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Background and aim of the work. Psychosocial needs in cancer patients seem to be underestimated and undertreated. The present research was designed to explore under-considered psychosocial needs (e.g., stressful life events, perceived social support, sense of mastery and depressive/anxious symptoms) of a female cancer group. The aim of the study was to test an assessment psycho-oncological model for female cancer patients. An assessment model of psychosocial needs and Stressful Life Events was operationalized and tests its predictive power. Methods. We used Discriminant Analysis to test predictive power of the model and of the single variables included in it. 236 oncological patients (mean age 55.50 ± 13.09) were matched with 232 healthy control groups in the study. The following instruments were chosen: the Florence Psychiatric Interview, Hospital Anxiety Depression Scale, Multidimensional Scale of Perceived Social Support, Beck Depression Inventory I, and Sense of Mastery. Results. The model satisfied the assumption criteria and was significant (Ʌ= .680, X2 = 109.73, p< .001). Conclusions. Stressful events, depression and anxiety were adequate markers of the assessment psycho-oncological model proposed for female cancer patients. The present study provides contributions in a clinical perspective: the results support the relevance of considering an assessment psychosocial model to use in female oncology for an accurate estimation of the women’s needs. Women affected by female cancer with an history of Stressful Early and Recent life events and high level of anxiety and depression could positively benefit from a psychotherapy treatment. (www.actabiomedica.it)

La malattia oncologica di un bambino espone l’intera famiglia a condizioni di forte stress fisico ed emotivo comportando spesso disequilibri e cambiamenti sia sul versante affettivo sia sociale. Al fine di effettuare un corretto screening dei pazienti oncologici e delle famiglie e un appropriato invio allo specialista da parte dell’equipe professionale (oltre che a garantire un appropriato percorso di cura) e stato deliberato dalla Regione Piemonte il PDTA in psicologia oncologica (2009). Il presente studio intende presentare i risultati preliminari relativi all’applicazione della Scheda di Complessita (strumento del PDTA che valuta le criticita bio-psico-sociali) all’interno della Struttura di Oncoematologia Pediatrica e Centro Trapianti dell’Ospedale Infantile Regina Margherita di Torino. I dati riguardano l’applicazione della Scheda da luglio 2011 a luglio 2014. Durante tale periodo la Scheda di Complessita e stata compilata al momento della diagnosi in merito a 308 famiglie (173 casi risultati globalmente complessi e 135 globalmente non complessi). Delle 173 schede risultate complesse, l’area maggiormente critica risulta essere quella psicologica che interessa 147 casi (42%). In 80 casi e gia stata effettuata la valutazione anche al momento della fine delle terapie oncologiche e dell’intervento psicologico: 57 casi rimangono o diventano non complessi mentre i restanti 23 risultano complessi anche nella fase della fine delle terapie. Tale complessita puo essere pero riferita al fatto che alcuni di questi casi (23) risultavano di complessita elevata nell’area sociale mentre altri (7) presentavano una complessita psicologica/psichiatrica precedente alla diagnosi. La Scheda risulta dunque uno strumento utile per valutare eventuali rischi nelle famiglie, scegliere l’intervento e il livello piu appropriato da adottare e valutarne l’outcome.

BAC KGROUND: Radiation therapy (RT ) has become one of the most widely-used and efficient treatments for cancer; nevertheless, people who undergo radiotherapy suffer the physical and psychological consequences of this stressful treatment, in addition to the psychosocial distress related to cancer. However, a Radiotherapy Unit is often a place where several patients crowd in from various hospitals with restricted timetables and, for logistic reasons, it is not easy to provide regular psychological sessions for each one. It is important to find a setting that allows us the involvement of the largest number of patients referred to the unit. In this study, we aimed to evaluate the feasibility and the effect of a brief intervention of cognitive-oriented diary on the quality of life, anxiety and depressive symptoms of patients undergoing radiotherapy (RT ), compared to a control group. METH ODS: The sample was constituted of 68 experimental subjects and 78 controls, treated with RT . Both groups were assessed with the Toronto Alexithymia Scale (TAS -20), the Hamilton Anxiety and Depression Scale (HA DS) and the EORTC -QLQ at the beginning and at the end of their RT . Experimental subjects were instructed to report emotions and thoughts before attending the RT sessions in a thought diary. RES ULTS : The experimental group showed a good adherence to the diary, a reduction in mean scores of anxiety (P

Nasopharyngeal carcinoma (NPC) is the head and neck cancer with the greatest impact on patients' quality of life. The aim of this explorative study is to investigate the psychological distress, coping strategies and quality of life of NPC patients in the post-treatment observation period. Twenty-one patients disease-free for at least two years were assessed with a medical and a psycho-oncological evaluation. Clinically relevant depressive symptoms (CRD) were present in 23.8% of patients and 33.3% reported clinically relevant anxiety symptoms (CRA). Patients with CRD and CRA showed a significantly higher score in the use of hopelessness/helplessness and anxious preoccupation coping strategies and a worse quality of life. Even in the post-treatment period, about a quarter of patients showed CRD and CRA. Results showed that patients with high anxiety or depressive symptoms seem to use dysfunctional coping strategies, such as hopelessness and anxious preoccupation, more than patients with lower levels of anxiety and depression. The use of these styles of coping thus seems to be associated to a higher presence of CRA or CRD symptomatology and to a worse quality of life.

