World Congress Of Psycho-oncology

WASHINGTON – Chalk up one for the little guy: Community cancer programs are better equipped for delivering psychosocial support services than are National Cancer Institute–designated Cancer Programs, investigators contend.

A survey conducted by oncology social workers in 60 large and small cancer programs across North America reveals that significantly more community cancer centers have comprehensive systems in place for screening, assessing, and managing the psychosocial needs of patients with cancer, said Dr. Brad Zebrack from the University of Michigan School of Social Work in Ann Arbor.

“We still have work to do in terms of monitoring quality of care on a systemwide level. There’s still room [for improvement in] educating providers about the value and the importance of psychosocial care, and a lot of work to do in overcoming the observed racial disparities that we’re seeing in the provision of care,” he said at the at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Zebrack reported results of APAQCC (“A Project to Assure Quality Cancer Care”), a multisite study looking at institutional capacity to provide psychosocial services as a function of patient, provider, and institutional characteristics.

The investigators enlisted the help of oncology social workers at 60 accredited cancer programs, including comprehensive cancer center programs, community cancer programs (CCPs), NCI-designated cancer programs (NCIPs), and nondesignated academic medical center–based programs. The social workers administered the 10-item NCI Psychosocial Matrix to a convenience sample of providers at their centers.

The matrix assesses capacity to provide psychosocial services on a scale of 1-5, with 1 signaling that no systematic process is in place, and 5 indicating optimal implementation. The matrix includes 10 items concerning provider-patient communications, patient-needs assessments, care planning and coordination, provider training and education, evaluation of service delivery and patient outcomes, and quality improvement.

A total of 2,491 professionals responded. The sample comprised primary- or mid-level providers, nurses, psychosocial care providers, ancillary care providers, and administrators or managers not directly involved in patient care.

They found that respondents from NCIPs consistently reported significantly lower levels of capacity. For example, 36% of NCIPs reported having multiple mechanisms and multiple opportunities for communicating to cancer patients and their families the importance of psychosocial needs and care, and 47% reported that they communicated about psychosocial care by at least one mechanism at least one time. In contrast, the respective percentages for CCPs were 46% and 51%. In all, 17% of NCIPs had a failing grade on communication, compared with just 3% of CCPs.

CCPs were also better at identifying psychosocial health needs of cancer patients (37% reported the highest level of assessments, and 34% reported at least screening and assessment, compared with 20% and 29% for NCIPs).

Continuity of psychosocial care, measured as the capacity to conduct follow-up, reevaluation, and adjustment of a psychosocial treatment plan, was also highest at CCPs and lowest at NCIPs (30% vs. 18%).

In an analysis of capacity by provider type, the authors found that hospitals with a greater than 30% racial minority population had significantly lower capacity to communicate the importance of psychosocial care (P less than .05). In an analysis by program type, NCIPs were also worse at communicating these ideas than other program types (P less than .05).

Their findings suggest that assessing institutional capacity, monitoring changes in services, and tracking patient outcomes will be required for improvement of the delivery of psychosocial services in cancer programs of all types, Dr. Zebrack said.

The study is supported by the Association of Oncology Social Work with an educational grant from Takeda Oncology. The authors reported having no conflicts of interest.

WASHINGTON – Chalk up one for the little guy: Community cancer programs are better equipped for delivering psychosocial support services than are National Cancer Institute–designated Cancer Programs, investigators contend.

A survey conducted by oncology social workers in 60 large and small cancer programs across North America reveals that significantly more community cancer centers have comprehensive systems in place for screening, assessing, and managing the psychosocial needs of patients with cancer, said Dr. Brad Zebrack from the University of Michigan School of Social Work in Ann Arbor.

“We still have work to do in terms of monitoring quality of care on a systemwide level. There’s still room [for improvement in] educating providers about the value and the importance of psychosocial care, and a lot of work to do in overcoming the observed racial disparities that we’re seeing in the provision of care,” he said at the at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Zebrack reported results of APAQCC (“A Project to Assure Quality Cancer Care”), a multisite study looking at institutional capacity to provide psychosocial services as a function of patient, provider, and institutional characteristics.

The investigators enlisted the help of oncology social workers at 60 accredited cancer programs, including comprehensive cancer center programs, community cancer programs (CCPs), NCI-designated cancer programs (NCIPs), and nondesignated academic medical center–based programs. The social workers administered the 10-item NCI Psychosocial Matrix to a convenience sample of providers at their centers.

The matrix assesses capacity to provide psychosocial services on a scale of 1-5, with 1 signaling that no systematic process is in place, and 5 indicating optimal implementation. The matrix includes 10 items concerning provider-patient communications, patient-needs assessments, care planning and coordination, provider training and education, evaluation of service delivery and patient outcomes, and quality improvement.

A total of 2,491 professionals responded. The sample comprised primary- or mid-level providers, nurses, psychosocial care providers, ancillary care providers, and administrators or managers not directly involved in patient care.

They found that respondents from NCIPs consistently reported significantly lower levels of capacity. For example, 36% of NCIPs reported having multiple mechanisms and multiple opportunities for communicating to cancer patients and their families the importance of psychosocial needs and care, and 47% reported that they communicated about psychosocial care by at least one mechanism at least one time. In contrast, the respective percentages for CCPs were 46% and 51%. In all, 17% of NCIPs had a failing grade on communication, compared with just 3% of CCPs.

CCPs were also better at identifying psychosocial health needs of cancer patients (37% reported the highest level of assessments, and 34% reported at least screening and assessment, compared with 20% and 29% for NCIPs).

Continuity of psychosocial care, measured as the capacity to conduct follow-up, reevaluation, and adjustment of a psychosocial treatment plan, was also highest at CCPs and lowest at NCIPs (30% vs. 18%).

In an analysis of capacity by provider type, the authors found that hospitals with a greater than 30% racial minority population had significantly lower capacity to communicate the importance of psychosocial care (P less than .05). In an analysis by program type, NCIPs were also worse at communicating these ideas than other program types (P less than .05).

Their findings suggest that assessing institutional capacity, monitoring changes in services, and tracking patient outcomes will be required for improvement of the delivery of psychosocial services in cancer programs of all types, Dr. Zebrack said.

The study is supported by the Association of Oncology Social Work with an educational grant from Takeda Oncology. The authors reported having no conflicts of interest.

WASHINGTON – Chalk up one for the little guy: Community cancer programs are better equipped for delivering psychosocial support services than are National Cancer Institute–designated Cancer Programs, investigators contend.

A survey conducted by oncology social workers in 60 large and small cancer programs across North America reveals that significantly more community cancer centers have comprehensive systems in place for screening, assessing, and managing the psychosocial needs of patients with cancer, said Dr. Brad Zebrack from the University of Michigan School of Social Work in Ann Arbor.

“We still have work to do in terms of monitoring quality of care on a systemwide level. There’s still room [for improvement in] educating providers about the value and the importance of psychosocial care, and a lot of work to do in overcoming the observed racial disparities that we’re seeing in the provision of care,” he said at the at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Zebrack reported results of APAQCC (“A Project to Assure Quality Cancer Care”), a multisite study looking at institutional capacity to provide psychosocial services as a function of patient, provider, and institutional characteristics.

The investigators enlisted the help of oncology social workers at 60 accredited cancer programs, including comprehensive cancer center programs, community cancer programs (CCPs), NCI-designated cancer programs (NCIPs), and nondesignated academic medical center–based programs. The social workers administered the 10-item NCI Psychosocial Matrix to a convenience sample of providers at their centers.

The matrix assesses capacity to provide psychosocial services on a scale of 1-5, with 1 signaling that no systematic process is in place, and 5 indicating optimal implementation. The matrix includes 10 items concerning provider-patient communications, patient-needs assessments, care planning and coordination, provider training and education, evaluation of service delivery and patient outcomes, and quality improvement.

A total of 2,491 professionals responded. The sample comprised primary- or mid-level providers, nurses, psychosocial care providers, ancillary care providers, and administrators or managers not directly involved in patient care.

