Individualized quality of life, standardized quality of life, and distress in patients undergoing a phase I trial of the novel therapeutic Reolysin (reovirus)

BACKGROUND: The purpose of this study was to evaluate the individualized and standardized quality of life (QL) and psychological distress of patients participating in a Phase I trial of the novel therapeutic reovirus (Reolysin). METHODS: 16 patients with incurable metastatic cancer were interviewed prior to being accepted into the phase I trial with a semi-structured expectations interview, the Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL-DW), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Brief Symptom Inventory (BSI), the Beck Depression Inventory (BDI), and the Spiritual Health Inventory (SHI). RESULTS: Patients were able to complete all measures. They felt hopeful and excited about the trial, with about two thirds hoping for disease regression and one third hoping for a cure. The most commonly spontaneously nominated areas of QL were family relationships, activities and friends, and the overall SEIQoL mean index score was 69. Health was nominated by only 38% of the sample. Scores on the SEIQoL were correlated with global QL on the EORTC QLQ C-30. Scores on the BDI and BSI were lower than reported for similar populations, and on the SHI scores were similar to other samples. Global QL on the EORTC QLQ C-30 and depression scores were associated with time to death in the nine patients who had died at the time of writing. CONCLUSIONS: Individualized QL is easy to assess in seriously ill cancer patients, provides useful information relative to each individual, and is related to standard QL measures. Repeated assessment of individualized QL of patients in Phase I trials would be a useful addition to the research

Disparities in psychosocial cancer care: a report from the International Federation of Psycho-oncology Societies.

BACKGROUND: The aim of the study was to understand the characteristics of the International Federation of Psycho-oncology Societies (FPOS) and possible disparities in providing psychosocial care in countries where psycho-oncology societies exist. METHOD: A survey was conducted among 29 leaders of 28 countries represented within the FPOS by using a questionnaire covering (i) characteristics of the society; (ii) characteristics of the national health care system; (iii) level of implementation of psycho-oncology; and (iv) main problems of psycho-oncology in the country. RESULTS: Twenty-six (90%) FPOS returned the questionnaires. One-third reported to have links with and support from their government, while almost all had links with other scientific societies. The FPOS varied in their composition of members' professions. Psychosocial care provision was covered by state-funded health services in a minority of countries. Disparities between countries arose from different causes and were problematic in some parts of the world (eg, Africa and SE Asia). Elsewhere (eg, Southern Europe and Eastern Europe), austerity policies were reportedly responsible for resource shortages with negative consequences on psychosocial cancer care. Half of FPOS rated themselves to be integrated into mainstream provision of care, although lack of funding was the most common complain. CONCLUSIONS: The development and implementation of psycho-oncology is fragmented and undeveloped, particularly in some parts of the world. More effort is needed at national level by strong coalitions with oncology societies, better national research initiatives, cancer plans, and patient advocacy, as well as by stronger partnership with international organizations (eg, World Health Organization and Union for International Cancer Control)

The practices of apartheid as a war crime: a critical analysis

The human suffering caused by the political ideology of apartheid in South Africa during the Apartheid era (1948-1994) prompted worldwide condemnation and a variety of diplomatic and legal responses. Amongst these responses was the attempt to have apartheid recognised both as a crime against humanity in the 1973 Apartheid Convention as well as a war crime in Article 85(4)(c) of Additional Protocol I. This article examines the origins, nature and current status of the practices of apartheid as a war crime and its possible application to the Israeli-Palestinian conflict

Unmet psychosocial supportive care needs and psychological distress in haematological cancer survivors: The moderating role of psychological flexibility.

Background The period immediately after the end of cancer treatment is a time when supportive care for the cancer patient decreases; this is known to increase risk of psychological distress and poor wellbeing. While there is broad recognition that unmet psychological and supportive care needs correlate with psychological wellbeing, little is understood about the factors that influence this relationship. This study explores the role of psychological flexibility, with a particular focus on its potential moderating role between unmet needs and psychological distress in haematological cancer survivors. Materials and Method Haematological cancer survivors were recruited for this cross-sectional study through two major UK blood cancer charities. Participants (n=91) were all over the age of 16 and had been diagnosed with any sub-type of haematological cancer more than 18 months previously. Participants completed self-report questionnaires assessing unmet psychological and supportive care needs (SCNS SF34), anxiety and depression (HADS), quality of life (EORTC QLQ-C30) and psychological flexibility (AAQ II). Results High levels of both unmet need and distress were present in the sample, indicating on-going care needs for these cancer survivors. Statistically significant correlations between unmet needs, psychological flexibility and all outcome variables (anxiety, depression, quality of life) were found. Using regression analysis based on Hayes’ methodology (Hayes, 2013), psychological flexibility was found to act as a moderator between unmet need and distress in four out of 15 models; specifically, the statistical relationship between need and distress emerged only when levels of psychological flexibility were at average level or above. Discussion Haematological cancer survivors have on-going supportive care needs that persist well beyond the end of active treatment. Unmet needs can, in turn, increase levels of anxiety and depression, and reduce quality of life in this patient group. The understanding offered by our data that psychological flexibility plays a moderating relationship between need and psychological distress creates opportunities for the development of theoretically-informed interventions to reduce both unmet need and distress in cancer patients. As such, these findings support the growing emphasis on Acceptance and Commitment based interventions for cancer patients

Feasibility of use of the anxiety thermometer in antenatal services

Of the 102 women approached, 101 (99%) completed the anxiety thermometer (AnxT). The women were aged between 22–44 years (mean age 34.5 years); about half were primigravida and half multigravida. Almost two-thirds rated their current anxiety as four or above out of a maximum of 10. The most frequently reported concern was health of baby, followed by fears and worries, tiredness, and sleep problems. The high participation rate suggests that the AnxT can be developed to screen anxiety and elicit perinatal and related concerns to facilitate consultation and appropriate triaging. The problem checklist was refined based on the current results

The decision-making process for breast reconstruction after cancer surgery: representations of heterosexual couples in longstanding relationships

International audienceOBJECTIVES: Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. To our knowledge, no research has studied the involvement of the partner in the decision-making process regarding breast reconstruction (BR) after cancer. This study aimed to gain a better understanding of the couples' decision-making process for BR in the cancer context and particularly to investigate the partners' involvement in this process.METHOD: Eighteen participants (nine women who underwent a mastectomy following a first breast cancer and their intimate partners) took part in this study. We conducted semidirective interviews, and a general inductive approach was chosen to capture the representations of the couples.RESULTS: The women in the sample were aged between 33 and 66 years (M = 54, SD = 7.5) and their partner between 40 and 76 years (M = 59, SD = 11.6). The duration of their intimate relationship was on average 18 years (SD = 10.4; minimum = 4; maximum = 33). The analysis revealed 11 major themes. The two most salient ones were 'external influence' and 'implication of the partner'. The exploration of the subthemes revealed that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. The partner's role is depicted as consultative and mostly supportive.CONCLUSION: These results provide new insights on the involvement of the partner in decision-making. Thus, it now seems crucial to develop a prospective study, which will help understand the progression of the decision-making process over time. Statement of contribution What is already known on this subject? Most people deal with intrusive life events such as cancer and the care trajectory together with their intimate partners. Shared decision-making between patients and physicians is now the 'gold standard' in Western Europe and the United States. However, in the context of breast reconstruction (BR) after cancer, factors guiding the decision-making process for BR, especially the potential involvement of the partner, are not very well understood. What does this study add? Provides a qualitative insight on the specific nature of heterosexual couples' representations regarding the decision-making process for breast reconstruction after cancer. Reveals that the decision-making process is often reported as an interrelated experience by the couples and as a dyadic stressor. Underlines the consultative function of partners with women engaged in breast reconstruction