Although the field of psychological reactions of patients in response to cancer and cancer treatment has been the object of intense psycho-oncology research, the DSM and ICD nosological systems fail to give proper space to this area. Both the ICD and DSM rubrics Psychological Factors affecting a Medical Condition fail to fully describe the several psychosocial implications of cancer. The development of Diagnostic Criteria for Psychosomatic Research (DCPR) is in line with the psychosomatic and biopsychosocial tradition and has given a new impulse to this area by translating psychosocial variables into operational tools for psychosocial variables with prognostic and therapeutic implications in medically ill patients. The application of the DCPR has been shown to be useful in a more precise identification of several psychological conditions affecting cancer patients. The DCPR dimensions of health anxiety, demoralization and alexithymia have been recognized in oncology, with a low overlap with a formal DSM psychiatric diagnosis; the DCPR dimensions dealing with the patients’ ways of perceiving, experiencing, evaluating, and responding to their health status (abnormal illness behaviour) have also been demonstrated, while more data are needed with regard to the complex area of somatization and somatic symptom presentation of distress in cancer patients, for which the DCPR clusters of somatization (functional somatic symptoms secondary to psychiatric disorders, persistent somatization, conversion symptoms, and anniversary reaction) can be of help. More research and the possible refinement of DCPR clustering dimensions are needed in order to understand the several and multiform psychosocial responses of cancer patients across the trajectory of the disease.

To date there is no agreement on the usefulness of physical symptoms to express a mood disorder diagnosis in psychoncology. The aim of this study was to evaluate the relevance of somatic, affective and cognitive clusters in mood disorders in oncological comorbidity. 151 consecutive in-patients of the Surgical Oncology Unit of S. Giovanni Battista Hospital (Turin, Italy) were evaluated for depression using the HADS and the MADRS. In addition, behavioural, somatic and cognitive clusters of the MADRS were analysed, comparing depressed and non-depressed patients, subdivided according to the HADS-D scores. Since the HADS does not consider the somatic symptoms of depression this comparison allowed us to evaluate the relevance of the three different clusters for depressive symptoms. According to the HADS, 57.4% of patients scored above the cut-off (≥ 8) for depression and 47,3% scored above the cut-off (≥ 8) for anxiety. As for the MADRS, 44% of patients scored between 0-9, indicating the absence of depression, 43.7% were found to have mild/moderate depressive symptoms and 12.3% showed severe mood depression. Comparison between patients above and below the cut-off of HADS-D showed significant differences in all the three clusters (p < 0.01). In addition, more relevant differences were observed in the affective and somatic clusters than in the cognitive cluster. Results of the present study suggest the importance of somatic symptoms in the perception and expression of psychological suffering in cancer patients.

Several studies have shown that 30–40% of cancer patients present psychosocial disorders according to the DSM-IV and WHO ICD-10 disease classification systems and a further 20-25% suffer from psychosocial conditions deserving medical attention (e.g., health anxiety, demoralisation). In order to increase the likelihood that cancer patients with psychosocial distress can be detected and offered opportunity to be helped, guidelines and psychological instruments such as the NCCN Clinical Practice Guidelines in Oncology on Distress Management and the Distress Thermometer (DT) have been developed and applied in cancer settings. A cutoff score of 4–5 on the DT has been repeatedly shown to optimise sensitivity and specificity in identifying “cases” both among cancer patients and their family members. However, clinical limitations have been raised regarding the DT. The tool can benefit from changes increasing its capacity to capture different psychological dimensions, Furthermore, the policy of screening for emotional distress in cancer patients is only the first step, and it may prove to no avail if not followed by more specific psychosocial oncology programmes aimed at improving referral and adherence to referral of cancer patients with high levels of emotional distress.