They found that respondents from NCIPs consistently reported significantly lower levels of capacity. For example, 36% of NCIPs reported having multiple mechanisms and multiple opportunities for communicating to cancer patients and their families the importance of psychosocial needs and care, and 47% reported that they communicated about psychosocial care by at least one mechanism at least one time. In contrast, the respective percentages for CCPs were 46% and 51%. In all, 17% of NCIPs had a failing grade on communication, compared with just 3% of CCPs.

CCPs were also better at identifying psychosocial health needs of cancer patients (37% reported the highest level of assessments, and 34% reported at least screening and assessment, compared with 20% and 29% for NCIPs).

Continuity of psychosocial care, measured as the capacity to conduct follow-up, reevaluation, and adjustment of a psychosocial treatment plan, was also highest at CCPs and lowest at NCIPs (30% vs. 18%).

In an analysis of capacity by provider type, the authors found that hospitals with a greater than 30% racial minority population had significantly lower capacity to communicate the importance of psychosocial care (P less than .05). In an analysis by program type, NCIPs were also worse at communicating these ideas than other program types (P less than .05).

Their findings suggest that assessing institutional capacity, monitoring changes in services, and tracking patient outcomes will be required for improvement of the delivery of psychosocial services in cancer programs of all types, Dr. Zebrack said.

The study is supported by the Association of Oncology Social Work with an educational grant from Takeda Oncology. The authors reported having no conflicts of interest.

WASHINGTON – Cancer survivors are almost twice as likely to be taking medication for anxiety, depression, or both, compared with people who have never had cancer, according to investigators from the Centers for Disease Control and Prevention.

Data from a national survey of more than 48,000 adults show that 15.1% of cancer survivors reported taking drugs for anxiety, and 14% reported taking depression medications, compared with 8.7% and 7.9%, respectively, of adults who never had a cancer diagnosis, reported Nikki A. Hawkins, Ph.D., a behavioral scientist in the CDC’s division of cancer prevention and control.

“We do know that there is a large population of cancer survivors in the U.S. taking these medications for anxiety and depression, which likely reflects the elevated emotional burden on this population,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Hawkins and her colleagues examined data from the National Health Interview Survey, a nationwide sample of approximately 35,000 U.S. households containing information on about 87,500 people.

The survey asks whether adult participants ever had cancer, the type, and their age at diagnosis, and includes questions about health behaviors such as smoking, as well as access to health care and utilization of preventive and screening services such as human-papillomavirus vaccination and Pap smear for cervical cancer prevention/detection, mammography for breast cancer screening, and fecal occult blood testing, sigmoidoscopy, or colonoscopy for colorectal cancer screening.

Since 2010, a subset of survey participants has been asked questions about functioning and disability, including physical domains (vision, hearing, mobility, etc.), and affect, including whether they take medications for depression and/or “for feeling worried, nervous, or anxious.”

The investigators included those who took part in the survey from 2010 through 2013, including 3,184 cancer survivors and 44,997 controls (no cancer diagnosis).

Sites of most recent cancer diagnoses include breast (in women), prostate, skin (melanoma), cervix, colorectal, hematologic, ovary/uterus, and other.

In all, 15% of patients had been diagnosed within the past 2 years, 29% from 2 to 5 years, 21% from 6 to 10 years, and 36% 11 or more years (numbers exceed 100% because of rounding).

Nearly twice as many cancer survivors reported taking medication for depression or anxiety, compared with the controls: 18% of survivors reported taking either of the medications, compared with 10.4% of controls. This translates into an estimate for the overall U.S. population of 2,383,954 cancer survivors taking medication for either anxiety or depression, Dr. Hawkins said.

Factors predictive of depression or anxiety medication use among cancer survivors included being female, white, non-Hispanic, age younger than 65 years, having never been married, lower levels of education, having a usual place for medical care, and a having a higher number of chronic health conditions.

With the exception of levels of education, the same factors were also predictive of anxiety and/or medication use among controls, the investigators found.

The study was limited by the use of self-reported survey data, and lack of information on the onset or duration of medication use, specific medications taken, or use of other nonpharmacologic therapies for anxiety or depression, Dr. Hawkins acknowledged.

Nonetheless, “these estimates can serve as a benchmark for medication use among the U.S. cancer survivor population, and moving forward, it will be important to look at the duration and onset of use to see exactly when the increase in medication happens and why it happens at that time,” she said.

WASHINGTON – Cancer survivors are almost twice as likely to be taking medication for anxiety, depression, or both, compared with people who have never had cancer, according to investigators from the Centers for Disease Control and Prevention.

Data from a national survey of more than 48,000 adults show that 15.1% of cancer survivors reported taking drugs for anxiety, and 14% reported taking depression medications, compared with 8.7% and 7.9%, respectively, of adults who never had a cancer diagnosis, reported Nikki A. Hawkins, Ph.D., a behavioral scientist in the CDC’s division of cancer prevention and control.

“We do know that there is a large population of cancer survivors in the U.S. taking these medications for anxiety and depression, which likely reflects the elevated emotional burden on this population,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Hawkins and her colleagues examined data from the National Health Interview Survey, a nationwide sample of approximately 35,000 U.S. households containing information on about 87,500 people.

The survey asks whether adult participants ever had cancer, the type, and their age at diagnosis, and includes questions about health behaviors such as smoking, as well as access to health care and utilization of preventive and screening services such as human-papillomavirus vaccination and Pap smear for cervical cancer prevention/detection, mammography for breast cancer screening, and fecal occult blood testing, sigmoidoscopy, or colonoscopy for colorectal cancer screening.

Since 2010, a subset of survey participants has been asked questions about functioning and disability, including physical domains (vision, hearing, mobility, etc.), and affect, including whether they take medications for depression and/or “for feeling worried, nervous, or anxious.”

The investigators included those who took part in the survey from 2010 through 2013, including 3,184 cancer survivors and 44,997 controls (no cancer diagnosis).

Sites of most recent cancer diagnoses include breast (in women), prostate, skin (melanoma), cervix, colorectal, hematologic, ovary/uterus, and other.

In all, 15% of patients had been diagnosed within the past 2 years, 29% from 2 to 5 years, 21% from 6 to 10 years, and 36% 11 or more years (numbers exceed 100% because of rounding).

Nearly twice as many cancer survivors reported taking medication for depression or anxiety, compared with the controls: 18% of survivors reported taking either of the medications, compared with 10.4% of controls. This translates into an estimate for the overall U.S. population of 2,383,954 cancer survivors taking medication for either anxiety or depression, Dr. Hawkins said.

Factors predictive of depression or anxiety medication use among cancer survivors included being female, white, non-Hispanic, age younger than 65 years, having never been married, lower levels of education, having a usual place for medical care, and a having a higher number of chronic health conditions.

With the exception of levels of education, the same factors were also predictive of anxiety and/or medication use among controls, the investigators found.

The study was limited by the use of self-reported survey data, and lack of information on the onset or duration of medication use, specific medications taken, or use of other nonpharmacologic therapies for anxiety or depression, Dr. Hawkins acknowledged.

Nonetheless, “these estimates can serve as a benchmark for medication use among the U.S. cancer survivor population, and moving forward, it will be important to look at the duration and onset of use to see exactly when the increase in medication happens and why it happens at that time,” she said.

WASHINGTON – Cancer survivors are almost twice as likely to be taking medication for anxiety, depression, or both, compared with people who have never had cancer, according to investigators from the Centers for Disease Control and Prevention.

Data from a national survey of more than 48,000 adults show that 15.1% of cancer survivors reported taking drugs for anxiety, and 14% reported taking depression medications, compared with 8.7% and 7.9%, respectively, of adults who never had a cancer diagnosis, reported Nikki A. Hawkins, Ph.D., a behavioral scientist in the CDC’s division of cancer prevention and control.

“We do know that there is a large population of cancer survivors in the U.S. taking these medications for anxiety and depression, which likely reflects the elevated emotional burden on this population,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Hawkins and her colleagues examined data from the National Health Interview Survey, a nationwide sample of approximately 35,000 U.S. households containing information on about 87,500 people.

