Stress Management or Post-traumatic Growth Facilitation to Diminish Distress in Cancer Survivors? A Randomized Controlled Trial

This randomized controlled trial compared the efficacy of cognitive behavioral stress management (CBSM) and positive psychotherapy in cancer (PPC) to reduce post-traumatic stress symptoms (PTSS) and distress, and to promote post-traumatic growth (PTG) in cancer survivors. Participants were 140 adult women randomly allocated to CBSM (n = 73) or PPC (n = 67). PTSS, distress, and PTG were assessed at pre- and post-intervention, and at 3- and 12-month follow-ups. Analysis showed PPC was more effective in decreasing PTSS (b = -7.61, p < .001) and distress (b = -3.66; p < .001) than CBSM, but neither therapy significantly increased PTG (b = 0.77, p = .76). The relational veracity of PTG and its role predicting reduced PTSS was observed only in the PPC arm. In conclusion, PPC appears to be a valid therapeutic option for assimilating and accommodating the experience of cancer after treatment completion

Internalizing and externalizing personality and subjective effects in a sample of adolescent cannabis users

Cannabis is the illicit substance most widely used by adolescents. Certain personality traits such as impulsivity and sensation seeking, and the subjective effects experienced after substance use (e.g. euphoria or relaxation) have been identified as some of the main etiological factors of consumption. This study aims to categorize a sample of adolescent cannabis users based on their most dominant personality traits (internalizing and externalizing profile). Then, to make a comparison of both profiles considering a set of variables related to consumption, clinical severity and subjective effects experienced. From a cross-sectional design, 173 adolescents (104 men and 69 women) aged 13 to 18 asking for treatment for cannabis use disorder in an Addictive Behavior Unit (UCAD) from the hospital were recruited. For the assessment, an ad hoc protocol was employed to register consumption, the Millon Adolescent Clinical Inventory (MACI) and the Addiction Research Center Inventory (ARCI) 49-item short form were also administered. Factor analysis suggested a two-profile solution: Introverted, Inhibited, Doleful, Dramatizing (-), Egotistic (-), Self-demeaning and Borderline tendency scales composed the internalizing profile, and Submissive (-), Unruly, Forceful, Conforming (-) and Oppositional scales composed the externalizing profile. The comparative analysis showed that the internalizing profile has higher levels of clinical severity and more subjective effects reported than the externalizing profile. These results suggest the need to design specific intervention strategies for each profile

ICOnnecta't: Development and Initial Results of a Stepped Psychosocial eHealth Ecosystem to Facilitate Risk Assessment and Prevention of Early Emotional Distress in Breast Cancer Survivors' Journey

Psychosocial interventions prevent emotional distress and facilitate adaptation in breast cancer (BC). However, conventional care presents accessibility barriers that eHealth has the potential to overcome. ICOnnecta't is a stepped digital ecosystem designed to build wellbeing and reduce psychosocial risks during the cancer journey through a European-funded project. Women recently diagnosed with BC in a comprehensive cancer center were offered the ecosystem. ICOnnecta't consists of four care levels, provided according to users' distress: screening and monitoring, psychoeducation campus, peer-support community, and online-group psychotherapy. Descriptive analyses were conducted to assess the platform's implementation, while multilevel linear models were used to study users' psychosocial course after diagnosis. ICOnnecta't showed acceptance, use and attrition rates of 57.62, 74.60, and 29.66%, respectively. Up to 76.19% of users reported being satisfied with the platform and 75.95% informed that it was easy to use. A total of 443 patients' needs were detected and responsively managed, leading 94.33% of users to remain in the preventive steps. In general, strong social support led to a better psychosocial course. ICOnnecta't has been successfully implemented. The results showed that it supported the development of a digital relation with healthcare services and opened new early support pathways

Video Conference vs Face‐to‐Face Group Psychotherapy for Distressed Cancer Survivors : A Randomized Controlled Trial

Objective This study assesses the effectiveness of face‐to‐face group positive psychotherapy for cancer survivors (PPC) compared to its online adaptation, online group positive psychotherapy for cancer survivors (OPPC), which is held via videoconference. A two‐arm, pragmatic RCT was conducted to examine the effects of both interventions on emotional distress, posttraumatic stress (PTSS) and posttraumatic growth (PTG) among cancer survivors and analyze attrition to treatment. Methods Adult women with a range of cancer diagnoses were invited to participate if they experienced emotional distress at the end of their primary oncological treatment. Emotional distress, PTSS and PTG were assessed at baseline, immediately after treatment and three months after treatment. Intention‐to‐treat analyses were carried out using general linear mixed models to test the effect of the interventions overtime. Logistic regressions were performed to test differential adherence to treatment and retention to follow‐up. Results A total of 269 individuals participated. The observed treatment effect was significant in both modalities, PPC and OPPC. Emotional distress (b = − 2.24, 95%CI = ‐3.15‐ −1.33) and PTSS (b = − 3.25, 95%CI = ‐4.97‐ −1.53) decreased significantly over time, and PTG (b = 3.08, 95%CI = 0.38‐5.78) increased significantly. Treatment gains were sustained across outcomes and over time. Analyses revealed no significant differences between modalities of treatment, after adjusting for baseline differences, finding that OPPC is as effective and engaging as PPC. Conclusions The OPPC treatment was found to be effective and engaging for female cancer early survivors. These results open the door for psycho‐oncology interventions via videoconference, which are likely to lead to greater accessibility and availability of psychotherapy

