patients’ optimism and resilience also reduce symptoms. Gender differences were found, with females showing lower quality of life than males, mainly in how they cope with cancer. Patients in the stage of treatment showed lower quality of life and higher symptoms. Such increase was observed in patients who received hormonotherapy or chemotherapy.DiscussionImportant practical implications can be drawn from results, which could help improve cancer patients’ quality of life through intervention strategies aimed at increasing their resilience, optimism and the social support provided by their closer sources. (shrink)

ContextColon cancer is the 3rd most common cancer in the world. The diagnosis leads the patient and his relatives into a process of mourning for their health and previous life. The literature highlights the impact of the disease on couples. Cancer can either alter or strengthen the relationship. The disease will directly or indirectly affect both partners. Such impact starts with the diagnosis and lasts long after treatments. No study has analyzed both emotional and sexual interactions between partners throughout the (...) illness so far.ObjectiveThis research aims to identify and describe whether congruence within couples tends to improve emotional and sexual adjustment.MethodThirteen couples took part in this research by answering a set of questionnaires investigating, in particular, dyadic coping strategies, marital and sexual satisfaction. Non-parametric analyses were performed on the quantitative data.ResultsEmotional satisfaction is good among the couples in our study. There are important similarities in partners’ emotional adjustment. Patients who are most satisfied with their couple typically have a partner who is also satisfied. This was an expected result based on the literature. Overall, sexual satisfaction is described as average, which is either related to a low frequency of sexual intercourse, or a gap between the ideal and actual frequency of intercourse. In terms of dyadic coping, similarities within couples tend to improve emotional and sexual adjustment. Couples in which communication about stress between the patient and their partner is congruent tend to report good marital satisfaction. We found the same results for delegated coping of both the patient and the partner, and for negative coping of the partner. Sexual adjustment is linked to a similar perception within the couple of a common dyadic coping.ConclusionEmotional and sexual adjustment is largely linked to the quality of the partner’s support. The congruence of couple support strategies has been identified as an important factor in emotional satisfaction. In addition, the more couples implement joint stress management, the better their sexual satisfaction. (shrink)

IntroductionWe aimed to study post-traumatic stress disorder symptoms in breast cancer patients during the coronavirus disease pandemic.Materials and methodsWe included BC patients receiving medical treatment during the first COVID-19 lockdown in France. PTSD symptoms were evaluated using the Impact of Event Scale-Revised questionnaire. Quality of life [Functional Assessment of Cancer Therapy-General ], cognitive complaints [Functional Assessment of Cancer Therapy–Cognitive Function ], insomnia [Insomnia Severity Index ], and psychosocial experiences during lockdown were also evaluated. Multivariable logistic regression was used to identify (...) clinical factors and psychosocial factors associated with PTSD symptoms.ResultsAmong the 253 included BC patients, 46% had metastatic cancer and 52% were treated by chemotherapy alone. COVID-19-induced adjustments in medical oncology practices were experienced by 27% of patients. No case of COVID-19 was reported; 23% of BC patients had PTSD symptoms. Compared to other patients, patients with PTSD symptoms had more fears relative to COVID-19 infection, had more feeling of isolation, and had more prescription or increased use of psychotropic drugs. In the multivariable model adjusted for clinical factors, fears relative to COVID-19 and increased use of psychotropic drugs were independently associated with PTSD symptoms. Besides, patients with PTSD symptoms had poor quality of life, and more cognitive complaints and insomnia.ConclusionPost-traumatic stress disorder symptoms were observed in 23% of BC patients during the first COVID-19 lockdown in France. Psychological supports are needed for patients treated during the COVID-19 pandemic. (shrink)

ObjectiveHormone positive breast cancer patients bear side effects of endocrine therapy and that may be related to depression and anxiety. We sought to find an association between mental health and side effects of endocrine therapy.MethodsA total of 398 patients participated. Sociodemographic, disease profile, and side effects questionnaires were administered. We screened for depressive and anxiety disorders by using the SDS and SAS.ResultsThe prevalence of depression and anxiety in our study were 33.4% and 13.3%, respectively. Depression was linked to education level, (...) night sweats, vaginal dryness, and fatigue ; anxiety was associated with education level, time to diagnosis, osteopenia, loss of hair, and fatigue. A stratified analysis according to age was performed as an exploratory. None of factor-age interactions was statistically significant.ConclusionSide effects of endocrine therapy were significantly associated with anxiety and depression. Side effects deserve greater emphasis and clinical interventions are needed to reduce anxiety and depression in breast cancer patients accepting ET. (shrink)

While cancer survivors commonly experience fear and anxiety, a substantial minority experience an enduring and debilitating fear that their cancer will return; a condition commonly referred to as fear of cancer recurrence. Despite recent advances in this area, little is known about FCR among people from Indigenous or other ethnic and racial minority populations. Given the high prevalence and poor outcomes of cancer among people from these populations, a robust understanding of FCR among people from these groups is critical. The (...) current review identified and aggregated existing literature on FCR amongst adult cancer survivors from Indigenous and minority populations. The protocol of this review was registered with PROSPERO in July 2020. A systematic search of bibliographic databases was conducted for relevant articles published from 1997 to November 2019. Data from eligible articles were extracted and appraised for quality by two independent reviewers. Nineteen articles from four countries met the inclusion criteria, including 14 quantitative, 4 qualitative and 1 mixed-methods study. Only one article reported on an Indigenous population. Few studies reported on FCR prevalence or severity. While the variation in tools used to measure FCR hindered a robust estimate of severity, results suggested some differences in FCR severity between minority and dominant populations, although these may have been due to study metholodological differences. Few factors were reported as being associated with FCR in minorities across multiple studies. The qualitative synthesis found five themes associated with the lived experience of FCR: variations in the lived experience of FCR; spirituality and worldview impacting on FCR; the importance of staying positive; complexities around support; and increasing cancer knowledge. The findings of this review highlight differences in FCR across cultures and contexts, which reinforces the need for culturally-specific approaches to this condition. The dearth of research in this area is of concern given the significant burden of cancer in these populations. A deeper understanding of this condition among Indigenous and minority populations is critical to developing and delivering appropriate and effective psychosocial care for cancer survivors from these groups. Systematic Review Registration: identifier [CRD42020161655]. (shrink)

The oncological disease experience is counted as a wound in the body and mind attributable to a traumatic experience that fragments and disorients the person’s biography. The neoplasia leaves marks and scars in both somatic and existential level. The illness experience suggests to patient to look for meaning that cannot be unheard. The literature associating the concept of liminality in oncological disease to understand the process of meaning making. The definition of new horizons of meaning, generated by crossing the limen, (...) opens up a new self-awareness and worldview. The autopoietic dimension present in oncological disease reveals new scenarios of generativity and existential planning in the direction of self-realization in the cipher of the possible. The contribution presents the story of Anastasia, a 41-years-old nurse. A few months after her new marriage and close to a professional promotion, she receives the diagnosis of cholangiocarcinoma: a very aggressive, low-incidence, neoplasia, without specific therapeutic lines and with a negative prognosis. Anastasia’s words, thoughts and emotions, collected in the course of some testimonies in a university classroom, are analyzed and deciphered within the pedagogical paradigm, refering to the perspective of pedagogical problematicism and phenomenological pedagogy. (shrink)

The coronavirus disease 2019 pandemic has strongly affected oncology patients. Many screening and treatment programs have been postponed or canceled, and such patients also experience fear of increased risk of exposure to the virus. In many cases, locus of control, coping flexibility, and perception of a supportive environment, specifically family resilience, can allow for positive emotional outcomes for individuals managing complex health conditions like cancer. This study aims to determine if family resilience, coping flexibility, and locus of control can mitigate (...) the negative affect caused by the pandemic and enhance positive affect in breast cancer patients. One hundred and fifty-four female patients with breast cancer completed the Walsh’s Family Resilience Questionnaire, the Perceived Ability to Cope With Trauma Scale, the Positive-Negative Affect Schedule, and the Mini Locus of Control Scale. Family resilience and internality of locus of control contribute significantly to positive affective responses. Family resilience is responsible for mitigating the negative affect perceived during the pandemic and is enhanced by external locus of control. Evidence suggests that clinical psychologists should develop and propose programs to support oncology patients’ family resilience, coping flexibility, and internal locus of control, allowing for decreased stress and improved adaptability for effectively managing cancer treatment during the pandemic. (shrink)