The survey asks whether adult participants ever had cancer, the type, and their age at diagnosis, and includes questions about health behaviors such as smoking, as well as access to health care and utilization of preventive and screening services such as human-papillomavirus vaccination and Pap smear for cervical cancer prevention/detection, mammography for breast cancer screening, and fecal occult blood testing, sigmoidoscopy, or colonoscopy for colorectal cancer screening.

Since 2010, a subset of survey participants has been asked questions about functioning and disability, including physical domains (vision, hearing, mobility, etc.), and affect, including whether they take medications for depression and/or “for feeling worried, nervous, or anxious.”

The investigators included those who took part in the survey from 2010 through 2013, including 3,184 cancer survivors and 44,997 controls (no cancer diagnosis).

Sites of most recent cancer diagnoses include breast (in women), prostate, skin (melanoma), cervix, colorectal, hematologic, ovary/uterus, and other.

In all, 15% of patients had been diagnosed within the past 2 years, 29% from 2 to 5 years, 21% from 6 to 10 years, and 36% 11 or more years (numbers exceed 100% because of rounding).

Nearly twice as many cancer survivors reported taking medication for depression or anxiety, compared with the controls: 18% of survivors reported taking either of the medications, compared with 10.4% of controls. This translates into an estimate for the overall U.S. population of 2,383,954 cancer survivors taking medication for either anxiety or depression, Dr. Hawkins said.

Factors predictive of depression or anxiety medication use among cancer survivors included being female, white, non-Hispanic, age younger than 65 years, having never been married, lower levels of education, having a usual place for medical care, and a having a higher number of chronic health conditions.

With the exception of levels of education, the same factors were also predictive of anxiety and/or medication use among controls, the investigators found.

The study was limited by the use of self-reported survey data, and lack of information on the onset or duration of medication use, specific medications taken, or use of other nonpharmacologic therapies for anxiety or depression, Dr. Hawkins acknowledged.

Nonetheless, “these estimates can serve as a benchmark for medication use among the U.S. cancer survivor population, and moving forward, it will be important to look at the duration and onset of use to see exactly when the increase in medication happens and why it happens at that time,” she said.

WASHINGTON – A substantial proportion of cancer patients say they want more information than they are getting about the costs of their care, investigators report.

Of 176 patients currently receiving treatment for cancer, 40.8% said they wanted more information than they were given on the cost of their treatment to society, and 48.7% said they weren’t given enough information about the costs to themselves, said Ashley Varner, manager for psycho-social oncology at the DeCesaris Cancer Institute, Anne Arundel Medical Center in Annapolis, Md.

“It’s very important for clinicians to be thinking that patients may want to know the costs of care, and that patients deserve to have that knowledge as part of the shared decision-making process,” she said in an interview.

It’s no secret that the costs of cancer care are high and climbing ever higher, with annual U.S. expenditures on cancer expected to reach $158 billion by 2020. The strains on budgets are felt by providers and patients alike, with 42%-50% of cancer patients reporting high financial distress, Ms. Varner and colleagues reported in a poster presentation at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To see which factors predicted patients’ desires for information about the costs of their care, the investigators surveyed a convenience sample of 176 patients from the ages of 28 through 87 years (median age 63) who were currently undergoing cancer treatment at a community medical center.

What’s it to you?

The patients were asked with structured questionnaires about their preferences for information and degree of control over medical decisions, and about the information they received from their oncologists, including about the costs of their care. The patients were also asked to estimate their monthly out-of-pocket treatment costs and were screened for psychological distress with the four-item Patient Health Questionnaire on anxiety and depression.

A majority of patients reported that their preferences were met with regard to the information they received about diagnosis (77%), treatment side effects (71.6%), and treatment effectiveness (75%). Similarly, most patients felt they were adequately informed about the chance of cure (65.6%) and life expectancy (56.3%).

But when it came to costs, just over half (52.2%) said they had been given sufficient information about the costs of their care to society, and less than half (47.4%) reported satisfaction with the information they got about the cost of care to them.

People with partners were significantly more likely to want more information about costs than singles, and younger people were significantly more likely to ask to know more than older people (P less than .05 for both comparisons).

“A nuanced assessment of each patient’s psychosocial characteristics, including control preferences and psychological and financial distress is warranted in order to anticipate and meet specific information preferences,” the investigators said.

Asked how clinicians can pluck financial information from the morass of health plan data, Ms. Varner explained that at her center, when a treatment has been decided on – whether chemotherapy, radiation, surgery, targeted agents, or a combination – financial coordinators contact each patient’s insurance company and develop written estimates which they offer to share with the patient at his or her discretion.

“That allows us then to put into place drug replacement programs or other types of assistance. For example, we know that patients who have Medicare only with no supplemental plan are at very high financial risk – they’re going to owe 20% of the cost of care, which is substantial. But there are often some resources that we can tap into if we know that ahead of time,” Ms. Varner said. 


WASHINGTON – A substantial proportion of cancer patients say they want more information than they are getting about the costs of their care, investigators report.

Of 176 patients currently receiving treatment for cancer, 40.8% said they wanted more information than they were given on the cost of their treatment to society, and 48.7% said they weren’t given enough information about the costs to themselves, said Ashley Varner, manager for psycho-social oncology at the DeCesaris Cancer Institute, Anne Arundel Medical Center in Annapolis, Md.

“It’s very important for clinicians to be thinking that patients may want to know the costs of care, and that patients deserve to have that knowledge as part of the shared decision-making process,” she said in an interview.

It’s no secret that the costs of cancer care are high and climbing ever higher, with annual U.S. expenditures on cancer expected to reach $158 billion by 2020. The strains on budgets are felt by providers and patients alike, with 42%-50% of cancer patients reporting high financial distress, Ms. Varner and colleagues reported in a poster presentation at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To see which factors predicted patients’ desires for information about the costs of their care, the investigators surveyed a convenience sample of 176 patients from the ages of 28 through 87 years (median age 63) who were currently undergoing cancer treatment at a community medical center.

What’s it to you?

The patients were asked with structured questionnaires about their preferences for information and degree of control over medical decisions, and about the information they received from their oncologists, including about the costs of their care. The patients were also asked to estimate their monthly out-of-pocket treatment costs and were screened for psychological distress with the four-item Patient Health Questionnaire on anxiety and depression.

A majority of patients reported that their preferences were met with regard to the information they received about diagnosis (77%), treatment side effects (71.6%), and treatment effectiveness (75%). Similarly, most patients felt they were adequately informed about the chance of cure (65.6%) and life expectancy (56.3%).

But when it came to costs, just over half (52.2%) said they had been given sufficient information about the costs of their care to society, and less than half (47.4%) reported satisfaction with the information they got about the cost of care to them.

People with partners were significantly more likely to want more information about costs than singles, and younger people were significantly more likely to ask to know more than older people (P less than .05 for both comparisons).

“A nuanced assessment of each patient’s psychosocial characteristics, including control preferences and psychological and financial distress is warranted in order to anticipate and meet specific information preferences,” the investigators said.

Asked how clinicians can pluck financial information from the morass of health plan data, Ms. Varner explained that at her center, when a treatment has been decided on – whether chemotherapy, radiation, surgery, targeted agents, or a combination – financial coordinators contact each patient’s insurance company and develop written estimates which they offer to share with the patient at his or her discretion.

“That allows us then to put into place drug replacement programs or other types of assistance. For example, we know that patients who have Medicare only with no supplemental plan are at very high financial risk – they’re going to owe 20% of the cost of care, which is substantial. But there are often some resources that we can tap into if we know that ahead of time,” Ms. Varner said. 


WASHINGTON – A substantial proportion of cancer patients say they want more information than they are getting about the costs of their care, investigators report.

Of 176 patients currently receiving treatment for cancer, 40.8% said they wanted more information than they were given on the cost of their treatment to society, and 48.7% said they weren’t given enough information about the costs to themselves, said Ashley Varner, manager for psycho-social oncology at the DeCesaris Cancer Institute, Anne Arundel Medical Center in Annapolis, Md.

