paywalled: Psychological Distress of the Bereaved Seeking Medical Counseling at a Cancer Center

 Blogger's Note/Opinion: the abstract is one of a few which is written in plain english and with an empathetic 'tone' both of which set it apart from many psycho-oncology papers

Psychological Distress of the Bereaved Seeking Medical Counseling at a Cancer Center

Abstract

Objective The death of a loved one is one of the most stressful events in life and is related to the physical and psychological wellbeing of the bereaved. Some bereaved individuals seek medical counseling to alleviate their distress. However, no studies have focused on the bereaved who have lost a loved one to cancer and have asked for medical help at a cancer center as a result. The aim of this study was to investigate the distress of the bereaved who sought consultation, as basic information for considering support.

Methods We conducted a survey of people consulting outpatient services for bereaved families between April 2007 and September 2009. Data were obtained from medical records at initial consultation and qualitatively analyzed by content analysis using all statements related to their distress.

Results Their statements were classified into 11 categories, which were further classified into six themes. The main categories of bereavement-related distress were as follows: (i) regret; (ii) anger; (iii) memories; (iv) loneliness; (v) anxiety; and (vi) hopelessness. ‘Regret’ was frequently recognized in their distress and it includes some points related to the cancer trajectory. 

Conclusions Psychological distresses of the bereaved who have lost a loved one and have asked for medical counseling are revealed. Their distresses are strongly related to the cancer trajectory of a family member. Some of these distresses are related to medical misunderstanding about the course of cancer. These findings might provide basic information for considering their appropriate treatment.

abstract: Psychiatric morbidity in gynecological outpatients

Psychiatric morbidity in gynecological outpatients - Judd - 2012 - Journal of Obstetrics and Gynaecology Research

Abstract

Aim:  To assess the prevalence of depression and anxiety in women presenting with gynecological symptoms, to determine how many women with these disorders were receiving treatment for them, and to investigate risk factors for these disorders.

Method:  Two hundred and sixty-four women seeking medical care from gynecology clinics at a specialist women's hospital completed a self-report questionnaire asking about sociodemographics, physical and mental health, personality (neuroticism) and psychosocial stressors.

Results:  A total of 91 women met the diagnostic criteria for one or more Patient Health Questionnaire (PHQ) diagnosis. Forty-six (17.4%) met criteria for major depressive disorder (MDD), 15 (5.7%) for panic disorder (PD) and 73 (27.7%) for generalized anxiety disorder (GAD). Thirty-nine (42.9%) of the 91 women met criteria for two or more disorders. An additional 23 (8.7%) met DSM-IV-TR criteria for minor (sub-threshold) depression. Fifty percent with MDD, 4% with minor depression, 53% with PD and 22% with GAD reported they were receiving treatment. Psychosocial stressors and the neuroticism score were risk factors for both anxiety and depression.

Conclusions:  Anxiety and depression are common amongst women attending a gynecology clinic. Clinicians should be alert to the possibility of these disorders and make specific enquiries about their emotional wellbeing.

abstract: [Assessment of health-related quality of life in cancer outpatients treated with chemotherapy] Japanese study

[Assessment of health-related quality of life in cancer outpatients treated with chemotherapy].


Abstract
Purpose: 
Few studies have been conducted to elucidate the health-related quality of life(HR-QOL) of cancer outpatients treated with chemotherapy. In this study, we attempted to determine the physical and psychological distress of cancer outpatients treated with chemotherapy.

Methods:
Two-hundred and ninety-six outpatients with various malignancies, including malignant lymphoma, and esophageal, gastric, pancreatic, colon, lung, breast, ovarian, uterine and skin cancers, were investigated using the Japanese version of the M. D. Anderson symptom inventory from March through June 2010 in Tokyo Medical University Hospital.