Cancer diagnosed during pregnancy is a rare event. The most common type of malignancy diagnosed in pregnant women is breast cancer, whose incidence is expected to raise in the next future due to delayed childbirth, as well as to the increased occurrence of the disease at young age. Pregnant women diagnosed with breast cancer are exposed to multiple sources of stress, which may lead to poorer obstetric outcomes, such as preterm birth and low birth weight. In addition, pregnancy involves physiological (...) changes in the breasts that may blur the signs of cancer, with delayed diagnosis and poor prognosis. However, the lived experience of these women was investigated in very few studies. Given this scenario, we conducted this qualitative study to describe and understand women’s subjective experience of being diagnosed with breast cancer during pregnancy. The study was conducted following the principles of Interpretative Phenomenological Analysis. Participants were five women with breast cancer diagnosed during pregnancy, purposefully recruited at a public hospital during medical visits and interviewed at treatment initiation. The interview transcripts were analyzed using thematic analysis. The textual analysis led to the identification of three main themes related to: the emotional storm experienced after cancer diagnosis, and the importance of receiving appropriate information and being focused on treatment decisions; physical changes and comparisons with healthy women, associated with feelings of sadness and inadequacy; being positive, feeling free to disclose all kinds of emotions, religion and spirituality as sources of strength. The paradoxical coexistence of pregnancy and cancer represents a stressful experience for women and their loved ones. Adopting a systemic perspective may be important to understand the effects of such a complex condition, also considering its impact on healthcare workers. (shrink)

Background: The number of cancer patients is constantly growing. Both WHO and IARC report that this number may reach up to 24 million new diagnosed cases in the next two decades. The proposed treatment and especially the diagnosis can have a significant impact on an individual's approach to the disease, as well as on the patient's quality of life.Objectives: The study aimed to assess the quality of life, feelings, and fear of cancer-treating oncological patients, before and during the COVID-19 pandemic.Material (...) and Methods: The study used the standardized WHOQOL quality of life questionnaire in a shortened version, the COVID-19 fear scale, and the AIS disease acceptance scale. The questionnaire survey was conducted among patients of cancer clinics. The study was conducted in two stages–before the COVID-19 pandemic and during the COVID-19 pandemic. Data from 450 correctly completed questionnaires were analyzed statistically. The obtained data were statistically processed using the Kruskal-Wallis and Mann-Whitney U test.Results: Among the surveyed patients of the cancer clinic, the quality of life during the COVID-19 pandemic decreased by 2%, compared to the period before the pandemic. The frequency of negative feelings associated with cancer increased during the COVID-19 pandemic–by 11% more men, and 4.4% of women determined the frequency of negative feelings to be 2–3 times a week. The level of fear associated with COVID-19 was moderate, with women having a higher level of fear.Conclusion: The development of the epidemic is very important in terms of public health. COVID-19 should be considered as one of the factors that bring about sudden changes in the mental health of the population, which may result from the dynamic development of this disease, dramatic media coverage, and own experiences. It has been shown that the sudden appearance of such a large stressor causes a decrease in patients' quality of life and an increase in negative feelings associated with chronic disease. (shrink)

Previous studies examining EEG and LORETA in patients with chronic pain discovered an overactivation of high theta and low beta power in central regions. MEG studies with healthy subjects correlating evoked nociception ratings and source localization described delta and gamma changes according to two music interventions. Using similar music conditions with chronic pain patients, we examined EEG in response to two different music interventions for pain. To study this process in-depth we conducted a mixed-methods case study approach, based on three (...) clinical cases. Effectiveness of personalized music therapy improvisations versus preferred music on chronic pain was examined with 16 participants. Three patients were randomly selected for follow-up EEG sessions three months post-intervention, where they listened to recordings of the music from the interventions provided during the research. To test the difference of EM versus preferred music, recordings were presented in a block design: silence, their own composed EM, preferred music, and a non-participant’s EM as a control. Participants rated their pain before and after the EEG on a 1–10 scale. We conducted a detailed single case analysis to compare all conditions, as well as a group comparison of entrainment-healing condition versus preferred music condition. Power spectrum and according LORETA distributions focused on expected changes in delta, theta, beta, and gamma frequencies, particularly in sensory-motor and central regions. Intentional moment-by-moment attention on the sounds/music rather than on pain and decreased awareness of pain was experienced from one participant. Corresponding EEG analysis showed accompanying power changes in sensory-motor regions and LORETA projection pointed to insula-related changes during entrainment-pain music. LORETA also indicated involvement of visual-spatial, motor, and language/music improvisation processing in response to his personalized EM which may reflect active recollection of creating the EM. Group-wide analysis showed common brain responses to personalized entrainment-healing music in theta and low beta range in right pre- and post-central gyrus. We observed somatosensory changes consistent with processing pain during entrainment-healing music that were not seen during preferred music. These results may depict top–down neural processes associated with active coping for pain. (shrink)

