Optimism and Social Support as Contributing Factors to Spirituality in Cancer Patients

Background/objective: The impact a cancer diagnosis and its treatment are affected by psychosocial factors and how these factors interrelate among themselves. The objective of this study was to analyze the relationship between optimism and social support in spiritual wellbeing in cancer patients initiating chemotherapy. Methods: A cross-sectional, multi-center (15 sites), prospective study was conducted with 912 cancer patients who had undergone curative surgery for a stage I-III cancer and were to receive adjuvant chemotherapy. They completed the Functional Assessment of Chronic Illness-Spiritual Well-being Scale (FACIT-Sp), Life Orientation Test-Revised (LOT-R), and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: Significant differences on spirituality scales (meaning/peace and faith) were detected depending on age (≤ 65 vs > 65), sex, marital status, employment, and cancer treatment. Married or partnered participants had significantly higher meaning/peace scores compared to their non-partnered counterparts (p = 0.001). Women, > 65 years, unemployed, and patients treated with chemotherapy and radiotherapy had significantly higher faith scores versus men, ≤ 65 years, employed, and subjects only receiving adjuvant chemotherapy (all p < 0.030). Multivariate analyses indicated that meaning/peace and faith correlated positively with optimism and social support. Conclusion: During oncological treatment, the positive effects of optimism and social support exhibit a positive correlation with spiritual coping. A brief assessment evaluation of these factors can aid in identifying at risk for a worse adaptation to the disease

Psychological factors and prognostic communication preferences in advanced cancer: multicentre study

Objectives: Communication regarding prognosis to patients with advanced cancer is fundamental for informed medical decision making. Our objective was to analyse (1) the proportion of subjects with advanced cancer who prefer to know their prognosis, (2) the characteristics associated with patients’ preference for prognostic information, (3) the psychological factors that impact the preference to know prognosis and 4) the concordance between preference for prognostic information perceived among physicians and patients. Methods: A prospective, cross-sectional design was adopted. Data were collected from 748 participants with advanced cancer at 15 tertiary hospitals in Spain. Participants completed the following questionnaires: Mental Adjustment to Cancer; Trust in the Physician; Uncertainty in Illness Scale Patient’s Prognostic Preferences. Results: Fifty-two per cent of advanced cancer sufferers preferred to know the prognosis of their disease. Compared with participants who preferred not to know, those who did reported more uncertainty, greater satisfaction with their physician and higher scores on positive attitude (all p=0.001). Thirty-seven per cent of the physicians believed that patients want to know their prognosis, indicating that they underestimate the number of such patients. No significant differences were found regarding preference to know prognosis as a function of sociodemographic and clinical variables. Conclusions: A substantial proportion of individuals with advanced cancer prefer to know the prognosis of their disease. It appears that knowing their prognosis was mainly motivated by a need to maintain a positive attitude, lessen uncertainty and by satisfaction with the physician. It is important to explore patients’ preferences for information to offer more personalised communication

Stoic attitude in patients with cancer from the NEOcoping study: cross-sectional study

Aim: Stoicism has been applied to describe a wide range of behaviors in the face of disease and influences an individual's use of coping strategies. This study tested the relationship between stoicism and social support, optimism, psychological distress, and coping strategies in patients with cancer. Method: NEOcoping is a multicenter, cross-sectional study. Participants' data were collected using a standardized, self-report form and LSS, MSPSS, Mini-MAC, BSI-18, and LOT-R questionnaires. Linear regression analyses were used to assess the association between stoicism and distress scores in both genders. A total of 932 individuals with non-metastatic, resected cancer were recruited. Results: Males perceived a higher risk of recurrence and toxicity with adjuvant chemotherapy and obtained higher stoic attitude scores than females. Women scored higher on somatization, depression, and anxiety. Patients with high stoicism scores were older and experienced more maladaptive coping (helplessness, anxious preoccupation), and depression, while those with lower stoicism scores had greater perceived social support, optimism, and positive attitude. In both males and females, stoicism correlated negatively with perceived social support, optimism, and positive attitude, and positively with helplessness, anxious preoccupation, and depression. In men, stoicism was directly and negatively associated with social support and optimism, and positively with anxious preoccupation. In women, stoicism was positively associated. In women, stoicism was directly and negatively associated with social support and positively with age and optimism. Stoicism was directly and positively associated with helplessness. Discussion: A stoic attitude was associated with lower social support, reduced optimism, and passive coping strategies (helplessness and anxious preoccupation) in this series of patients with cancer

