Journal Article Annotations
2022, 4th Quarter

Palliative Care

Annotations by Barbara Lubrano di Ciccone, MD and R Garrett Key, MD
January, 2023

Prevalence of anxiety and depression in people with different types of cancer or haematologic malignancies: a cross-sectional study.
Communicating With Nursing Home Residents About End of Life.

PUBLICATION #1 — Palliative Care

Prevalence of anxiety and depression in people with different types of cancer or haematologic malignancies: a cross-sectional study.

E L Zeilinger C Oppenauer, M Knefel, V Kantor, C Schneckenreiter, S Lubowitzki, K Krammer, C Popinger, A Kitta, L Kum, F Adamidis, M Unseld, E K Masel, T Füreder, S Zöchbauer-Müller, R Bartsch, M Raderer, G Prager , M T Krauth, W R Sperr, E Porpaczy, P B Staber, P Valent, A Gaiger

Abstract: Epidemiol Psychiatr Sci. 2022 Oct 17;31:e74. doi: 10.1017/S2045796022000592.

Aims:
Cancer patients often present with psychological symptoms that affect their quality of life, physical health outcomes and survival. Two of the most frequent psychiatric comorbidities are anxiety and depression. However, the prevalence of these disorders among cancer patients remains unclear, as studies frequently report varying rates. In the present study, we aimed to provide robust point estimates for the prevalence of anxiety and depression for both a mixed cancer sample and for 13 cancer types separately, considering confounding variables.

Methods:
In a sample of 7509 cancer outpatients (51.4% female), we used the Hospital Anxiety and Depression Scale to assess rates of anxiety and depression. Applying ordinal logistic regression models, we compared the prevalence of anxiety and depression between different cancer types, controlling for age and gender.

Results:
About one third of our sample showed symptoms of anxiety (35.2%) or depression (27.9%), and every sixth patient had a very likely psychiatric condition, with women being more frequently affected. Elderly patients more often showed signs of depression. The prevalence of anxiety and depression was significantly higher in lung and brain cancer patients, than in other cancer patients. Lowest depression rates were found in breast cancer patients.

Conclusions:
The prevalence of anxiety and depression is high in cancer patients. Type of cancer is an important predictor for anxiety and depressive symptoms, with lung and brain cancer patients being highly burdened. Considering a personalised medicine approach, physicians should take into account the high prevalence of psychiatric comorbidities and include psychiatric consultations in the treatment plan.

Annotation

The finding:
The Hospital Anxiety and Depression Scale (HADS) was administered to 7509 outpatients to determine the point prevalence of anxiety and depression among patients with different cancer types. Anxiety was present in 35% of patients; depression, in 28%. Every sixth patient was likely to have a psychiatric condition. Being female, elderly, or having lung or brain cancer were associated with anxiety or depression. The lowest rates of depression were found among patients with breast cancer.

Strength and weaknesses:
The authors did not control for cancer stage or treatment phase, including current or past chemotherapy or therapy response. Additionally, in the context of cancer, the use of screening instruments for depression and anxiety are often over-inclusive regarding a potential diagnosis, and the HADS has not been validated for brain cancers. As a single-centre study, the generalisability of results may be limited. Nevertheless, the large sample size of the present study should be emphasised as a strength. Using an unselected mixed cancer patient sample might reflect prevalence as actually encountered in an outpatient clinic, thus providing a realistic picture of the actual burden of outpatient cancer patients.

Relevance:
It is known that there is a high proportion of psychological burden in cancer patients. This article highlights the importance of ongoing screening for depression and anxiety in all cancer patients, particularly in patient with lung and brain cancers. There should be a low threshold for providing mental health services.

PUBLICATION #2 — Palliative Care

Communicating With Nursing Home Residents About End of Life.

Janet Sopcheck, Ruth M Tappen

Abstract: Am J Hosp Palliat Care. 2022 Nov;39(11):1257-1265. doi: 10.1177/10499091211064835. Epub 2021 Dec 30.

Approximately 33% of the 1.2 million older individuals residing in nursing homes have the capacity to discuss their preferences for end-of-life care, and 35% will die within their first year in the nursing home. These conversations necessary to promote care consistent with the resident’s preferences are often limited and most often occur when the resident is actively dying. The purpose of this secondary analysis was to understand the resident’s perspectives on end-of-life communication in the nursing home and suggest approaches to facilitate this communication. We interviewed 46 participants (16 residents, 10 family members, and 20 staff) in a Southeast Florida nursing home from January to May 2019. The data were analyzed using descriptive and pattern coding and matrices to decipher preliminary categories and thematic interpretation within and across each participant group. Two themes emerged from this secondary analysis that residents assume others know their end-of-life preferences, and past experiences may predict future end-of-life choices. Residents and family members were willing to discuss end-of-life care. Study findings also suggested that past experiences with the end-of-life and critical illness of another could impact residents’ and family members’ end-of-life care decisions, and that nurses’ recognition of subtle signs of a resident’s decline may trigger provider-initiated end-of-life conversations. Future research should focus on strategies to promote earlier end-of-life discussions to support independent decision-making about end-of-life care in this relatively dependent population of older adults.

Annotation

The Finding:
End-of-life (EOL) communication is relatively infrequent in the sample of nursing home medical personnel and also family members. Nursing home residents are generally willing to talk about EOL preferences but often assume that their end-of-life preferences are already known by either family or medical staff without explicit discussion. Their choices about EOL care are likely to be influenced by personal experiences around deaths to which they have been close. Provider-initiated conversations about EOL preferences may improve outcomes and decision making in this large vulnerable population.

Strength and weaknesses:
The strengths of this secondary analysis are that it includes a wealth of first-hand narrative statements from nursing home residents, staff, and family members around EOL communication preferences. Weaknesses include a small and local sample size from one institution in Florida and therefore unclear generalizability to other populations.

Relevance:
C-L Psychiatrists are often involved in the care of nursing home patients either in their residence, during acute medical hospitalization, and during transition events that can result in initial nursing home placement. This position offers opportunity to initiate or clarify discussions of EOL preferences to improve outcomes for patients and families as they navigate the later stages of life.