“It’s very important for clinicians to be thinking that patients may want to know the costs of care, and that patients deserve to have that knowledge as part of the shared decision-making process,” she said in an interview.

It’s no secret that the costs of cancer care are high and climbing ever higher, with annual U.S. expenditures on cancer expected to reach $158 billion by 2020. The strains on budgets are felt by providers and patients alike, with 42%-50% of cancer patients reporting high financial distress, Ms. Varner and colleagues reported in a poster presentation at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To see which factors predicted patients’ desires for information about the costs of their care, the investigators surveyed a convenience sample of 176 patients from the ages of 28 through 87 years (median age 63) who were currently undergoing cancer treatment at a community medical center.

What’s it to you?

The patients were asked with structured questionnaires about their preferences for information and degree of control over medical decisions, and about the information they received from their oncologists, including about the costs of their care. The patients were also asked to estimate their monthly out-of-pocket treatment costs and were screened for psychological distress with the four-item Patient Health Questionnaire on anxiety and depression.

A majority of patients reported that their preferences were met with regard to the information they received about diagnosis (77%), treatment side effects (71.6%), and treatment effectiveness (75%). Similarly, most patients felt they were adequately informed about the chance of cure (65.6%) and life expectancy (56.3%).

But when it came to costs, just over half (52.2%) said they had been given sufficient information about the costs of their care to society, and less than half (47.4%) reported satisfaction with the information they got about the cost of care to them.

People with partners were significantly more likely to want more information about costs than singles, and younger people were significantly more likely to ask to know more than older people (P less than .05 for both comparisons).

“A nuanced assessment of each patient’s psychosocial characteristics, including control preferences and psychological and financial distress is warranted in order to anticipate and meet specific information preferences,” the investigators said.

Asked how clinicians can pluck financial information from the morass of health plan data, Ms. Varner explained that at her center, when a treatment has been decided on – whether chemotherapy, radiation, surgery, targeted agents, or a combination – financial coordinators contact each patient’s insurance company and develop written estimates which they offer to share with the patient at his or her discretion.

“That allows us then to put into place drug replacement programs or other types of assistance. For example, we know that patients who have Medicare only with no supplemental plan are at very high financial risk – they’re going to owe 20% of the cost of care, which is substantial. But there are often some resources that we can tap into if we know that ahead of time,” Ms. Varner said. 


WASHINGTON – Patients with cancer who have good coping skills – the ability to roll with the punches – are more likely to want an active role in treatment decisions, investigators say.

Among adults who were currently undergoing chemotherapy for a variety of cancers, those with a more active coping style, greater psychological resilience, and greater “openness to experience” were more likely to be active participants in the clinical decision-making process, reported Alexis Colley, a third-year medical student at the University of California Berkeley and UC San Francisco joint medical program.

Demographic factors also appear to play a role in patient participation.

“There has been quite a bit of research which shows that certain factors like younger age, higher education, and higher income tend to be associated with people who want to participate actively,” Ms. Colley said in an interview at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To explore the role of psychological factors in patients’ decision-making choices, the investigators enrolled 868 adults, mean age 57, with breast, lung, gastrointestinal, or gynecologic cancers, who had received chemotherapy within the last 4 weeks and were scheduled for at least two additional cycles.

The patients were asked to report their decision-making roles and psychological factors on several validated instruments. These included evaluations of:

• The patient’s self-reported and actual decision-making roles with the Control Preferences Scale.

• Coping ability with the Brief COPE Scale.

• Resilience with the Connor–Davidson Resilience Scale.

• Personality with the Neuroticism-Extraversion-Openness Five-Factor Inventory.

In multivariate analysis, factors significantly associated with more active decision-making included the demographic factors of younger age (P less than .001) and more years of education (P = .011), and the psychological variables of active coping style (P less than .001), greater use of emotional support in coping (P = .002), openness to experience (P = .014), and higher levels of neuroticism (P less than .030).

In contrast, people with more comorbidities were less prone to be active decision makers (P = .028), as were those who experienced more evening fatigue (P less than .001).

“This relationship between decision-making role and number of comorbid conditions may indicate that serious illness affects patient involvement in the decision-making process because of a need for increased support and guidance as illness progresses,” the authors write in a poster presentation.

There was a high degree of concordance (89.5%) between patients’ preferred and actual decision-making roles, the authors found. They noted that “patients with more active roles and preferred roles that match their actual role have better health outcomes and are more satisfied.”

The study points to the need for further study of the role that psychological factors can play in patient decision making, Ms. Colley said.

“The question arises as to how one’s coping style might be a strong influence on the way they want to participate in decision making, and perhaps as clinicians we can support or teach various coping styles that might help people achieve the role they want and/or achieve a more active role which might then lead to better outcomes, “ she said.

WASHINGTON – Patients with cancer who have good coping skills – the ability to roll with the punches – are more likely to want an active role in treatment decisions, investigators say.

Among adults who were currently undergoing chemotherapy for a variety of cancers, those with a more active coping style, greater psychological resilience, and greater “openness to experience” were more likely to be active participants in the clinical decision-making process, reported Alexis Colley, a third-year medical student at the University of California Berkeley and UC San Francisco joint medical program.

Demographic factors also appear to play a role in patient participation.

“There has been quite a bit of research which shows that certain factors like younger age, higher education, and higher income tend to be associated with people who want to participate actively,” Ms. Colley said in an interview at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To explore the role of psychological factors in patients’ decision-making choices, the investigators enrolled 868 adults, mean age 57, with breast, lung, gastrointestinal, or gynecologic cancers, who had received chemotherapy within the last 4 weeks and were scheduled for at least two additional cycles.

The patients were asked to report their decision-making roles and psychological factors on several validated instruments. These included evaluations of:

• The patient’s self-reported and actual decision-making roles with the Control Preferences Scale.

• Coping ability with the Brief COPE Scale.

• Resilience with the Connor–Davidson Resilience Scale.

• Personality with the Neuroticism-Extraversion-Openness Five-Factor Inventory.

In multivariate analysis, factors significantly associated with more active decision-making included the demographic factors of younger age (P less than .001) and more years of education (P = .011), and the psychological variables of active coping style (P less than .001), greater use of emotional support in coping (P = .002), openness to experience (P = .014), and higher levels of neuroticism (P less than .030).

In contrast, people with more comorbidities were less prone to be active decision makers (P = .028), as were those who experienced more evening fatigue (P less than .001).

“This relationship between decision-making role and number of comorbid conditions may indicate that serious illness affects patient involvement in the decision-making process because of a need for increased support and guidance as illness progresses,” the authors write in a poster presentation.

There was a high degree of concordance (89.5%) between patients’ preferred and actual decision-making roles, the authors found. They noted that “patients with more active roles and preferred roles that match their actual role have better health outcomes and are more satisfied.”

The study points to the need for further study of the role that psychological factors can play in patient decision making, Ms. Colley said.

“The question arises as to how one’s coping style might be a strong influence on the way they want to participate in decision making, and perhaps as clinicians we can support or teach various coping styles that might help people achieve the role they want and/or achieve a more active role which might then lead to better outcomes, “ she said.

WASHINGTON – Patients with cancer who have good coping skills – the ability to roll with the punches – are more likely to want an active role in treatment decisions, investigators say.

Among adults who were currently undergoing chemotherapy for a variety of cancers, those with a more active coping style, greater psychological resilience, and greater “openness to experience” were more likely to be active participants in the clinical decision-making process, reported Alexis Colley, a third-year medical student at the University of California Berkeley and UC San Francisco joint medical program.

Demographic factors also appear to play a role in patient participation.

“There has been quite a bit of research which shows that certain factors like younger age, higher education, and higher income tend to be associated with people who want to participate actively,” Ms. Colley said in an interview at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

To explore the role of psychological factors in patients’ decision-making choices, the investigators enrolled 868 adults, mean age 57, with breast, lung, gastrointestinal, or gynecologic cancers, who had received chemotherapy within the last 4 weeks and were scheduled for at least two additional cycles.