Role of sex on psychological distress, quality of life, and coping of patients with advanced colorectal and non-colorectal cancer

Patients with advanced gastrointestinal cancer must cope with the negative effects of cancer and complications. However, data on psychological distress, quality of life, and coping strategies in patients with advanced colorectal cancer compared to non-colorectal cancer based on sex is lacking. This was a multicenter study conducted in 203 patients that completed questionnaires evaluating psychological distress, quality of life, and coping strategies before starting systemic cancer treatment. Based on these data, the degree of disease acceptance in gastrointestinal malignancies may depend on sex and location of the primary digestive neoplasm

Peripheral Blood Mononuclear Cells Predict Therapeutic Efficacy of Immunotherapy in NSCLC

In lung cancer immunotherapy, biomarkers to guide clinical decisions are limited. We now explore whether the detailed immunophenotyping of circulating peripheral blood mononu-clear cells (PBMCs) can predict the efficacy of anti-PD-1 immunotherapy in patients with advanced non-small-cell lung cancer (NSCLC). We determined 107 PBMCs subpopulations in a prospective cohort of NSCLC patients before starting single-agent anti-PD-1 immunotherapy (study group), an-alyzed by flow cytometry. As a control group, we studied patients with advanced malignancies before initiating non-immunotherapy treatment. The frequency of PBMCs was correlated with treatment outcome. Patients were categorized as having either high or low expression for each bi-omarker, defined as those above the 55th or below the 45th percentile of the overall marker expres-ion within the cohort. In the study group, three subpopulations were associated with significant differences in outcome: high pretreatment levels of circulating CD4+CCR9+, CD4+CCR10+, or CD8+CXCR4+ T cells correlated with poorer overall survival (15.7 vs. 35.9 months, HR 0.16, p = 0.003; 22.0 vs. NR months, HR 0.10, p = 0.003, and 22.0 vs. NR months, HR 0.29, p = 0.02). These differences were specific to immunotherapy-treated patients. High baseline levels of circulating T cell subpopulations related to tissue lymphocyte recruitment are associated with poorer outcomes of immunotherapy-treated advanced NSCLC patientsProjects PIE15/00068, PI17/01865, and PI20/01458 (Instituto de Salud Carlos III) awarded to R.C.; Projects FIS PI19/01491 and CIBER Cardiovascular (Fondo de Investigación Sanitaria del Instituto de Salud Carlos III with co-funding from the Fondo Europeo de Desarrollo Regional FEDER) awarded to A.A.; CNIO Bioinformatics Unit is supported by the Instituto de Salud Carlos III (ISCIII); Project RETOS RTI2018-097596-B-I00 (AEI/10.13039/501100011033 MCI/FEDER, UE); Projects PI17/00801 and PI21/01111 grants from Instituto de Salud Carlos III and JR17/00007 awarded to N.R.-L., and Project Molecular Analysis of the Exhaled Breath Condensate in the Management of Solitary Pulmonary Nodule (ideas semilla AECC 2019), from Asociación Española Contra el Cáncer (AECC), awarded to J.

Prediction of quality of life in early breast cancer upon completion of adjuvant chemotherapy

Quality of life (QoL) is a complex, ordinal endpoint with multiple conditioning factors. A predictive model of QoL after adjuvant chemotherapy can support decision making or the communication of information about the range of treatment options available. Patients with localized breast cancer (n = 219) were prospectively recruited at 17 centers. Participants completed the EORTC QLQC30 questionnaire. The primary aim was to predict health status upon completion of adjuvant chemotherapy adjusted for multiple covariates. We developed a Bayesian model with six covariates (chemotherapy regimen, TNM stage, axillary lymph node dissection, perceived risk of recurrence, age, type of surgery, and baseline EORTC scores). This model allows both prediction and causal inference. The patients with mastectomy reported a discrete decline on all QoL scores. The effect of surgery depended on the interaction with age. Women with ages on either end of the range displayed worse scores, especially with mastectomy. The perceived risk of recurrence had a striking effect on health status. In conclusion, we have developed a predictive model of health status in patients with early breast cancer based on the individual's profile

