Background

Head and neck cancer (HNC) diagnosis could trigger post-traumatic stress disorder (PTSD). In addition, adverse childhood experiences (ACEs), depression, and individual differences in cortisol levels could influence the vulnerability to PTSD in cancer patients. Single nucleotide variants (SNVs) on genes of the hypothalamic-pituitary-adrenal axis, involved in stress response, such as CRHR1 (rs110402, C/T), FKBP5 (rs3800373, G/T), and NR3C1 (rs41423247, C/G), may impact cortisol production. However, the influence of psychosocial and genetic factors on HNC-related PTSD is not fully known. This study aimed to evaluate the association between these vulnerability factors and HNC-related PTSD.

Methods

Eighty-five HNC patients were included in this study. The PTSD Checklist (Civilian Version) (PCL-C) instrument measured PTSD. The ACEs were collected by related questions about physical, sexual, and emotional abuse, and family issues. Beck Depression Inventory (BDI) measured depression information. The genomic DNA of all patients was analyzed by real-time PCR to identify the SNVs genotypes. The PCL-C and BDI cut-off points were 44 and 31, respectively. Differences between groups were assessed by Fisher’s exact test or chi-square, and logistic regression.

Results

Eighteen patients (21.2%) met the criteria for PTSD. Thirty-four of patients (40.0%) presented a least two ACEs. Eighteen patients (21.2%) met the criteria for severe depression. PTSD was most common in HNC patients with at least two ACEs (66.7% vs. 32.8%, p= 0.01), with severe depression at diagnosis (72.2% vs. 7.5%, p< 0.0001), and in who carried variant CRHR1 TT genotype (38.9% vs. 11.9%, p= 0.01), on the univariate analysis. After multivariate analysis, severe depression (OR: 37.8, 95% CI: 8.2-173.7, p< 0.0001) and CRHR1 TT (OR: 6.53, 95% CI: 1.22-34.87, p= 0.02) remained significant.

Conclusions

Severe depression and variant CRHR1 TT genotype seem to influence the PTSD in our sample. We believe that our results, once validated in a larger study, could contribute to identifying psychological and genetic aspects that may influence vulnerability to PTSD in HNC patients, which would benefit from psychological interventions.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

In Sweden, recommendations to reduce the risk of COVID-19 has relied on each citizen’s own sense of responsibility rather than mandatory lockdowns. We studied how COVID-19-related anxiety and self-isolation correlated to seropositivity and PCR-positivity in Swedish patients with cancer.

Methods

In a longitudinal cohort study at Uppsala University Hospital in Sweden; 622 cancer patients on active treatment, and 358 cancer care staff were included April 1^st 2020 to August 1^st 2020. Serological testing for COVID-19 was done at inclusion and every 8-12-week until March 30^th 2021, until vaccination started. Patients initially completed a survey regarding self-reported degree of COVID-19-related anxiety and self-isolation.

Results

622 patients were included; solid malignancy (SM) n=475, hematological malignancy (HM) n=147. 10.5% of SM patients and 6.5% of HM patients became seropositive. Staff seropositivity was higher, 16.2% (p=0.003). PCR-positivity for SM patients (n=52, 11.0%) was similar to seropositivity (n=50, 10.5%), while HM patients had higher PCR-positivity (n=14, 9.7%) than seropositivity (n=10, 6.8%). PCR-positive HM patients required more advanced in-patient treatment (67%) compared to PCR-positive SM patients (29%). High anxiety was expressed by 193 patients (31%), and no to mild anxiety by 403 (65%). Patients with SM expressed higher anxiety than those with HM (n=159, 35% vs n=34, 25%, p=0.04), but self-isolated to a similar degree (53.8% vs 57.6%). Women (OR: 3.37, 2.29-5.02, p=0.001) and patients born outside of Sweden (OR: 2.47, 1.11-5.62, p=0.027) expressed more anxiety. Patients with high anxiety were numerically less likely to test seropositive (7.2% vs 10.6%, p=0.23), while the reverse was seen for those who self-isolated (10.9% vs 8.1%, p=0.27).