The patients were asked to report their decision-making roles and psychological factors on several validated instruments. These included evaluations of:

• The patient’s self-reported and actual decision-making roles with the Control Preferences Scale.

• Coping ability with the Brief COPE Scale.

• Resilience with the Connor–Davidson Resilience Scale.

• Personality with the Neuroticism-Extraversion-Openness Five-Factor Inventory.

In multivariate analysis, factors significantly associated with more active decision-making included the demographic factors of younger age (P less than .001) and more years of education (P = .011), and the psychological variables of active coping style (P less than .001), greater use of emotional support in coping (P = .002), openness to experience (P = .014), and higher levels of neuroticism (P less than .030).

In contrast, people with more comorbidities were less prone to be active decision makers (P = .028), as were those who experienced more evening fatigue (P less than .001).

“This relationship between decision-making role and number of comorbid conditions may indicate that serious illness affects patient involvement in the decision-making process because of a need for increased support and guidance as illness progresses,” the authors write in a poster presentation.

There was a high degree of concordance (89.5%) between patients’ preferred and actual decision-making roles, the authors found. They noted that “patients with more active roles and preferred roles that match their actual role have better health outcomes and are more satisfied.”

The study points to the need for further study of the role that psychological factors can play in patient decision making, Ms. Colley said.

“The question arises as to how one’s coping style might be a strong influence on the way they want to participate in decision making, and perhaps as clinicians we can support or teach various coping styles that might help people achieve the role they want and/or achieve a more active role which might then lead to better outcomes, “ she said.

WASHINGTON – Fatigue and sleep disturbances are common among patients who have undergone hematopoietic stem cell transplants, but those who feel they have good social support can rest a little easier, say investigators.

Patients who prior to undergoing HSCT had a sense of worth, felt integrated in a social network, and had close attachments were more likely to have better-quality sleep than were their counterparts who felt more isolated and detached, reported Savitri Viozat, a research assistant at the University of Wisconsin Carbone Cancer Center in Madison.

“Devising interventions to optimize social support during the pretransplant period may help to improve sleep quality,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

The investigators asked 431 adults who were scheduled to undergo either autologous or allogeneic HSCT to complete before transplant the Social Provisions Scale, a validated instrument measuring social support, and to complete the Pittsburgh Sleep Quality Inventory and Fatigue Symptom Inventory before transplant and at 1, 3, 6, and 12 months post HSCT.

To gauge the effects of support on sleep, the researchers created mixed-effects linear regression models controlling for transplant regimen, age, and time since transplant.

They found that in the 12 months following HSCT, patients who reported having better social support before transplant had significantly better sleep quality, fewer nighttime sleep disturbances, less sleep-related dysfunction during waking hours, and longer sleep duration (P less than .05 for all comparisons). In addition, patients with better support had shorter sleep latency (time to fall alseep, P less than .01).

There were no significant associations between social support and either sleep efficiency or use of sleep-aid medications, the authors found.

As Ms. Viozat mentioned, the association between support and better sleep was strongest at the 1- and 3-month post-HSCT intervals.

The three dimensions of support most strongly associated with better quality sleep were worth, social integration, and attachment. The dimension of reliable alliance (assurance of continued assistance) also was associated with better sleep duration and lower disturbance, and the dimension of guidance was significantly associated with lower daytime dysfunction and shorter sleep latency.

Nurturance, the only dimension of social support that includes caring for others as well as being cared for by others, was not associated with any improvements in posttransplant sleep quality.

Insomnia interventions

Two other studies presented at the meeting looked at insomnia interventions in patients with cancer.

Kevin Hochard, Ph.D., and colleagues at the University of Chester, England, conducted a systematic review of studies on insomnia interventions for patients with cancer being treated with curative intent. They found that cognitive behavioral therapy (CBT) and mindfulness interventions were common and generally resulted in small but significant improvement in sleep, quality of life, and mood.

A cognitive behavioral therapy intervention for cancer survivors was the focus of a different study, led by Eric Zhou, Ph.D., of the Dana-Farber Cancer Institute in Boston.

Twenty-five of 34 participants completed a program consisting of three CBT sessions over 4 weeks emphasizing sleep restriction and stimulus control, with brief discussions of cognitive factors related to insomnia and sleep hygiene.

There were overall improvements in both sleep efficiency (from 77.8% to 88.7%), and reductions in the mean Insomnia Severity Index total (16.5 to 10.6) from preintervention to postintervention (P less than .01 for all comparisons).

“All participants believed the program helped to improve their understanding of insomnia and all but one reported overall satisfaction with the program. Only 1 in 3 had discussed their insomnia symptoms with medical providers in the prior year,” Dr. Zhou and colleagues wrote.

WASHINGTON – Fatigue and sleep disturbances are common among patients who have undergone hematopoietic stem cell transplants, but those who feel they have good social support can rest a little easier, say investigators.

Patients who prior to undergoing HSCT had a sense of worth, felt integrated in a social network, and had close attachments were more likely to have better-quality sleep than were their counterparts who felt more isolated and detached, reported Savitri Viozat, a research assistant at the University of Wisconsin Carbone Cancer Center in Madison.

“Devising interventions to optimize social support during the pretransplant period may help to improve sleep quality,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

The investigators asked 431 adults who were scheduled to undergo either autologous or allogeneic HSCT to complete before transplant the Social Provisions Scale, a validated instrument measuring social support, and to complete the Pittsburgh Sleep Quality Inventory and Fatigue Symptom Inventory before transplant and at 1, 3, 6, and 12 months post HSCT.

To gauge the effects of support on sleep, the researchers created mixed-effects linear regression models controlling for transplant regimen, age, and time since transplant.

They found that in the 12 months following HSCT, patients who reported having better social support before transplant had significantly better sleep quality, fewer nighttime sleep disturbances, less sleep-related dysfunction during waking hours, and longer sleep duration (P less than .05 for all comparisons). In addition, patients with better support had shorter sleep latency (time to fall alseep, P less than .01).

There were no significant associations between social support and either sleep efficiency or use of sleep-aid medications, the authors found.

As Ms. Viozat mentioned, the association between support and better sleep was strongest at the 1- and 3-month post-HSCT intervals.

The three dimensions of support most strongly associated with better quality sleep were worth, social integration, and attachment. The dimension of reliable alliance (assurance of continued assistance) also was associated with better sleep duration and lower disturbance, and the dimension of guidance was significantly associated with lower daytime dysfunction and shorter sleep latency.

Nurturance, the only dimension of social support that includes caring for others as well as being cared for by others, was not associated with any improvements in posttransplant sleep quality.

Insomnia interventions

Two other studies presented at the meeting looked at insomnia interventions in patients with cancer.

Kevin Hochard, Ph.D., and colleagues at the University of Chester, England, conducted a systematic review of studies on insomnia interventions for patients with cancer being treated with curative intent. They found that cognitive behavioral therapy (CBT) and mindfulness interventions were common and generally resulted in small but significant improvement in sleep, quality of life, and mood.

A cognitive behavioral therapy intervention for cancer survivors was the focus of a different study, led by Eric Zhou, Ph.D., of the Dana-Farber Cancer Institute in Boston.

Twenty-five of 34 participants completed a program consisting of three CBT sessions over 4 weeks emphasizing sleep restriction and stimulus control, with brief discussions of cognitive factors related to insomnia and sleep hygiene.

There were overall improvements in both sleep efficiency (from 77.8% to 88.7%), and reductions in the mean Insomnia Severity Index total (16.5 to 10.6) from preintervention to postintervention (P less than .01 for all comparisons).

“All participants believed the program helped to improve their understanding of insomnia and all but one reported overall satisfaction with the program. Only 1 in 3 had discussed their insomnia symptoms with medical providers in the prior year,” Dr. Zhou and colleagues wrote.

WASHINGTON – Fatigue and sleep disturbances are common among patients who have undergone hematopoietic stem cell transplants, but those who feel they have good social support can rest a little easier, say investigators.