This chapter focuses on the dual roleDual role of the physician-researcherPhysician-researcher in clinical trialsClinical trial involving childhood cancerCancer. As the cure rate of childhood cancerCancer has improved from less than 10% in the 1950’s to nearly 80% currently, it is important to note that this is due to dedicated empirical collaborative clinical trialsClinical trial, without which these achievements would not have been possible. However, there are several ethical issues involved in childhood cancerCancer research as the disease is life-threatening. These ethical (...) issues include the tension between the dual roleDual role of being clinician-researcher, recruitment issues, and the translation of clinical research findings into clinical care. Other issues such as proxyProxyconsentConsent and therapeutic misconceptionTherapeutic misconception have been discussed in other chapters. (shrink)

Genetic cancer predisposition testing in the paediatric population poses unique ethical dilemmas. Using the hypothetical example of a teenager with cancer with a high probability of having an underlying cancer predisposition syndrome, we discuss the ethical considerations that affect the decision-making process. Because legally these decisions are made by parents, genetic testing in paediatrics can remove a child’s autonomy to preserve his or her own ‘open future’. However, knowledge of results confirming a predisposition syndrome can potentially be beneficial in modifying (...) treatment and surveillance plans and enabling at-risk family members to obtain cascade testing for themselves. Considering virtue ethics to envision the best characters of the patient, parents and healthcare providers can guide them to the better choice to test or not to test, with the ultimate goal of achieving the best outcome for survival andeudaimonia, human flourishing reliably sought out. (shrink)

Prostate cancer (PCa) is one of the the most common cancers in men. A blood test called prostate-specific antigen (PSA) has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of (...) overdiagnosis and overtreatment as part of the screening. The US Preventive Services Task Force (USPSTF) in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55–69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions. (shrink)

PurposeCancer can be a burden on the relationship and even lead to relationship dissolution. Previous studies about the impact of cancer on close relationships almost exclusively involve cancer patients. So far, little is known about the views of spouses. Therefore, this study focuses on partners or ex-partners of cancer patients.MethodsIn this cross-sectional study, N = 265 partners or ex-partners of cancer patients are examined regarding a possible separation, the reasons for separation and the influence of the cancer on the relationship. (...) In addition, predictors of separation and the positive or negative perception of the impact of cancer on the relationship were investigated.ResultsThe separation rate was marginally lower than in the general population in Germany. The most frequent reason for separation was the death of the cancer patient, followed by relationship problems, and the cancer disease itself. Among those who were separated, 57.4% reported that cancer contributed to the separation. On average, the influence of cancer on relationship dissolution is indicated with 82.9%. Also, for those who stayed together, 83.7% reported an impact of the cancer on the relationship, of which 55.9% reported a negative impact. Logistic regressions indicated that higher levels of depression were associated with greater odds of a more negative perception of the influence of cancer on the relationship, whereas a more satisfied relationship tended to be associated with a more positive perception. Those who had no psychological treatment in the past, lower anxiety levels and lower relationship satisfaction had an increased risk of separation. Overall, relationship satisfaction was significantly lower than in the general population in Germany.ConclusionIn particular, psychological factors such as depression and anxiety as well as relationship satisfaction appear to be factors influencing separation and the perception of the influence of cancer on the relationship as positive or negative. Therefore, it seems to be reasonable to consider these aspects in the psychosocial support and also to include the partners in order to achieve a stable and satisfied relationship which has a positive effect on health and psychological well-being. (shrink)

Introduction: Novel coronavirus is having a devastating psychological impact on patients, especially patients with cancer. This work aims to evaluate mood disorders of cancer patients undergoing radiation therapy during COVID-19 in comparison with cancer patients who underwent radiation therapy in 2019.Materials and Methods: We included all the patients undergoing radiation therapy at our department in two-time points and during the COVID-19 outbreak. All the patients were asked to fulfill a validated questionnaire, the Symptom Distress thermometer, and the Beck Depression Inventory (...) v.2. We took into account the COVID-19 outbreak and also sex, age, week of radiation treatment, and disease.Results: We included 458 patients, with a median age of 64 years. STAI-Y1 median score was 40, whereas the median score of SDT was five and BDI-2 median score was 11. STAI-Y1, SDT, and BDI-2 were significantly correlated with the COVID-19 outbreak, sex, week of treatment, and disease.Conclusions: The prevalence of mood disorders in patients undergoing radiation therapy is higher than expected and even higher during the COVID-19 outbreak. These measurements could be useful as a baseline to start medical humanities programs to decrease these scores. (shrink)

ObjectivesDepression and anxiety persist in cancer patients, creating an additional burden during treatment and making it more challenging in terms of management and control. Studies on the prevalence of depression and anxiety among cancer patients in the Middle East are limited and include many limitations such as their small sample sizes and restriction to a specific type of cancer in specific clinical settings. This study aimed to describe the prevalence and risk factors of depression and anxiety among cancer patients in (...) the inpatient and outpatient settings.Materials and MethodsA total of 1,011 patients formed the study sample. Patients’ psychological status was assessed using the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, and the Generalized Anxiety Disorder 7-item scale. The prevalence rate of depressive and anxious symptomatology was estimated by dividing the number of patients who exceeded the borderline score: 10 or more for each subscale of the HADS scale, 15 or more for the GAD-7 scale, and 15 or more in the PHQ-9 by the total number of the patients. Risk factors were identified using logistic regression.ResultsThe prevalence of depressive and anxious symptomatology among all patients was 23.4% and 19.1–19.9%, respectively. Depressive symptomatology was more prevalent across patients who were hospitalized compared with patients in the outpatient setting. Similarly, anxious symptomatology was more prevalent in the inpatient setting. In the inpatient setting, depressive symptomatology was more prevalent among patients with bladder cancer, while severe anxious symptomatology was more prevalent across patients with lung cancer. In the outpatient setting, depressive and anxious symptomatology was more prevalent among breast and prostate cancer patients, respectively. Despite that, around 42.7% and 24.8% of the patients, respectively, reported that they feel anxious and depressed, and only 15.5% of them were using medications to manage their conditions.ConclusionOur study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting and advanced disease stages. In addition, the underutilization of antidepressant therapy was observed. There is a need to consider mental disorders as part of the treatment protocol for cancer patients. Enhanced clinical monitoring and treatment of depression and anxiety of cancer patients are required. (shrink)

Cancer is typically spoken of as a “complex” disease. But, in what sense are cancers “complex”? Is there one sense, or several? What implications does this complexity have – both for how we study, and how we intervene upon cancers? The aim of this paper is first, to clarify the variety of senses in which cancer is spoken of as "complex" in the scientific literature, and second, to discover what explanatory and predictive roles such features play.

Background: Psychological distress is common among patients with cancer, with severe consequences on their quality of life. Anxiety and depression are the most common clinical presentation of psychological distress in cancer patients, but in some cases cancer may represent a traumatic event resulting in posttraumatic stress disorder. Currently, Eye Movement Desensitization and Reprocessing therapy is considered an evidence-based treatment for PTSD, but recent studies also showed its effectiveness for anxiety and depression. The aim of the present systematic review is to (...) summarize the current literature on the effect of EMDR on cancer-related psychological distress.Methods: A literature search was conducted for peer-reviewed articles about “EMDR” and “cancer patients” in the following electronic databases: PubMed, MEDLINE, Science Direct, Google Scholar, and Cochrane library.Results: Our search identified 7 studies in which EMDR was used with a total of 140 cancer patients. The psychiatric diagnosis was PTSD in 3 studies. Otherwise, the diagnosis concerned the anxious and depressive disorder spectrum. Overall, EMDR treatment schedules used were highly heterogeneous, with a different number of sessions and a different duration of therapy. However, across all studies analyzed EMDR therapy was judged to be adequate in reducing symptoms of psychological distress in this population.Conclusions: According to the results of our analysis, the level of evidence regarding EMDR efficacy in cancer patients is limited by the scarcity of studies and their low methodological quality. Although better quality research is needed, available data suggest that EMDR could be a promising treatment for psychological distress in patients with cancer. (shrink)

Cancer patients are interested in complementary and alternative therapies. Providing complementary therapies to them should be based on the four principles of medical ethics. Ignoring these principles creates many ethical challenges in treating these patients. Shared decision-making between physician and patient is essential for the choice of complementary therapies. The use of complementary medicine that does not have the evidence on effectiveness causes that shared decision-making is not based on precise information, and therefore, patient autonomy is not achieved. When the (...) conventional treatment of a cancer patient is replaced by a treatment for which there is no evidence of effectiveness, the principle of beneficence is violated. Failure to follow the basic standards of care in the provision of complementary medicine causes the patient to face profound side effects, indicating a lack of compliance with the principle of nonmaleficence. In the moral analysis of two patients’ treatment, we encounter violations of the principles of medical ethics. The traditional doctor must fully observe the principles of medical ethics in caring for their patients. The need for this is especially significant in patients with complex and severe disease. (shrink)