Conclusions

Seroprevalence for COVID-19 among cancer patients was not impacted by a higher degree of anxiety or self-isolation in Sweden in 2020, with guidelines resembling those adopted globally today. Patients with hematological malignancies expressed less anxiety but were more likely to require advanced care if diagnosed with COVID-19, and less likely to develop an antibody response.

Legal entity responsible for the study

The authors.

Funding

Lions Cancerforskningsfond SciLifeLab COVID-19.

Disclosure

I. Glimelius: Financial Interests, Institutional, I participate as scientific board on an educational event: Janssen Cilag; Financial Interests, Personal, I participate in a real-world initiative to study register-based data supported by Takeda: Takeda; Financial Interests, Personal, Safety board for evaluation of side-effects from the viral vector developed within the company: Lokon Pharma. All other authors have declared no conflicts of interest.

Background

A cancer diagnosis results in significant distress and adverse psychosocial sequelae, including suicide, the 10th leading cause of death in the United States. Primary risks for death by suicide include depression, and opioid abuse, which are prevalent amongst cancer survivors. Yet, it remains unclear whether they are also associated with other suicidal outcomes, such as ideation, planning, and suicidal attempt. This study examined associations between suicide-related outcomes, depression and non-medical use of pain prescriptions among cancer survivors in the United States.

Methods

We used cross-sectional data from the National Survey on Drug Use and Health (NSDUH; 2015-2019), a nationwide study in the United States that provides data on mental health and other health concerns. Outcomes of interest were patient-reported suicidal ideation, suicidal planning, and suicidal attempt. Participants were grouped as: individuals with a history of cancer, individuals without a history of cancer, but with fair/poor health, and individuals without a history of cancer but with excellent/very good/good health.

Results

Weighted logistic regression analyses that adjusted for sociodemographics and substance use showed associations between a history of cancer and suicidal ideation (aOR = 1.32, 95% CI 1.10, 1.58). Among individuals with a history of cancer, depression and non-medical use of pain prescriptions were consistently associated with suicidal ideation (aORdepression = 7.37, 95% CI 4.52, 12.03; aORpain prescriptions = 3.36, 95% CI 1.27, 8.91, planning (aORdepression = 10.31, 95% CI 5.79, 18.34; and aORpain prescriptions = 3.77, 95% CI 1.20, 11.85), and attempt (aORdepression = 4.29, 95% CI 1.41, 13.06).

Conclusions

Individuals with a history of cancer are at increased odds of adverse suicidal outcomes, driven by depression and non-medical pain prescription. Routinely assessing for depression and non-medical use of pain prescriptions may be a crucial suicide prevention strategy in oncology.

Legal entity responsible for the study

The authors.

Funding

National Institutes of Health (National Institute of Dental and Craniofacial Research).

Disclosure

N. Osazuwa-Peters: Financial Interests, Personal, Advisory Board: Navigating Cancer. All other authors have declared no conflicts of interest.

Background

This study examines the impact of past health events on coping with cancer. The structure of the study was based on the assumption that cancer is a source of stress resulting from the inevitable changes in previous functioning of people with cancer and while the coping strategies which they adopt may be explained in terms of the transactional theory of stress and coping (Lazarus, Folkman) and the critical life events model (Filipp). These two concepts provided the theoretical basis for the study, the focus of which was on defining the role played by antecedents (understood as an earlier experience of loss of health as a result of a serious illness) in the course of the stress transaction in cancer patients. The role of antecendens in coping with stress has only been hinted at in the literature and this role is still unclear.

Methods

121 participants were included in the study. The primary criteria for selection of participants were diagnosis of breast or colorectal cancer and treatment with chemotherapy. The participants were asked to complete a specially designed set of questionnaires which assessed their and their relatives' prior experience of loss of health due to serious illness. To interpret the answers various significant differences tests were used (Mann-Whitney, Kruskal-Wallis and Dunn's correction test) and the significance level p=0.05 was considered to be appropriate for the testing of all statistical hypotheses.

Results

Patients who have experienced a previous loss of health have more unfavourable views on cancer when faced with having to struggle with the disease. In consequence they adopt less effective coping strategies and experience stronger emotional reactions. Colorectal cancer patients are a particularly vulnerable group.

Conclusions

Among cancer patients, when planning psychological assistance, one should take into account earlier experience of loss of health, in order to introduce appropriately selected psychological interventions reducing the level of psychological stress to vulnerable groups.

Legal entity responsible for the study

The authors.

Funding

Greater Poland Cancer Centre.

Disclosure

All authors have declared no conflicts of interest.

Background

Protective measures adopted to contain COVID-19 should not impair cancer pts' psychological wellbeing and clinical status. We assessed anxiety/depression levels and perceptions/beliefs towards COVID-19 vaccination in adult cancer pts who accepted vaccination at the University and Hospital Trust of Verona and Camposampiero Hospital in the Veneto region.

Methods

A self-reported questionnaire was administered to pts undergoing COVID-19 vaccination. 27 items were investigated: i) demographics/clinical characteristics; ii) psychological status (Hospital Anxiety and Depression Scale - HADS - and Distress Thermometer - DT); iii) awareness about infection risks, interference with anticancer treatments, and vaccine side effects, using a 4-points Likert scale.

Results

Only 1.7% of invited pts refused COVID-19 vaccination. Breast (23%) and gastrointestinal (26%) were the most represented cancer sites. Data collected in Verona (1112 respondents) demonstrated mild levels of anxiety, depression, and distress in 75%, 78%, and 64% of pts, respectively. Seventy two percent of pts strongly believed that vaccine can reduce the risk of COVID-19 infection/complications, 62% reported feeling less worried about contracting COVID-19, 63% were not worried that vaccine side effects could interfere with anticancer treatments, and 56% believed that COVID-19 vaccine would not compromise their health. Data collected at the Camposampiero Hospital (286 respondents) confirmed the mild levels of anxiety (80%), depression (72%) and distress (69%) at both vaccine administrations and the increased confidence that vaccine side effects would not interfere with anticancer treatments (58% vs 40%) and that the COVID-19 vaccine would not compromise health (65% vs 42%).

Conclusions

During the COVID-19 vaccination campaign, adult cancer pts demonstrated a favorable psychological status and encouraging levels of vaccine confidence, supporting the role of physician-patient communication in driving the adoption of preventive measures and healthcare recommendations.

Legal entity responsible for the study

The authors.

Funding

The ORCHESTRA project has received funding from the European Union’s Horizon 2020 research and innovation program (grant number 101016167).

Disclosure

All authors have declared no conflicts of interest.

Background

Receiving a diagnosis of cancer may be associated with increased psychosocial distress. Without objective assessments, healthcare professionals tend to underestimate psychological distress, and fail in the recognition, triage and referral of distressed patients. The specific aim is study the improvement in screening by adding a psychological first evaluation.

Methods

A descriptive prospective design has been used to analyze the data of distress thermometer (DT) in initial visits in the cancer unit comparing to the DT o plus psychological evaluation. Data collection was conducted over a six month period. The variables studied were: age, sex, type of tumor, intensity and causes of distress and need for psychological treatment.

Results

139 patients answered the DT screening tool. On average, the participants were 59.4 years old and 54% of them were female. The most frequent diagnoses reported were breast cancer (27%), colorectal cancer (18%) and lung cancer (16.5%). 42 % rated over the cut point of DT (>4). When we used only the DT screening tool (n = 83) 54% with emotional distress dismiss psycho-oncology attention. After including a first consultation with the psycho-oncologist to the DT screening tool (n = 56) only the 23% of patients refused to undergo psychological treatment.

Conclusions

Although the Distress Thermometer is a good screening tool to emotional distress in cancer patients, it does not guarantee adequate psychological attention for recently diagnosed cancer patients. It seems to be important refer patients to the psychologist to improve their attention and treat emotional aspects that can affect their quality of life.

Legal entity responsible for the study

SAAS.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Cancer patients and survivors dealing with adverse events due to cancer treatment, experience impairments in their overall quality of life. In particular, literature reports the potential cardiotoxic effects of cancer therapies, clinically observable up to 10 years after the completion of interventions. However, even though associations between psycho-social factors and cardiovascular diseases have been appreciated in literature, less attention has been given to psycho-social features as correlates of cancer treatment adverse events.

Methods

To address this gap in literature, we completed a two-round Delphi consensus study in order to obtain an expert consensus regarding which psycho-social variables may be linked to cancer treatment adverse events. First, through a literature narrative review, we identified 23 psychosocial constructs related to cardiovascular diseases. Then, a panel of experts, consisting of 32 researchers and professionals in the field of psycho-oncology, clinical and health psychology and oncology, were invited via email to participate in the online Delphi consensus procedure. Participants were asked to rate their level of agreement on considering and measuring the selected constructs on a 5-point Likert scale, to give reasons for their evaluations, and finally to suggest any further variable.

Results

Coming from the two-round Delphi consensus study have suggested the importance of considering fifteen psychological constructs such as anxiety, caregiver burden, cognitive impairment, depression, distress, fatigue, generalized anxiety disorder, loneliness, perceived social support, perceived stress, quality of life, self-control and self-management, stressful life events, self-efficacy, and resilience. Perceived stress and distress were the variables showing the highest level of consensus.

Conclusions

Psycho-social factors may have an impact on adjustment and self-management of cancer treatment adverse events; in particular perceived stress is considered to play a key role. Further studies in this direction are crucial to better investigate direct and indirect links of these psychological constructs with the management of treatment-related adverse events.

Legal entity responsible for the study

The authors.

Funding

CARDIOCARE European Project, a HORIZON2020 funded project (Grant agreement ID: 945175).

Disclosure

All authors have declared no conflicts of interest.

Background

Mental health issues are under-evaluated and under-treated in gynaecological cancer survivors. Information on the prevalence and neurological correlates of these psychological issues, will help in planning of targeted treatment strategies for this problem. The aim of this study to screen gynaecological cancer survivors for mental health issues and to correlate it with serum neurochemical biomarkers.

Methods

This study included gynaecological cancer survivors in the age group of 18-55 years. The study subjects were assessed using DASS-21 for depression, anxiety and stress screening and WHO ASSISTv3.0 for alcohol, smoking and substance involvement screening. Disease characteristics of cancer survivors were abstracted from medical records. Serum levels of neurochemical biomarkers i.e. Brain Derived Nerve Growth Factor (BDNF), Neuropeptide Y (NPY) and peptide Substance P (SP), were analyzed.

Results

A total of 143 gynaecological cancer survivors were identified. 22.4% of the study population did feel depressed after being diagnosed with gynaecological cancer. The prevalence of depression was not associated with site (p=0.308) or stage of cancer (p=0.778). Serum BDNF level was significantly high in screen positives for depression (98.11±10.7 ng/ml vs 80.47±6.6 ng/ml; p=0.04). Serum NPY (p=0.48) and SP (p=0.68) were not significantly associated. 27.3% patients were screened positive for anxiety, which was not associated with site (p=0.166), stage (p=0.774) of cancer or neurochemical marker levels. 13.33% of the study population did use psychoactive substance after being diagnosed with cancer, independent of site (p=0.233)/stage (p=0.826) of disease. Though, the levels of BDNF and NPY did not correlate with psychoactive substance use, however, serum levels of substance P were significantly associated with its use (101.42 pg/ml vs 81.19; p= 0.02 pg/ml).

Conclusions

Mental health conditions are highly prevalent in gynaecological cancer survivors. Depression is associated with high BDNF levels and substance use with substance P levels. Future trials should focus on elucidating mental health conditions and utility of the neurochemical correlates in these patients.

Legal entity responsible for the study

The authors.

Funding

AIIMS Intra-mural Research Grant.

Disclosure

All authors have declared no conflicts of interest.

Background

The incidence of early-onset colorectal cancer (defined as adults aged under 50) is increasing. A diagnosis of early-onset colorectal cancer and its treatment presents unique challenges for these patients and there is a need for better understanding of their supportive care needs. The aim of this study was to explore the lived experiences of individuals receiving treatment for early-onset colorectal cancer, the resulting impact on their lives, and their needs for support.

Methods

Individuals diagnosed and treated for early-onset colorectal cancer in the UK in the last 5 years were recruited from social media. Virtual semi-structured interviews were held with participants from August 2021 to March 2022, which were recorded and transcribed verbatim. Data were analysed using thematic analysis.

Results

Twenty-one individuals participated in interviews (n=16 females and n=5 males), with stage I-IV disease. Participants reported a negative psychological impact including anxiety, body image and fertility concerns. Participants expressed an appreciation for the NHS and healthcare professionals, along with frustrations regarding aspects of their care. Online forums and social media were helpful sources of information and support. Participants also spoke about the impact of cancer treatment on their families and friends.

Conclusions

Our study highlights the unique issues experienced by this patient group during treatment, including the lack of specific care and recognition of younger adults with colorectal cancer. There is a need for more holistic care of these individuals, with service improvement particularly required in the areas of mental health support and fertility counselling.

Legal entity responsible for the study

The authors.

Funding

HSC R&D Division, Public Health Agency, Northern Ireland.

Disclosure

All authors have declared no conflicts of interest.

Background

Patients with metastasis deal with specific challenges from a psychological viewpoint, that go beyond negative emotions and anxiety/depression. While treatment options increase their chances of survival, they perceive end of life as possibly close and their future in terms of time running out. This affects goal setting or ability to set and pursue objectives, both in terms of health management and personal life, disrupting well-being and treatment adherence. It is important to advance our understanding of motivation/goal setting in metastatic patients, to inform health management interventions.

Methods

This study aims to explore disease-related alterations in goal-setting in metastatic patients. In-depth interviews have been conducted with 7 female with metastatic breast cancer.

Results

The interviews confirmed the alteration of the capacity of patients to structure their goals. They reported desires that do not depend on personal agency and could not be structured in courses of actions (e.g., “I just want to live long enough to see my daughter’s wedding”). At the same time, their ability to structure attainable goals appears annihilated. However, after support during the interview, participants were able to recover in part their ability to set goals and to identify ways to pursue them. Goals important for patients that emerged from the interviews were: pursuing old ambitions that were put aside (e.g., long-desired travel); the need for authentic communication with loved ones (e.g., stop hiding the illness); and the pursuit of personal health despite the illness (e.g., take care of their body by physical activity).

Conclusions

This study aims to explore disease-related alterations in goals setting in metastatic patients. Taking care of patients’ perception of their ability to manage their life goals is relevant to support well-being and adherence to clinical treatments. The so-called “implementation intentions” technique may be useful as it entails assisting individuals in identifying and structuring personal goals, filling in the gap between intention and behaviors. Future research may integrate implementation intentions' recommendations in psychological support and eHealth solutions.

Legal entity responsible for the study

IEO, European Institute of Oncology IRCCS, Milan, Italy.

Funding

Fondazione Umberto Veronesi.

Disclosure

All authors have declared no conflicts of interest.

Background

Micronuclei analysis is considered in oncology as a potential biomarker, used for risk assessment and prognosis purposes. This pilot study aimed to determine if there is a genotoxic effect caused by bullying in children and adolescents, through the examination of the difference between the frequency of bullying, micronuclei, and other nuclear abnormalities, between Central Nervous System cancer patients and healthy volunteers.

Methods

Prior Ethics Committee approval. Subjects from 4-17 y/o were recruited (N=39): 19 patients with CNS cancer in treatment and 20 healthy volunteers. All participants answered questionnaires: PedsQL 4.0, family violence and bullying. Samples were collected by exfoliating buccal mucosa through cytobrush. Participants were divided in four groups according to diagnosis and experience of bullying.

Results

No age or sex difference was observed between groups; the most frequent tumor was astrocytoma. 23 subjects (59%) met the criteria for bullying. Correlating sex and bullying, 12 (66%) were males of which 6 (50%) were patients and 6 (50%) volunteers, and 11 (52.3%) were females, 5 (45.4%) patients and 6 (54.5%) volunteers, with no statistic difference. Significant differences in micronuclei were found among groups (Table). Table: 1436P

Distribution of nuclear abnormalities

Conclusions

Correlation between binucleated cells, NBUDs and bullying suggest the genotoxic effect of the latter. Findings open a new investigation line, to generate more information between abuse and genetic damage and enforce preventing strategies for both mental and physical health on childhood and adolescence.

Legal entity responsible for the study

Unviersidad Autonoma de Nuevo León.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Cancer-related cognitive impairment (CRCI) has severe implications for quality of life and sosio-economic functioning in cervical cancer survivors (CCS). Neurophychological (NP) testing remains the gold standard for assessing cognitive late effects, but data on the association between subjective and objective CRCI in cervical cancer is scarce. This cross-sectional study aimed to examine frequency and severity of objective CRCI in CCS reporting significant subjective cognitive impairment (CI) and explore associations between subjective and objective CRCI.

Methods

Cervical cancer survivors (CCS) reporting significant subjective CI, defined as 1.5 standard deviation (SD) below normative mean, underwent NP testing covering attention/working memory, verbal learning and memory, processing speed, verbal fluency, and executive functions. Patients were compared to healthy, age-matched controls. According to International Cognition and Cancer Task Force recommendations, objective CI was defined as scores of ≥2 SD below the control group mean in one test or ≥1,5 SD in two or more tests.

Results

In total, 65 CCS and 74 controls completed NP testing. The CCS group performed significantly reduced across all cognitive domains compared to healthy controls (all p-values <.001). At domain level 21 women (32,3%) in the CCS group showed objective CI compared to 5 (6,7%) in the control group (p<.001), with processing speed and verbal memory being the most affected domains (26,5% and 21,3% respectively). Correlation analyses between subjective CI and cognitive domain scores revealed significant correlation on verbal memory (p=.009) and attention and working memory (p=.011) only, indicating no strong association between the magnitude of subjective CI and level of cognitive performance.

Conclusions

Almost 1/3 of CCS reporting subjective CI showed proof of objective CI. Although cognitive impairment is evident in CCS, our results also support evidence that objective and subjective CI represent different constructs. Differentiating subjective and objective CI might be important when tayloring effective interventions to improve cognitive function in CCS.

Legal entity responsible for the study

The authors.

Funding

Jan Kåre Heiberg and Marthe Vildåsen.

Disclosure

K. Lindemann: Financial Interests, Personal, Advisory Board: MSD, Eisai; Financial Interests, Personal, Other, Speaker: GSK; Financial Interests, Institutional, Research support paid to institution: GSK; Financial Interests, Institutional, Support for clinical study paid to institution: AstraZeneca, MSD, Roche, Nykode; Financial Interests, Institutional, Advisory Board: MSD; Financial Interests, Institutional, Invited Speaker, Consultancy: AstraZeneca; Personal and Institutional, Deputy Medical Director: NSGO; Other, Personal, Member: NSGO, ESGO, ASMO. All other authors have declared no conflicts of interest.