Patients who prior to undergoing HSCT had a sense of worth, felt integrated in a social network, and had close attachments were more likely to have better-quality sleep than were their counterparts who felt more isolated and detached, reported Savitri Viozat, a research assistant at the University of Wisconsin Carbone Cancer Center in Madison.

“Devising interventions to optimize social support during the pretransplant period may help to improve sleep quality,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

The investigators asked 431 adults who were scheduled to undergo either autologous or allogeneic HSCT to complete before transplant the Social Provisions Scale, a validated instrument measuring social support, and to complete the Pittsburgh Sleep Quality Inventory and Fatigue Symptom Inventory before transplant and at 1, 3, 6, and 12 months post HSCT.

To gauge the effects of support on sleep, the researchers created mixed-effects linear regression models controlling for transplant regimen, age, and time since transplant.

They found that in the 12 months following HSCT, patients who reported having better social support before transplant had significantly better sleep quality, fewer nighttime sleep disturbances, less sleep-related dysfunction during waking hours, and longer sleep duration (P less than .05 for all comparisons). In addition, patients with better support had shorter sleep latency (time to fall alseep, P less than .01).

There were no significant associations between social support and either sleep efficiency or use of sleep-aid medications, the authors found.

As Ms. Viozat mentioned, the association between support and better sleep was strongest at the 1- and 3-month post-HSCT intervals.

The three dimensions of support most strongly associated with better quality sleep were worth, social integration, and attachment. The dimension of reliable alliance (assurance of continued assistance) also was associated with better sleep duration and lower disturbance, and the dimension of guidance was significantly associated with lower daytime dysfunction and shorter sleep latency.

Nurturance, the only dimension of social support that includes caring for others as well as being cared for by others, was not associated with any improvements in posttransplant sleep quality.

Insomnia interventions

Two other studies presented at the meeting looked at insomnia interventions in patients with cancer.

Kevin Hochard, Ph.D., and colleagues at the University of Chester, England, conducted a systematic review of studies on insomnia interventions for patients with cancer being treated with curative intent. They found that cognitive behavioral therapy (CBT) and mindfulness interventions were common and generally resulted in small but significant improvement in sleep, quality of life, and mood.

A cognitive behavioral therapy intervention for cancer survivors was the focus of a different study, led by Eric Zhou, Ph.D., of the Dana-Farber Cancer Institute in Boston.

Twenty-five of 34 participants completed a program consisting of three CBT sessions over 4 weeks emphasizing sleep restriction and stimulus control, with brief discussions of cognitive factors related to insomnia and sleep hygiene.

There were overall improvements in both sleep efficiency (from 77.8% to 88.7%), and reductions in the mean Insomnia Severity Index total (16.5 to 10.6) from preintervention to postintervention (P less than .01 for all comparisons).

“All participants believed the program helped to improve their understanding of insomnia and all but one reported overall satisfaction with the program. Only 1 in 3 had discussed their insomnia symptoms with medical providers in the prior year,” Dr. Zhou and colleagues wrote.

WASHINGTON – Exercise can have significant and clinically important mental health benefits for both cancer patients and their caregivers, investigators report.

Among patients with cancer and depression, those who took part in a home-based exercise program had the most rapid improvement of depressive symptoms, whereas patients enrolled in a supervised, structured exercise program had the longest-lasting benefits. Both groups had better resolution of depression than did controls, reported Dr. Gregory T. Levin, an accredited exercise physiologist and postdoctoral research fellow at the University of Calgary (Alta.).

©iStock/thinkstockphotos.com

Exercise should be considered as a component of precision medicine, where we can tailor an exercise intervention for a person depending on their mental health status, their cancer status, or the outcomes that we’re trying to attain, whether that’s [creating] changes in depression or improving muscle strength and muscle function,” Dr. Levin said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Levin and his colleagues conducted a study to determine whether certain types of exercise programs might be more effective than others at reducing symptoms of depression in cancer survivors, compared with controls.

They first screened the participants to ensure that only cancer patients with established clinical depression or elevated depressive symptoms would be invited to take part. Patients were eligible if they reported that they were currently being treated for depression, if they scored more than 10 on the Hospital Anxiety and Depression Scale (HADS), or if they met diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) self-rating scale for depression.

They enrolled 32 participants with a mean age of 58.9 years to either a 12-week, clinic-based supervised exercise program (10 patients), a home-based exercise program (8), or usual care (14).

Patients in the supervised exercise group had two weekly sessions of resistance and aerobic training. Patients in the home-based group were given printed material and asked to keep an exercise diary, and were encouraged to exercise at least 150 minutes each week. These patients also received a weekly follow-up phone call. Controls were not told to exercise but were encouraged to maintain usual activities, did not receive printed material, and were not contacted regarding exercise.

For the primary endpoint of depression, both the home-based intervention and the supervised exercise groups had significant reductions in mean HADS scores after 12 weeks, from a baseline of 6.4 to 2.2 for the home-based group (P = .006), and from 6.9 to 2.4 for the supervised group (P = .021). In contrast, controls had a slight increase in scores, from a mean of 7.22 at baseline to 7.76 at week 12.

The most rapid change occurred among the home-based exercisers, who saw the greatest gain during the first 6 weeks. During the second 6 weeks, however, the supervised exercisers saw a sharper decline in scores, compared with the other two groups, possibly because of a loss of motivation among the home-based group.

There was no interaction effect for anxiety over the 12 weeks, but the pattern of decline in anxiety was similar to that seen with depression, with home-based exercisers having a steep decline over the first 6 weeks of the program and then plateauing, while the supervised exercisers saw a greater drop in anxiety scores over the second 6-week period.

Mental health questionnaire scores also favored the exercise groups, compared with controls.

“The exercise program was able to alleviate the depressive symptoms, but the rate of change differed. The home-based [exercise program] initially was favored, and that might be largely due to psychological reasons of distraction, self-efficacy, and mastery, where those self-managed patients take on an exercise regime, are proud of themselves for sticking to it, and notice rapid changes. But then it might become boring and they might stop any time they don’t see changes of such high magnitude,” Dr. Levin said.

Caregiver study

The effects of exercise on the psychological well-being of caregivers was the focus of a scientific poster by Dr. Sylvie Lambert and her colleagues from McGill University in Montreal and the Princess Margaret Cancer Centre in Toronto.

They conducted a systematic review of 14 studies evaluating the effects of exercise and specific types of physical activity on caregivers’ psychosocial well-being. The studies looked at caregivers of patients with cancer and other chronic diseases or disabilities.

They found that overall, exercise has significant beneficial effects on decreasing depression, burden, stress, anger, and anxiety. Most of the interventions used a combination of physical activities, including walking, yoga, meditation, aerobics, tai chi, strength training, stretching, and daily activities such as gardening, housework, etc.

“Physical activity interventions hold promise to improve caregivers’ outcomes, and the findings of this review would suggest that health care providers could promote their use among caregivers,” Dr. Lambert and her colleagues wrote.

WASHINGTON – Exercise can have significant and clinically important mental health benefits for both cancer patients and their caregivers, investigators report.

Among patients with cancer and depression, those who took part in a home-based exercise program had the most rapid improvement of depressive symptoms, whereas patients enrolled in a supervised, structured exercise program had the longest-lasting benefits. Both groups had better resolution of depression than did controls, reported Dr. Gregory T. Levin, an accredited exercise physiologist and postdoctoral research fellow at the University of Calgary (Alta.).

©iStock/thinkstockphotos.com

Exercise should be considered as a component of precision medicine, where we can tailor an exercise intervention for a person depending on their mental health status, their cancer status, or the outcomes that we’re trying to attain, whether that’s [creating] changes in depression or improving muscle strength and muscle function,” Dr. Levin said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Levin and his colleagues conducted a study to determine whether certain types of exercise programs might be more effective than others at reducing symptoms of depression in cancer survivors, compared with controls.

They first screened the participants to ensure that only cancer patients with established clinical depression or elevated depressive symptoms would be invited to take part. Patients were eligible if they reported that they were currently being treated for depression, if they scored more than 10 on the Hospital Anxiety and Depression Scale (HADS), or if they met diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) self-rating scale for depression.