Introduction. The paper aims to establish whether cancer discourse can alter when being communicated via social networks. We supposed that every platform has intrinsic characteristics which might affect the way certain topics are being delivered. Because there has been much criticism from the cancer community about the media representation, we decided to observe what might be called an alternative discourse of cancer of social networks. Therefore, we chose to review Instagram accounts of two cancer influencers, who aspire to revise existing (...) stereotypes about people with an incurable disease.Methodology and sources. The chosen methodology includes the statistical concordance analysis, Metaphorical Identification Procedure (MIP), structural semantic and syntactic studies of two narratives organized as a minicorpus. The combined approach was employed to reveal lexical markers of both cancer discourse and Instagram narratives in the narratives of two Insta influencers Nicky Newman and Laura Hughes.Results and discussion. The results of the study suggest that Instagram narratives of cancer patients differ from other texts about cancer. Bloggers strive to maintain constant simultaneous communication with a large number of people; therefore, their texts are designed to be entertaining, involving and diverse in subject matter. When narrating about their life with the cancer diagnosis, bloggers broadcast a positive media image of a happygo-lucky person. In the narratives chosen for this study, there is hardly an example of the CANCER-WAR metaphor. The main ways of conceptualizing cancer are the CANCERCONSPIRACY, CANCER-JOURNEY, CANCER-COHABITANT metaphors.Conclusion. Quantitative analysis of the English language corpus aimed at identifying key words and concordances of the lexeme ”cancer”, does not help fully define the cancer discourse. It is necessary to further research into the obtained data. Consequently, it is necessary to take into account the genre of ”cancer” narratives. (shrink)

Religious coping and spiritual struggles were qualitatively analyzed in 15 semi-structured interviews with Norwegian Hodgkin’s disease survivors. We asked, How is religious coping expressed in 15 Norwegian Hodgkin’s disease survivors? The analyses were theory-driven, using religious coping and spiritual struggles theories as explorative tools. Especially we focused on coping processes, coping dynamics, coping styles, and coping activities. The analyses show that religiousness functioned as a positive factor in coping with cancer in 14 of the 15 participants, equally distributed as conservational (...) and transformational coping. The combination of the belief in a good, present God, eventually positive divine power, accessible through prayer, and religious support from people around the participants, were the most prominent activities in the religious coping processes. The religious coping had a character of being collaborative for almost all of the participants. Many participants had severe spiritual struggles. For many of the participants, it was difficult not only to be sick, but also to be a survivor. Theories on religious coping and spiritual struggles were useful and adaptable to a Norwegian sample regarding the main dynamics in the religious coping and spiritual struggles processes. The analyses detected a few different religious coping activities in this Norwegian sample compared to those identified in American samples, with the importance of meeting God in nature as the most significant difference. (shrink)

Background:Doctors should disclose the diagnosis to patients according to the principle of autonomy. However, not disclosing the diagnosis and prognosis to cancer patients remains common in mainland China.Objective:The study explored the experiences and attitudes of patients with cancer, family members, and the medical staff in truth-telling.Research design:A quantitative survey with three closed-ended questionnaires was conducted.Participants:In all, 137 patients with cancer, 134 family members caring for cancer cases, and 54 medical staff were surveyed. Descriptive statistics were used to summarize all characteristics, (...) and the chi-square test was performed to analyze group differences in attitudes toward cancer disclosure.Ethical considerations:This study was approved by the Committee on Ethics of Biomedicine Research, at the Second Military Medical University (HJEC-2018-YF-001). Informed consent was obtained from all participants prior to study commencement.Findings:A total of 59.8% of patients were informed about their diagnosis within 1 week, and 19.7% inferred theirs. The medical staff preferred to prioritize family members in informing about patient diagnosis while 77.4% of patients preferred to be told the whole truth at the time of initial diagnosis. More patients than family members and medical staff wanted the patients to be informed about the diagnosis ( p < 0.001). A significant difference was found between the patients and family members regarding who should tell the patients.Discussion:The willingness of patients in knowing the truth was underestimated by their family members as well as the medical staff. Guessing the truth indirectly may exert negative effects on the patients, and not telling the truth is inappropriate in patients who want to be informed.Conclusion:Disclosure of a cancer diagnosis is a complex process involving medical practice, as well as a range of cultural, ethical, and legal factors. The medical staff should first assess each patient’s willingness in truth-telling and inform about disease diagnosis with respect. Emotional support and comfort from family members are encouraged. Anyone in the patient’s care team, especially nurses, could be integrated in the process of truth-telling. (shrink)