Consumo de sustancias, adicción y cáncer. Puntos clave

In this review we have conducted an update on three points of interest and/or controversy in the field of addiction in Oncology. Firstly, we focus on the role of substance use as a risk factor in the development and progression of cancer. In this sense, alcohol and tobacco have been widely studied but little is known about other drugs such as marijuana or opioids. Recent works show interesting results about the potential role of these drugs. Secondly we review the aberrant use of medically-prescribed opioids, an issue of growing interest in oncology. It is a concept described in non-oncologic chronic pain but to date, little is known about its relevance and its features in oncologic patients. Finally we discuss the possible role of marijuana in the treatment of cancer symptoms or chemotherapeutic side effects. This is an issue of great complexity and the research conducted on is probably biased by non-scientific aspects as legal constraintsEn esta revisión nos proponemos realizar una actualización acerca de tres aspectos que son objeto de interés y/o controversia en el campo de las adicciones en Oncología. En primer lugar nos centraremos en el papel del consumo de sustancias como factor de riesgo tanto en el desarrollo como en la evolución del cáncer. En el momento actual existen datos contrastados acerca de tabaco y alcohol, pero es menos conocido el posible papel de otras drogas como la marihuana o los opioides. Estudios recientes muestran resultados interesantes acerca de estas drogas. En segundo lugar revisaremos un problema de interés creciente en Oncología, el llamado consumo aberrante de opioides prescritos médicamente. Se trata de un concepto descrito en dolor crónico no oncológico y actualmente, queda pendiente delimitar su prevalencia y características específicas en los pacientes oncológicos. Finalmente discutiremos el posible papel de la marihuana en el tratamiento de síntomas asociados al cáncer o de los efectos secundarios de los tratamientos antineoplásicos. Se trata de un tema de gran complejidad y los resultados obtenidos de la investigación realizada hasta la fecha están probablemente sesgados por aspectos no científicos como las limitaciones legales

El impacto de internet en cáncer: ¿Ha revolucionado el acceso a información sobre salud y la relación con los profesionales sanitarios?

La aparición de Internet y la generalización de su uso a partir de la década de los noventa han transformado la red en una de las principales fuentes de información sanitaria, especialmente en el ámbito oncológico. En la literatura científica y en nuestro actual contexto sociocultural se cuestiona si esta facilitación del acceso a información ha transformado positivamente la interacción paciente-salud y paciente-profesional sanitario. En la interacción paciente-salud, el uso de Internet podría promover que los usuarios fueran más proactivos y responsables en la mejora de su bienestar y calidad de vida. En la relación paciente-profesional, Internet ofrecería a los profesionales sanitarios nuevas formas de empoderamiento facilitando la autonomía del paciente, su implicación en la toma de decisiones, autocuidado y adhesión a tratamientos. Sin embargo, Internet puede plantear nuevos problemas al poner a disposición del paciente una información que quizá no sabe o no quiere gestionar, con potencial para generarle mayor confusión o malestar y afectar a la relación de confianza entre profesional sanitario-paciente. Esta revisión bibliográfica analiza el impacto de Internet en cáncer en términos de oportunidad o conflicto con objeto de determinar su potencial terapéutico

Video conference vs face-to-face group psychotherapy for distressed cancer survivors: A randomized controlled trial

Objective This study assesses the effectiveness of face‐to‐face group positive psychotherapy for cancer survivors (PPC) compared to its online adaptation, online group positive psychotherapy for cancer survivors (OPPC), which is held via videoconference. A two‐arm, pragmatic RCT was conducted to examine the effects of both interventions on emotional distress, posttraumatic stress (PTSS) and posttraumatic growth (PTG) among cancer survivors and analyze attrition to treatment. Methods Adult women with a range of cancer diagnoses were invited to participate if they experienced emotional distress at the end of their primary oncological treatment. Emotional distress, PTSS and PTG were assessed at baseline, immediately after treatment and three months after treatment. Intention‐to‐treat analyses were carried out using general linear mixed models to test the effect of the interventions overtime. Logistic regressions were performed to test differential adherence to treatment and retention to follow‐up. Results A total of 269 individuals participated. The observed treatment effect was significant in both modalities, PPC and OPPC. Emotional distress (b = − 2.24, 95%CI = ‐3.15‐ −1.33) and PTSS (b = − 3.25, 95%CI = ‐4.97‐ −1.53) decreased significantly over time, and PTG (b = 3.08, 95%CI = 0.38‐5.78) increased significantly. Treatment gains were sustained across outcomes and over time. Analyses revealed no significant differences between modalities of treatment, after adjusting for baseline differences, finding that OPPC is as effective and engaging as PPC. Conclusions The OPPC treatment was found to be effective and engaging for female cancer early survivors. These results open the door for psycho‐oncology interventions via videoconference, which are likely to lead to greater accessibility and availability of psychotherapy

An exploratory study in breast cancer of factors involved in the use and communication with health professionals of Internet information

Objective To study the impact of the spontaneous use of Internet on breast cancer patients and on their relationship with health professionals. Methods A mixed methodology was used. Two questionnaires were designed through three focus groups, and then administered to 186 patients and 59 professionals in order to assess: (1) patients' use of Internet for health-related information and (2) the impact of this information on patients' psychological outcomes and on their relationship with professionals. Results Patients spent more time looking for illness-related information after diagnosis, using interactive communities more than static information websites. Patients and professionals disagreed about the use of Internet in terms of the knowledge it provides, and its psychological impact. The main barrier reported by patients regarding the sharing of online information with their professionals was the belief that it would damage their relationship. Conclusions Both professionals and patients have a protectionist conception of the therapeutic relationship. This attitude tends to dismiss the positive impact that the use of Internet and the new communication tools may have in cancer patients. New resources should provide an "Internet Prescription" and modes of interaction to facilitate a more open digital communication