They enrolled 32 participants with a mean age of 58.9 years to either a 12-week, clinic-based supervised exercise program (10 patients), a home-based exercise program (8), or usual care (14).

Patients in the supervised exercise group had two weekly sessions of resistance and aerobic training. Patients in the home-based group were given printed material and asked to keep an exercise diary, and were encouraged to exercise at least 150 minutes each week. These patients also received a weekly follow-up phone call. Controls were not told to exercise but were encouraged to maintain usual activities, did not receive printed material, and were not contacted regarding exercise.

For the primary endpoint of depression, both the home-based intervention and the supervised exercise groups had significant reductions in mean HADS scores after 12 weeks, from a baseline of 6.4 to 2.2 for the home-based group (P = .006), and from 6.9 to 2.4 for the supervised group (P = .021). In contrast, controls had a slight increase in scores, from a mean of 7.22 at baseline to 7.76 at week 12.

The most rapid change occurred among the home-based exercisers, who saw the greatest gain during the first 6 weeks. During the second 6 weeks, however, the supervised exercisers saw a sharper decline in scores, compared with the other two groups, possibly because of a loss of motivation among the home-based group.

There was no interaction effect for anxiety over the 12 weeks, but the pattern of decline in anxiety was similar to that seen with depression, with home-based exercisers having a steep decline over the first 6 weeks of the program and then plateauing, while the supervised exercisers saw a greater drop in anxiety scores over the second 6-week period.

Mental health questionnaire scores also favored the exercise groups, compared with controls.

“The exercise program was able to alleviate the depressive symptoms, but the rate of change differed. The home-based [exercise program] initially was favored, and that might be largely due to psychological reasons of distraction, self-efficacy, and mastery, where those self-managed patients take on an exercise regime, are proud of themselves for sticking to it, and notice rapid changes. But then it might become boring and they might stop any time they don’t see changes of such high magnitude,” Dr. Levin said.

Caregiver study

The effects of exercise on the psychological well-being of caregivers was the focus of a scientific poster by Dr. Sylvie Lambert and her colleagues from McGill University in Montreal and the Princess Margaret Cancer Centre in Toronto.

They conducted a systematic review of 14 studies evaluating the effects of exercise and specific types of physical activity on caregivers’ psychosocial well-being. The studies looked at caregivers of patients with cancer and other chronic diseases or disabilities.

They found that overall, exercise has significant beneficial effects on decreasing depression, burden, stress, anger, and anxiety. Most of the interventions used a combination of physical activities, including walking, yoga, meditation, aerobics, tai chi, strength training, stretching, and daily activities such as gardening, housework, etc.

“Physical activity interventions hold promise to improve caregivers’ outcomes, and the findings of this review would suggest that health care providers could promote their use among caregivers,” Dr. Lambert and her colleagues wrote.

WASHINGTON – Exercise can have significant and clinically important mental health benefits for both cancer patients and their caregivers, investigators report.

Among patients with cancer and depression, those who took part in a home-based exercise program had the most rapid improvement of depressive symptoms, whereas patients enrolled in a supervised, structured exercise program had the longest-lasting benefits. Both groups had better resolution of depression than did controls, reported Dr. Gregory T. Levin, an accredited exercise physiologist and postdoctoral research fellow at the University of Calgary (Alta.).

©iStock/thinkstockphotos.com

Exercise should be considered as a component of precision medicine, where we can tailor an exercise intervention for a person depending on their mental health status, their cancer status, or the outcomes that we’re trying to attain, whether that’s [creating] changes in depression or improving muscle strength and muscle function,” Dr. Levin said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Levin and his colleagues conducted a study to determine whether certain types of exercise programs might be more effective than others at reducing symptoms of depression in cancer survivors, compared with controls.

They first screened the participants to ensure that only cancer patients with established clinical depression or elevated depressive symptoms would be invited to take part. Patients were eligible if they reported that they were currently being treated for depression, if they scored more than 10 on the Hospital Anxiety and Depression Scale (HADS), or if they met diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) self-rating scale for depression.

They enrolled 32 participants with a mean age of 58.9 years to either a 12-week, clinic-based supervised exercise program (10 patients), a home-based exercise program (8), or usual care (14).

Patients in the supervised exercise group had two weekly sessions of resistance and aerobic training. Patients in the home-based group were given printed material and asked to keep an exercise diary, and were encouraged to exercise at least 150 minutes each week. These patients also received a weekly follow-up phone call. Controls were not told to exercise but were encouraged to maintain usual activities, did not receive printed material, and were not contacted regarding exercise.

For the primary endpoint of depression, both the home-based intervention and the supervised exercise groups had significant reductions in mean HADS scores after 12 weeks, from a baseline of 6.4 to 2.2 for the home-based group (P = .006), and from 6.9 to 2.4 for the supervised group (P = .021). In contrast, controls had a slight increase in scores, from a mean of 7.22 at baseline to 7.76 at week 12.

The most rapid change occurred among the home-based exercisers, who saw the greatest gain during the first 6 weeks. During the second 6 weeks, however, the supervised exercisers saw a sharper decline in scores, compared with the other two groups, possibly because of a loss of motivation among the home-based group.

There was no interaction effect for anxiety over the 12 weeks, but the pattern of decline in anxiety was similar to that seen with depression, with home-based exercisers having a steep decline over the first 6 weeks of the program and then plateauing, while the supervised exercisers saw a greater drop in anxiety scores over the second 6-week period.

Mental health questionnaire scores also favored the exercise groups, compared with controls.

“The exercise program was able to alleviate the depressive symptoms, but the rate of change differed. The home-based [exercise program] initially was favored, and that might be largely due to psychological reasons of distraction, self-efficacy, and mastery, where those self-managed patients take on an exercise regime, are proud of themselves for sticking to it, and notice rapid changes. But then it might become boring and they might stop any time they don’t see changes of such high magnitude,” Dr. Levin said.

Caregiver study

The effects of exercise on the psychological well-being of caregivers was the focus of a scientific poster by Dr. Sylvie Lambert and her colleagues from McGill University in Montreal and the Princess Margaret Cancer Centre in Toronto.

They conducted a systematic review of 14 studies evaluating the effects of exercise and specific types of physical activity on caregivers’ psychosocial well-being. The studies looked at caregivers of patients with cancer and other chronic diseases or disabilities.

They found that overall, exercise has significant beneficial effects on decreasing depression, burden, stress, anger, and anxiety. Most of the interventions used a combination of physical activities, including walking, yoga, meditation, aerobics, tai chi, strength training, stretching, and daily activities such as gardening, housework, etc.

“Physical activity interventions hold promise to improve caregivers’ outcomes, and the findings of this review would suggest that health care providers could promote their use among caregivers,” Dr. Lambert and her colleagues wrote.

WASHINGTON – Treating depression in cancer patients has the potential to simultaneously improve the patients’ mental health while reducing health care costs, investigators say.

Patients with cancer and depression have significantly more emergency and nonemergency visits and are more likely to be hospitalized as well as rehospitalized within 30 days than nondepressed cancer patients, suggesting that active treatment of depression in cancer patients can pay off in both better patient care and lower costs, reported Dr. Brent Mausbach, a clinical psychologist at the University of California, San Diego Moores Cancer Center.

“If we’re looking at 1,000 depressed cancer patients and we compare them to 1,000 nondepressed cancer patients, what this essentially equates to is over $4 million in extra cost – and this only includes the cost of the emergency department and hospitalizations; it does not include the cost of other visits that these patients may be making,” he said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Mausbach and colleagues took a retrospective look at the charts of 5,055 patients with cancer treated at their center in 2011, including 561 with a diagnosis of depression and 4,494 with no depression.

The investigators counted the total number of visits, emergency department (ED) visits, and 30-day readmissions, and calculated the probability that a randomly selected depressed patient would have more visits than a randomly selected nondepressed patient.