Psychometric Properties of the PDRQ-9 in Cancer Patients: Patient-Doctor Relationship Questionnaire

Background: The patient-doctor relationship is an important concept in health care. The aim of this study was to evaluate the psychometric properties, convergent validity, and factorial invariance of the Patient Doctor Relationship Questionnaire (PDRQ-9). Method: Confirmatory factor analysis was conducted to explore the scale's dimensionality and test for strong measurement invariance across sex, age, and tumor site in a prospective, multicenter cohort of 560 patients who completed the PDRQ-9, Health-related Quality of Life Questionnaire (EORTC-QLQC30), and Brief Symptom Inventory (BSI) scales. Results: The data supported a unidimensional structure. Thresholds and factor loadings could be constrained to be invariant across sex, age, and tumor site, indicating strong measurement invariance. Scores derived from the unidimensional structure exhibited satisfactory degrees of reliability and determinacy. Evidence of convergent validity was supported by modest positive correlations with functional (p<.001) and global quality-of-life (p<.001) and negative correlations with psychological distress (p<.001). Low satisfaction with the oncologist was associated with anxiety (p=.006), and depression (p=.004). Conclusions: The PDRQ-9 is a suitable, valid instrument for assessing the quality of patient-doctor relationships in cancer patients

Current professional standing of young medical oncologists in Spain : a nationwide survey by the Spanish Society of Medical Oncology + MIR section

There is a lack of knowledge about the career paths and employment situation of young medical oncologists. The aim of our study was to evaluate the current professional standing of these professionals in Spain. The Spanish Society of Medical Oncology + MIR section conducted a national online survey in May 2021 of young medical oncology consultants (< 6 years of expertise) and final year medical oncology residents. A total of 162 responses were eligible for analysis and included participants from 16 autonomous communities; 64% were women, 80% were consultants, and 20% were residents. More than half of the participants performed routine healthcare activity and only 7% research activity. Almost three quarters (73%) were subspecialized in a main area of interest and almost half of these chose this area because it was the only option available after residency. Half of the respondents (51%) considered working abroad and 81% believed the professional standing in Spain was worse than in other countries. After finishing their residency, only 22 were offered a job at their training hospital. Just 16% of participants had a permanent employment contract and 87% were concerned (score of ≥ 5 on a scale of 1-10) about their job stability. In addition, one quarter of the participants in our study showed an interest in increasing their research activity. The choice of subspecialty in medical oncology may depend on job opportunities after residency rather than personal interest. The abundance of temporary contracts may have influenced the job stability concerns observed. Future mentoring strategies should engage in building a long-term career path for young medical oncologists. The online version contains supplementary material available at 10.1007/s12094-022-02989-3

Effect of excess weight and immune-related adverse events on the efficacy of cancer immunotherapy with anti-PD-1 antibodies

Immunotherapy is an effective treatment in advanced cancer, although predictors of response are limited. We studied whether excess weight influences the efficacy outcomes of immunotherapy. We have also evaluated the combined prognostic effect of excess weight and immune-related adverse events (irAEs). Efficacy of anti-PD-1 treatment was evaluated with both objective radiological response (ORR) rate and progression-free survival (PFS), and toxicity with irAEs. We studied the association between excess weight and ORR, PFS or irAEs. 132 patients diagnosed with advanced cancer were included. Median body mass index (BMI) was 24.9 kg/m2. 64 patients had normal weight (BMI&lt;25 kg/m2), and 64 patients had excess weight (BMI≥25 kg/m2). Four patients had underweight and were excluded from further analysis. ORR was achieved in 50 patients (38.0%), median PFS was 6 months. 44 patients developed irAEs (33.3%). ORR was higher in excess weight patients than in patients with normal weight (51.6% vs 25.0%; OR 3.45, p = .0009). PFS was improved in patients with excess weight (7.25 months vs 4 months, HR 1.72, p = .01). The incidence of IrAEs was not different in patients with excess weight (54.5% vs 43.2%, p = .21). When high BMI and irAEs were combined, we observed a marked prognostic trend in ORR rate (87.5% vs 6.2%; OR 161.0, p &lt; .00001), and in PFS (14 months vs 3 months; HR 5.89, p &lt; .0001). Excess weight patients with advanced cancer that receive single-agent anti-PD-1 antibody therapy exhibit a significantly improved clinical outcome compared with normal BMI patients. This association was especially marked when BMI and irAEs were considered combined.This study was funded in part by the project Discovery, Validation and Implementation of Biomarkers for Precision Oncology [PIE15/00068], and the project FIS PI17/01865 from the Instituto de Salud Carlos III, Ministerio de Economia y Competitividad, awarded to RC, and the projects [JR 17/00007 and PI17/008], awarded to NRL