Somatic illness is not only an individual experience of physical and psychological suffering, but also a psychosocial status that modulates the patient’s interpersonal relationships. Receiving a diagnosis of cancer causes severe distress. The patient’s family, too, feels the emotional ups and downs of the patient. Like the patient, they feel distressed during the onset, course and outcome of the disease. Minimizing the interpersonal impact of the illness contributes to an improved quality of life for both patients and caregivers. Thus, it is widely assumed that cancer treatments should include some kind of psychological support for the patient and family members. All of these treatments are aimed at improving collaboration and illness perception among family, patients and healthcare professionals, and support the family during the course of the disease and cancer therapies. The family system theory is a valuable framework to explain how the disease of the patient and the family's daily life are interconnected. The therapeutic alliance with the family is a powerful tool to improve the quality of life for the patient, as well as to relieve the psychological distress of the family members who are involved. The following pages describe the objectives and conversational techniques that can be a tool for psychosocial work with the family of a cancer patient. The goal of this intervention is to help the patient’s family to understand their problems and acknowledge the anxiety and fear of mourning that can impede their capacity to face the everyday problems they must cope with. To achieve this goal, it is recommended that a meeting (or a series of meetings) be scheduled, and conducted both in hospital and in the home. The steps to set up and conduct a family meeting are described in the paper, with special emphasis on communication skills required to meet family expectations and discuss the crucial issues of their everyday life.

The paper by ESMO ‘The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO)’ [1] conveys some important key messages for the whole oncology community. A working group (WG) involving 21 oncology and related societies would like to comment on the paper from a multidisciplinary perspective in the conviction that a more transparent and open definition of individual professional roles better supports the patients' care and facilitates best practices and progress in comprehensive cancer care.

The aims of the study were to assess sociodemographic and clinical factors associated with suicidal ideation in patients with cancer who required a psycho-oncological support. Among 504 participants, there were 136 (23 men and 113 women) cancer patients who completed psychological assessment when admitted to the Psycho-oncology Outpatient Clinic between 2006 and 2011. Suicidal ideation was assessed by Item 9 of the Brief Symptom Inventory, Hopelessness was assessed by the hopelessness subscale of the Mini-Mental Adjustment to Cancer Scale, and Depression was assessed by the depression subscale of the Hospital and Anxiety Depression Scale. Around 30% of this sample reported affective symptoms and around 20% reported suicidal ideation and hopelessness. Patients who reported suicidal ideation were more hopeless (18.8 ± 6.7 vs. 15.7 ± 5.2; t(134) = 2.54; p0.05) and reported more depression (11.8 ± 4.8 vs. 6.8 ± 4.1; t(134) = 5.30; p0.001). It is evident that cancer can result in a strong psychological distress in the patient. It is important, therefore, that cancer patients receive a proper assistance and psychological support and that both the possible presence of depression and suicidal ideation are constantly monitored.

Communication is the essential component for good clinical practice within a patient-centered approach, with guidelines empathizing the role of communication and the mandatory need to train physicians in communication in order to assure optimal psychosocial care of cancer patients, including the psychosocial interview patient assessment, prescription, and follow-up. The aim of this chapter is to briefly summarize some principles of communication when dealing with cancer patients with psychiatric disorders in order to facilitate assessment and promote adherence to treatment and to suggest guidelines which the clinician may use to achieve these goals. For these reasons, the protocol SPIKES-Rx has been specifically developed to guide doctors in the appropriate interactions to promote patient agreement with recommendations for psychopharmacological management when psychotropic drugs are prescribed.

Pharmacotherapy is an important component of treatment for more severe and persistent depression in patients with cancer and advanced disease. The initiation of such treatment should follow a careful diagnostic assessment, and the choice of an antidepressant should be based upon the symptom profile of the patient, the antidepressant side-effect profile, and the least potential for interaction with chemotherapy and other medications. Although an antidepressant medication with a rapid onset of action is desirable in this population, psychostimulants and other such agents have not been shown to be effective. Psychotherapy should typically be provided in conjunction with pharmacotherapy and, in the case of minor depression, may be the sole therapeutic modality. This includes attentive psychoeducation on common concerns about antidepressants expressed by medical patients, in order to ensure safety and enhance compliance.