They controlled for patient demographics (age, sex, and race/ethnicity), insurance status, months since cancer diagnosis, comorbidities, and metastasis.

They found that patients who were depressed had a mean of 26.9 visits over 12 months vs. 15 for nondepressed patients. Compared with nondepressed patients, depressed patients had a 72.5% probability of having more health care visits.

The median number of visits to the health care system among depressed cancer patients was 21, compared with 8 for nondepressed patients.

In all, 28.3% of depressed patients had one or more emergency department visits for any reason, compared with 11.5% of nondepressed patients (odds ratio, 3.05; adjusted OR, 2.45).

Similarly, depressed patients were significantly more likely to be hospitalized than their nondepressed counterparts (OR, 2.41; aOR, 1.81), and to be rehospitalized within 30 days (OR, 2.31; aOR, 2.03).

Patients with depression also had significantly longer hospital stays, at a mean of 6.1 vs. 4.7 for those without depression.

“For the emergency department, hospitalization, and 30-day rehospitalization data, we think the effects seemed pretty consistent across all those outcomes. Essentially there was about a doubling of the risk for patients who have depression for all of those outcomes relative to patients without depression,” Dr. Mausbach said.

He noted that there is an “overwhelming temptation” for investigators to assume the between-person effects they saw could translate directly into within-person effects. For example, an observer might extrapolate from the data that treating depression in an individual patients could halve that patient’s use of health care resources, but a longitudinal study would be required to correctly address that question, he said.

Additionally, the study was limited by a lack of data on cancer stage and grade, and by the uncertainties surrounding a chart-recorded diagnosis of depression.

“Can we treat depression and then have an impact on lower health care use and overall costs? We need to demonstrate this using clinical trials or pseudo-experimental designs, which would include taking a look at people who actually received psychotherapy or medications, and checking to see whether by using these treatments they actually had a reduction in total number of health care visits,” Dr. Mausbach said.

The study was institutionally supported. The authors reported having no conflicts of interest.

WASHINGTON – Treating depression in cancer patients has the potential to simultaneously improve the patients’ mental health while reducing health care costs, investigators say.

Patients with cancer and depression have significantly more emergency and nonemergency visits and are more likely to be hospitalized as well as rehospitalized within 30 days than nondepressed cancer patients, suggesting that active treatment of depression in cancer patients can pay off in both better patient care and lower costs, reported Dr. Brent Mausbach, a clinical psychologist at the University of California, San Diego Moores Cancer Center.

“If we’re looking at 1,000 depressed cancer patients and we compare them to 1,000 nondepressed cancer patients, what this essentially equates to is over $4 million in extra cost – and this only includes the cost of the emergency department and hospitalizations; it does not include the cost of other visits that these patients may be making,” he said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Mausbach and colleagues took a retrospective look at the charts of 5,055 patients with cancer treated at their center in 2011, including 561 with a diagnosis of depression and 4,494 with no depression.

The investigators counted the total number of visits, emergency department (ED) visits, and 30-day readmissions, and calculated the probability that a randomly selected depressed patient would have more visits than a randomly selected nondepressed patient.

They controlled for patient demographics (age, sex, and race/ethnicity), insurance status, months since cancer diagnosis, comorbidities, and metastasis.

They found that patients who were depressed had a mean of 26.9 visits over 12 months vs. 15 for nondepressed patients. Compared with nondepressed patients, depressed patients had a 72.5% probability of having more health care visits.

The median number of visits to the health care system among depressed cancer patients was 21, compared with 8 for nondepressed patients.

In all, 28.3% of depressed patients had one or more emergency department visits for any reason, compared with 11.5% of nondepressed patients (odds ratio, 3.05; adjusted OR, 2.45).

Similarly, depressed patients were significantly more likely to be hospitalized than their nondepressed counterparts (OR, 2.41; aOR, 1.81), and to be rehospitalized within 30 days (OR, 2.31; aOR, 2.03).

Patients with depression also had significantly longer hospital stays, at a mean of 6.1 vs. 4.7 for those without depression.

“For the emergency department, hospitalization, and 30-day rehospitalization data, we think the effects seemed pretty consistent across all those outcomes. Essentially there was about a doubling of the risk for patients who have depression for all of those outcomes relative to patients without depression,” Dr. Mausbach said.

He noted that there is an “overwhelming temptation” for investigators to assume the between-person effects they saw could translate directly into within-person effects. For example, an observer might extrapolate from the data that treating depression in an individual patients could halve that patient’s use of health care resources, but a longitudinal study would be required to correctly address that question, he said.

Additionally, the study was limited by a lack of data on cancer stage and grade, and by the uncertainties surrounding a chart-recorded diagnosis of depression.

“Can we treat depression and then have an impact on lower health care use and overall costs? We need to demonstrate this using clinical trials or pseudo-experimental designs, which would include taking a look at people who actually received psychotherapy or medications, and checking to see whether by using these treatments they actually had a reduction in total number of health care visits,” Dr. Mausbach said.

The study was institutionally supported. The authors reported having no conflicts of interest.

WASHINGTON – Treating depression in cancer patients has the potential to simultaneously improve the patients’ mental health while reducing health care costs, investigators say.

Patients with cancer and depression have significantly more emergency and nonemergency visits and are more likely to be hospitalized as well as rehospitalized within 30 days than nondepressed cancer patients, suggesting that active treatment of depression in cancer patients can pay off in both better patient care and lower costs, reported Dr. Brent Mausbach, a clinical psychologist at the University of California, San Diego Moores Cancer Center.

“If we’re looking at 1,000 depressed cancer patients and we compare them to 1,000 nondepressed cancer patients, what this essentially equates to is over $4 million in extra cost – and this only includes the cost of the emergency department and hospitalizations; it does not include the cost of other visits that these patients may be making,” he said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Mausbach and colleagues took a retrospective look at the charts of 5,055 patients with cancer treated at their center in 2011, including 561 with a diagnosis of depression and 4,494 with no depression.

The investigators counted the total number of visits, emergency department (ED) visits, and 30-day readmissions, and calculated the probability that a randomly selected depressed patient would have more visits than a randomly selected nondepressed patient.

They controlled for patient demographics (age, sex, and race/ethnicity), insurance status, months since cancer diagnosis, comorbidities, and metastasis.

They found that patients who were depressed had a mean of 26.9 visits over 12 months vs. 15 for nondepressed patients. Compared with nondepressed patients, depressed patients had a 72.5% probability of having more health care visits.

The median number of visits to the health care system among depressed cancer patients was 21, compared with 8 for nondepressed patients.

In all, 28.3% of depressed patients had one or more emergency department visits for any reason, compared with 11.5% of nondepressed patients (odds ratio, 3.05; adjusted OR, 2.45).

Similarly, depressed patients were significantly more likely to be hospitalized than their nondepressed counterparts (OR, 2.41; aOR, 1.81), and to be rehospitalized within 30 days (OR, 2.31; aOR, 2.03).

Patients with depression also had significantly longer hospital stays, at a mean of 6.1 vs. 4.7 for those without depression.

“For the emergency department, hospitalization, and 30-day rehospitalization data, we think the effects seemed pretty consistent across all those outcomes. Essentially there was about a doubling of the risk for patients who have depression for all of those outcomes relative to patients without depression,” Dr. Mausbach said.

He noted that there is an “overwhelming temptation” for investigators to assume the between-person effects they saw could translate directly into within-person effects. For example, an observer might extrapolate from the data that treating depression in an individual patients could halve that patient’s use of health care resources, but a longitudinal study would be required to correctly address that question, he said.

Additionally, the study was limited by a lack of data on cancer stage and grade, and by the uncertainties surrounding a chart-recorded diagnosis of depression.

“Can we treat depression and then have an impact on lower health care use and overall costs? We need to demonstrate this using clinical trials or pseudo-experimental designs, which would include taking a look at people who actually received psychotherapy or medications, and checking to see whether by using these treatments they actually had a reduction in total number of health care visits,” Dr. Mausbach said.

The study was institutionally supported. The authors reported having no conflicts of interest.