Índice de Respuesta Inflamatoria Sistémica (IRIS): Factor Pronóstico en el Cáncer de Páncreas

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 28-01-2021Esta tesis tiene embargado el acceso al texto completo hasta el 28-07-2022Introducción: La estadificación tumoral al diagnóstico determina el abordaje terapéutico de los pacientes con cáncer de páncreas. La intervención quirúrgica ofrece la única oportunidad de curación, pero solo el 20% es resecable al diagnóstico. Los mediadores inflamatorios e inmunes modulan la carcinogénesis, la invasión tumoral y la capacidad del tumor de diseminación. El Índice de Respuesta Inflamatoria Sistémica (IRIS) definido por neutrófilo x monocito/linfocito se ha posicionado como factor pronóstico. Material y Métodos: Estudio observacional y longitudinal, no intervencionista de cohortes con análisis retrospectivo de datos. Cohorte de casos con cáncer de páncreas resecable: 88 pacientes intervenidos entre Enero 2009 y Diciembre 2018. Cohorte de casos con cáncer de páncreas avanzado: 178 diagnosticados entre Enero 2012 y Diciembre 2018. Las funciones de supervivencia global (SG), supervivencia libre de enfermedad (SLE) y supervivencia libre de progresión (SLP) se estiman mediante Kaplan-Meier. Para estudiar su capacidad predictiva se estiman las áreas bajo la curva ROC. Resultados: Cohorte cáncer de páncreas resecable: Mediana de edad 67 años. Mediana SG fue de 19.5 meses y SLE fue de 13 meses. En el análisis univariante, la edad (HR 1.04, CI95% 1.01-1.07, P=0.003), el ECOG PS (HR 2.50, CI95% 1.47-4.24, P=0.001), las comorbilidades (HR 2.75, CI95% 1.55-4.91, P=0.001) y el IRIS ≥1.82x109 (HR 1.85, CI 95% 0.99-3.45, P=0.05) se asociaron de forma estadísticamente significativa con la SG. Cohorte cáncer de páncreas avanzado: Mediana de edad 66 años. 59 (36%) recibieron gemcitabina + nab-paclitaxel, 40 (24%) gemcitabina, 22 (17%) mFOLFIRINOX, 13 (7%) otros regímenes. 27 (16%) no recibieron tratamiento. Los valores de IRIS ≥2.3×109/L previos a la quimioterapia fueron un factor pronóstico negativo e independiente de SG comparado con IRIS <2.3×109/L (5 versus 16 meses, HR 2.87, CI 95% 2.02-4.07, P<0.0001). En la totalidad de la cohorte, los valores de IRIS incrementaron después del tratamiento (1.6×109/L vs. 2.3×109/L; P=0.007, respectivamente). Los pacientes con progresión de la enfermedad presentaron valores de IRIS previos al tratamiento superiores que pacientes en respuesta (2.7×109/L versus 1.2×109/L, respectivamente; P<0.001). Los pacientes con un IRIS previo al tratamiento de ≥2.3×109/L se beneficiaron más de mFOLFIRINOX (mediana de SG de 17 meses comparado con 6 y 4 meses para gemcitabina + nab-paclitaxel y gemcitabina, respectivamente; P<0.001). Conclusiones: Los pacientes con cáncer de páncreas con un IRIS elevado presentaron peor pronóstico. Un valor elevado de IRIS después de tres ciclos de tratamiento quimioterápico se asoció con progresión de la enfermedad. Un incremento en el IRIS podría tener relación con una elevada carga tumoral. El IRIS ha resultado ser un factor pronóstico independiente en ambas cohortes de pacientes, requiriendo una validación prospectiv