Results:
The results of the survey questionnaire indicated that 59 patients suffered from fatigue, 56 experienced numbness or tingling, 48 felt drowsy, 39 had low moods, 40 felt distressed, 38 had no appetite, 38 had dry mouth, 37 were in pain, 37 had disturbed sleep, 31 had shortness of breath, 24 had nausea, 17 suffered from vomiting, and 13 patients had memory problems. Furthermore, these symptoms interfered with work(65 patients), walking(56 patients), mood(52 patients), life enjoyment(49 patients), general activity(49 patients), and relationships with other people(42 patients). Medications prescribed for HR-QOL control were non-steroidal anti-inflammatory drugs (93 patients), morphine(32 patients), and adjuvant analgesics(47 patients).

Conclusion:
The present findings may help in the development of management strategies for physical and psychological distress, and improve HR-QOL of cancer outpatients treated with chemotherapy.

Medscape: The Case for Retaining Bereavement Exclusion

"....
"The evidence suggests that the excluded episodes are best considered a normal variation in bereavement and not a mental disorder," he added.
Reflection Advisable
In an accompanying editorial, Mario Maj, MD, PhD, of the Department of Psychiatry, University of Naples, Italy, and chairperson of the World Health Organization Working Group on the Classification of Mood and Anxiety Disorders, concludes that the removal of the BE from the diagnosis of major depressive episode can only be justified by "strong and unequivocal new research evidence. Wakefield and First's review...suggests that such a solid and consistent new evidence is not available."
"Further reflection," Dr. Maj writes, "seems therefore warranted before proceeding with the deletion of the bereavement exclusion.".....

abstract: Psychological impact of recall on women with BRCA mutations undergoing MRI surveillance

CONCLUSIONS:

While breast MRI surveillance did not have a detrimental psychological impact on women with a BRCA1 or BRCA2 mutation, recalling these very high-risk women for further imaging after a false positive MRI scan temporarily increased their global anxiety.

abstract: Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption

CONCLUSION: A notable percentage of patients discharged from the ICU report moderate to extreme pain, anxiety, and fear, and inability to sleep during their ICU stay; and 29% to 48% have no recall of specific ICU events.

eMedicine: Selective Serotonin Reuptake Inhibitors and CYP2D6: eMedicine Genomic Medicine (anxiety/depression)

Treating the Whole Patient Blog: Antidepressant Pretreatment and Chemotherapy > CMELLC - Life Long Learning > Treating the Whole Patient

Question:
"In cancer treatment, should patients undergoing chemotherapy be premedicated with anti-anxiety medications or antidepressants (with or without symptoms of anxiety or depression) to help them feel more responsive to chemotherapy by reducing inflammation in the body? Discuss the pros and cons of this idea."...cont'd

free full access: The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients

Conclusions

Participants generally found the portal easy to use; however, the perceived value of improved participation was not detected in the self-efficacy scores. Having access to personal health information did not increase anxiety levels. While these results suggest that the use of this PHR (personal health records) may be of benefit for informing patients, further research is required to investigate the impact on the experiences of patients, their participation in their care, their relationships with the health care team, and their health outcomes.

A Longitudinal Investigation of Psychological Disorders in Patients Prior and Subsequent to a Diagnosis of Ovarian Cancer

Difficulty Accepting a Terminal Prognosis Linked with Depression, Anxiety, and Suffering -- A Cancer Journal for Clinicians

Note: VERY SENSITIVE TOPIC Dissenting Opinion
Not all clinicians agree with the foregoing interpretations of these findings. "I've certainly seen people who denied dying up to their last breath and somehow never accepted it," Dr. Holland tells CA. "Were they more upset? I'm not sure."
She cautioned against allowing the findings by Dr. Thompson and colleagues to set a tone in which nonaccepting patients are viewed as dysfunctional. Death is as individualized as is life, she argues, invoking Sir William Osler, who said "Basically, people die as they have lived."

media news: Symptoms have little value for early detection of ovarian cancer including editorial commentary

Cancer Recurrence Fears - MD Anderson Cancer Center

"For many cancer survivors, the fear of recurrence is oppressive. It hinders them from enjoying everyday activities and profoundly affects their quality of life. However, by learning to manage their anxieties, patients can become more confident about their survivorship."