Identifying Patients with Cancer Who Need More Psychosocial Support

TON May 2016 Vol 9 No 3

San Francisco, CA—Preliminary results from a prospective study suggest that assessing psychological factors in cancer patients prior to initiating therapy can identify patients most at risk for emotional distress who might need psychosocial support. This assessment can inform effective screening protocols and individualize treatment planning, say the authors. The study was reported at the 2016 Genitourinary Cancers Symposium.

“Improvements in cancer treatment have led to more survivors and more focus on surviving cancer patients’ quality of life [QOL],” noted lead author Sara J. Walker, PhD, a neuropsychologist at Oregon Health & Science University, Portland. “Survivors often experience psychological stress that impacts their quality of life and disease-related mortality. If you can assess state and trait correlates prior to initiating treatment, you can predict declines in quality of life post-treatment. We were interested in this because we have seen some cancer patients go through the wringer but remain optimistic, while we have seen others go ‘down for the count.’ We hope that identifying those at risk for declines in quality of life can inform developing the best screening practices to identify patients who can benefit from interventions aimed at moderating their response.”

The investigators sought to correlate psychological states and personality traits with QOL prior to radiotherapy in 38 patients with localized nonmetastatic prostate cancer. She explained that state refers to how a person is feeling now, while traits are stable over time. The investigators assessed depressive state using the Patient Health Questionnaire (PHQ-9), anxiety state using the Generalized Anxiety Disorder 7-item (GAD-7) scale, and personality traits (ie, Neuroticism, Extraversion, Openness, Agreeableness, Conscientiousness) using the NEO Five-Factor Inventory-3 (NEO-FFI-3). The Functional Assessment of Cancer Therapy-­Prostate (FACT-P) questionnaire assessed physical, social, emotional, and functional well-being.

Median age was 68 years, and median level of education was 16 years; 86% were European-American, 8% Hispanic-Latino, 3% were African-American, and 3% “Other.”

Participants completed questionnaires between simulated radiation visits and their first day of radiation therapy.

QOL indices fell across a wide range, although average well-being tended to fall in the upper ranges for physical, social, emotional, and functional domains. Depression and anxiety symptoms also fell across a wide range; on average, most patients had mild or minimal depression and anxiety. Personality trait factor scores tended to cluster around the norm, with some scores falling lower (Neuroticism) or higher (Agreeableness).

Extraversion was positively associated with social and functional well-being, as well as well-being related to symptoms of prostate cancer (P <.05 for all 3 comparisons). Contrary to the authors’ original hypothesis, traits of Openness, Agreeableness, and Conscientiousness were not significantly correlated with any QOL domain.

As the authors hypothesized, higher depression and anxiety levels were significantly negatively correlated with physical, emotional, functional, and prostate cancer–specific well-being (P <.001 for all comparisons), as was Neuroticism (P <.01). One surprising finding was that social well-being was not significantly associated with psychological state or trait risk factors.

Next, Dr Walker and colleagues plan to measure prospectively the predictive value of baseline state and trait risk and protective factors on posttreatment QOL, treatment satisfaction, and other outcome measures related to behavioral and physical health.

“Determining if and how baseline state and trait factors affect direct response to psycho-oncologic interventions will also be an important future direction in furthering our ability to offer individual and holistic treatment planning,” the authors wrote.

Reference

Walker SJ, Chen Y, Paik K, et al. Psychological state and trait correlates of quality of life prior to radiotherapy for prostate cancer. Poster presented at: 2016 Genitourinary Cancers Symposium; January 7-9, 2016; San Francisco, CA. Abstract 129.

Related Items


Subscribe Today!

To sign up for our newsletter or print publications, please enter your contact information below.

I'd like to receive: