Journal Article Annotations
2022, 4th Quarter

Psychooncology

Annotations by Christian Bjerre Real, MD, MMCI, Deepti Chopra, M.B.B.S., MPH, Daniel McFarland, MD, and Marie Tobin, MD
January, 2023

Biobehavioral Implications of Chimeric Antigen Receptor T-cell Therapy: Current State and Future Directions.
Optimising implementation of telehealth in oncology: A systematic review examining barriers and enablers using the RE-AIM planning and evaluation framework.
Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine.

PUBLICATION #1 — Psychooncology

Biobehavioral Implications of Chimeric Antigen Receptor T-cell Therapy: Current State and Future Directions.

Mallory R Taylor, Angela Steineck, Sheila Lahijani, Anurekha G Hall, Heather S L Jim, Rachel Phelan, Jennifer M Knight

Abstract: Transplant Cell Ther. 2023 Jan;29(1):19-26. doi: 10.1016/j.jtct.2022.09.029. Epub 2022 Oct 5.

Chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable clinical responses in hematologic malignancies. Recent advances in CAR T-cell therapy have expanded its application into other populations including older patients and those with central nervous system and solid tumors. Although its clinical efficacy has been excellent for some malignancies, CAR T-cell therapy is associated with severe and even life-threatening immune-mediated toxicities, including cytokine release syndrome and neurotoxicity. There is a strong body of scientific evidence highlighting the connection between immune activation and neurocognitive and psychological phenomena. To date, there has been limited investigation into this relationship in the context of immunotherapy. In this review, we present a biobehavioral framework to inform current and future cellular therapy research and contribute to improving the multidimensional outcomes of patients receiving CAR T-cell therapy.

Annotation

The finding:
This narrative review utilizes current research to build a biobehavioral framework which speaks of the interrelatedness between cellular immunity dysfunction, psychosocial distress, and neurocognitive events in the context of CAR-T cell therapy. It also discusses current evidence on treatment strategies within such constructs both in the behavioral and pharmacological realms.

Strength and weaknesses:
Biobehavioral frameworks are generally useful in the field of psychosomatics, and especially so in emerging research areas (such as CAR-T Cell therapy), as it grounds our current understanding and suggests future research directions. The narrative nature of the review lacks a literature methodology which allows for selection bias.

Relevance:
C-L psychiatrists are increasingly involved in treating neuropsychiatric complications of CAR-T cell therapy. Deepening our understanding of the relationship among immune, affective, and neurocognitive phenomena supports better treatment plans and communication with primary teams.

PUBLICATION #2 — Psychooncology

Optimising implementation of telehealth in oncology: A systematic review examining barriers and enablers using the RE-AIM planning and evaluation framework.

Stella Bu, Allan ‘Ben’ Smith, Anna Janssen, Candice Donnelly, Ann Dadich, Lisa J Mackenzie, Andrea L Smith, Alison L Young, Verena S Wu, Sarah J Smith, Ursula M Sansom-Daly.

Abstract: Crit Rev Oncol Hematol. 2022 Dec;180:103869. doi: 10.1016/j.critrevonc.2022.103869. Epub 2022 Nov 7.

Telehealth facilitates access to cancer care for patients unable to attend in-person consultations, as in COVID-19. This systematic review used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate telehealth implementation and examine enablers and barriers to optimal implementation in oncology. MEDLINE, PubMed, CINAHL, and the Cochrane Database of Systematic Reviews were searched between January 2011-June 2022. Eighty-two articles representing 73 studies were included. One study explicitly used the RE-AIM framework to guide study design, conduct, or reporting. Reach (44%) and implementation (38%) were most commonly reported, maintenance (5%) least commonly. Key telehealth implementation enablers included professional-led delivery, patient-centred approaches, and positive patient perceptions. Key barriers included patient discomfort with technology, limited supporting clinic infrastructure, and poor access to reliable internet connection and videoconferencing. While a patient-centred and professional-supported approach enables telehealth implementation, technology and infrastructure constraints need surmounting for sustained implementation beyond the COVID-19 pandemic.

Annotation

The finding:
The review evaluates various dimensions of telehealth programs in oncology using the RE-AIM framework to evaluate the feasibility of sustaining implementation of these programs. The authors identified 73 studies: one-third were randomized controlled trials, one-third were from heterogenous cancer sites, and a majority were recruited from hospital settings. They found a wide range of participation (10–100%), and approximately a third of the studies reported participant’s reason declining telehealth. Effectiveness of telehealth programs were assessed not only at the patient level but also at the system level. Patient outcomes primarily assessed quality of life (QOL) measures with 35% of studies noting significant improvement in QOL post telehealth intervention and 22% noting no difference. When compared to control (standard hospital care), QOL outcomes were not different. System level findings revealed 58% of studies found telehealth to be more cost effective whereas 16% found no difference, and the remaining 16% found telehealth to be more costly. Another system level finding was training staff in telehealth lowered rate of attrition and site-specific information regarding telehealth infrastructure was lacking in most studies.

Strength and weaknesses:
The paper is a comprehensive review that provides a platform for further assessment and development of telehealth in oncology settings. Authors highlight the various impacts of telehealth on patients, staff and organizational outcomes that may help clinicians tailor their practice or help administrators craft a more meaningful hybrid model of healthcare delivery. Knowledge of enablers and barriers can help guide future telehealth programs. Due to variability in studies—sample size, participation rate and location of hospital setting—some specific data cannot be easily generalized.

Relevance:
This review will help C-L psychiatrists and service leaders anticipate potential concerns in implementing, sustaining, or expanding telehealth programs in the post-COVID era.

PUBLICATION #3 — Psychooncology

Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine.

Oscar Fraile-Martinez, Miguel A Alvarez-Mon, Cielo Garcia-Montero, Leonel Pekarek, Luis G Guijarro, Guillermo Lahera, Miguel A Saez, Jorge Monserrat, Domitila Motogo, Javier Quintero, Melchor Alvarez-Mon, Miguel A Ortega.

Abstract: Front Oncol. 2022 Sep 16;12:956923. doi: 10.3389/fonc.2022.956923. eCollection 2022.

In recent years, the incidence of different types of cancer and patient survival have been rising, as well as their prevalence. The increase in survival in recent years exposes the patients to a set of stressful factors such as more rigorous follow-up and more aggressive therapeutic regimens that, added to the diagnosis of the disease itself, cause an increase in the incidence of depressive disorders. These alterations have important consequences for the patients, reducing their average survival and quality of life, and for these reasons, special emphasis has been placed on developing numerous screening tests and early recognition of depressive symptoms. Despite that cancer and major depressive disorder are complex and heterogeneous entities, they also share many critical pathophysiological mechanisms, aiding to explain this complex relationship from a biological perspective. Moreover, a growing body of evidence is supporting the relevant role of lifestyle habits in the prevention and management of both depression and cancer. Therefore, the present study aims to perform a thorough review of the intricate relationship between depression and cancer, with a special focus on its biological links, clinical management, challenges, and the central role of lifestyle medicine as adjunctive and preventive approaches to improve the quality of life of these patients.

Annotation

The finding:
This is a review of several proposed biological mechanisms underlying the relationship between cancer and depression. The paper highlights similarities between constitutional systemic homeostatic mechanisms in the initiation and propagation of cancer and the development of depression. The article is a comprehensive survey of these mechanisms generally showing the similarity in biological disruption in both cancer and depression. Particular attention is given to gut ‘dysbiosis’ and inflammation common to both diseases. Attention is also given to lifestyle interventions on symptom management in patients with cancer. The discussion on lifestyle management is a particularly unique aspect of this article as it is potentially actionable when considering the dysregulated biology and depressive symptoms in patients with cancer.

Strength and weaknesses:
Overall, this review article is a literature survey and provides a comprehensive assessment of underlying biological mechanisms to both cancer and depression. The article provides numerous thought-provoking and hypothesis-generating ideas based on extant literature and data. The topic is extremely broad, and one weakness of the article is its lack of an integrated synthesis of the material. The authors could do a better job of explaining what all the data ultimately mean for the field and how a researcher or clinician would might advance the field.

Relevance:
The C-L psychiatrist should be aware of the basic science underlying symptom management. The focus on lifestyle management, along with gut inflammation and circadian disruption should be considered in the management of depression in patients with cancer.