[Resumen] En España, cada año se diagnostican 900 casos de cáncer en la población infantil, siendo la 2ª causa de muerte después de los accidentes. Los tipos de cáncer que más afectan a los niños son la leucemia, el linfoma, el tumor cerebral y sarcomas de huesos y tejidos blandos. Cuando un diagnóstico de cáncer es confirmado, los padres son los primeros en conocer la mala noticia, experimentando un sinfín de sentimientos como rabia, dolor, temor y negación. Es ahí cuando comienzan las preguntas “¿Qué y cómo se lo digo a mi hijo?” Según varios estudios, el tipo de información que deciden darle depende de variables como la edad del niño, que conocimientos posee acerca de la enfermedad, la religión e incluso si hay otros niños en la familia. También hay que tener en cuenta el tipo de cáncer, pronóstico y fase en la que se encuentra. El objetivo de este estudio es explorar cómo, con el paso de los años, esos padres de niños supervivientes al cáncer han construido esa experiencia vital que va desde el momento en el que se les comunica la “mala noticia” hasta que ellos la trasladan a sus hijos. Se plantea un estudio cualitativo con abordaje fenomenológico con el fin de obtener un conocimiento holístico y profundo de la realidad. Se llevarán a cabo entrevistas semi-estructuradas a padres de niños supervivientes de cáncer diagnosticados y/o tratados en la Comunidad Autónoma (CCAA) de Galicia, a través de preguntas abiertas formuladas en un orden específico. [Abstract] In Spain , every year 900 cases of cancer are diagnosed in children, being the 2nd leading cause of death after accidents. The types of cancer that affect children are leukemia, lymphoma, brain tumors and sarcomas of bone and soft tissue. When a diagnosis of cancer is confirmed , parents are the first to hear the bad news, experiencing a myriad of emotions such as anger, pain, fear and denial. That's when the questions begin "What and how do I tell my son?" According to several studies, the type of information you decide to give depends on variables such as age of the child, that has knowledge about the disease, religion and even if there are other children in the family. Also keep in mind the type of cancer, prognosis and stage at which it is. The objective of this study is to explore how, over the years, those parents of children with cancer survivors have built this life experience that goes from the moment you are told "bad news" until they move to the their children. A qualitative study with a phenomenological approach in order to obtain a holistic and deep understanding of reality arises. They conducted semi-structured interviews parents of child survivors of cancer diagnosed and / or treated in the Autonomous Community of Galicia, through open questions in a specific order interviews. Traballo fin de grao (UDC.FEP). Enfermaría. Curso 2013/2014

At least 25–30 % of patients with cancer and even a higher percentage of those in an advanced phase of illness meet the criteria for a psychiatric diagnosis, including depression, anxiety, stress-related syndromes, including severe adjustment disorders, sleep disorders, and delirium. A number of studies in psycho-oncology have accumulated over the last 35 years on the use of psychotropic drugs as a pillar in the treatment of psychiatric disorders. Major advances in research have also shown the efficacy of psychotropic drugs as adjuvant treatment of cancer-related symptoms, such as pain, hot flashes, pruritus, nausea and vomiting, fatigue, and cognitive impairment. The knowledge about pharmacokinetics and pharmacodynamics, clinical use, safety, side effects, and efficacy of drugs in cancer care is essential. The aims of this chapter are to consider the need for an integrated psychological and psychopharmacological intervention, as the concept of psychopharmoncology specifies, favoring the vision of an integrated and multidimensional approach in oncology, and palliative care services as well as in community-based cancer centers. Open image in new window

Background: Psychological studies have documented the presence of a self-punishment profile in cancer patients. Recent immuno-oncological studies have shown that within the group of CD4+ cells, which play a fundamental role in the generation of anticancer immunity, there is a subtype of cells that in contrast mediates the suppression of the anticancer immunity, the so-called T-regulatory cells (T-reg), which may be identified as CD4 +CD25+ cells. Patients and Methods: On this basis, we performed a psychoncological study to evaluate CD4+CD25+ cell numbers in relation to the response to Rorschach's test in a group of 30 cancer patients suffering from the most frequent tumor histotypes. Results: Normal values obtained in our laboratory (95% confidence limits) of T-reg lymphocytes and CD4+/CD4+CD25+ were 4mm3, respectively. The psychological profile of self-punishment was found in 18/30 patients (60%). The percentage of patients with abnormally high CD4+CD25+ values observed in the group with self-punishment was significantly higher than that found in patients without self punishment (11/18 vs. 3/12 (25%), p

Background: The anti-oxidant and immunomodulating natural agents may enhance the efficacy of cancer chemotherapy. One of the most important agents is the pineal hormone melatonin (MLT) which may exert both anti-oxidant and antiproliferative immunostimulating anticancer effects. This study was performed to evaluate the efficacy of a biochemotherapeutic regimen in metastatic cancer patients, and its therapeutic activity in relation to the psychospiritual status of patients. Methods: The study included 50 metastatic non-small cell lung cancer (NSCLC) patients and a control group of 100 patients. Chemotherapy consisted of cisplatin plus gemcitabine. MLT was given orally at 20 mg/day in the evening. Patients were subdivided into 5 psychic profiles, as follows: spiritual faith, rationale faith, anxiety, apathy, and accusation behavior. Results: Tumor response rate was significantly higher in patients treated by chemotherapy plus MLT than in those treated by chemotherapy alone (21/50 vs. 24/100, p < 0.001). However, the percentage of objective tumor regressions obtained in patients with spiritual faith was significantly higher than that found in the overall other patients concomitantly treated by chemotherapy plus MLT (6/8 vs. 15/42, p < 0.01). Conclusions: In conclusion, the efficacy of chemotherapy may be enhanced by the pineal hormone MLT, by representing a new promising biochemotherapeutic combination; also despite its objective ability to enhance chemotherapy efficacy, the activity of MLT is depending at least in part on the psychospiritual status of cancer patients, and it is maximal in the presence of a real spiritual faith.