Journal Article Annotations
2024, 3rd Quarter

Psychooncology

Annotations by Christian Bjerre Real, MD, MMCI, Deepti Chopra, M.B.B.S., MPH, Daniel McFarland, MD and Marie Tobin, MD
October, 2024

Exploring the Relationship Among Financial Hardship, Anxiety, and Depression in Patients With Cancer: A Longitudinal Study.
Body mass index and risk of over 100 cancer forms and subtypes in 4.1 million individuals in Sweden: The Obesity and Disease Development Sweden (ODDS) pooled cohort study.
The effect of mindfulness-based interventions on biomarkers in cancer patients and survivors: A systematic review.

PUBLICATION #1 — Psychooncology

Exploring the Relationship Among Financial Hardship, Anxiety, and Depression in Patients With Cancer: A Longitudinal Study.

Betina Yanez, Laura M Perry, John Devin Peipert, Maja Kuharic, Chloe Taub, Sofia F Garcia, Alma Diaz, Diana Buitrago, Quan Mai, Laila A Gharzai, David Cella, Sheetal M Kircher.

Abstract: JCO Oncol Pract. 2024 Aug 15:OP2400025. doi: 10.1200/OP.24.00025. Online ahead of print.

Purpose:
Financial hardship (FH) is a complex issue in cancer care, affecting material conditions, well-being, and coping behaviors. This study aimed to longitudinally examine FH, anxiety, depressive symptoms, and their associations while incorporating social determinants of health and health care cost covariates in a sample of patients diagnosed with cancer.

Methods:
This prospective, longitudinal cohort study analyzed data from 2,305 participants from the Northwestern University Improving the Management of Symptoms during and following Cancer Treatment trial. Outcomes assessed at baseline and at 3, 6, 9, and 12 months postbaseline included depressive symptoms, anxiety, and FH. Analysis involved random intercept cross-lagged panel models to explore between- and within-person effects, incorporating factors such as age, sex, insurance status, neighborhood area deprivation, health care charges, out-of-pocket costs, and health literacy.

Results:
The cohort had a mean age of 60.7 (standard deviation [SD] = 12.7) years and was mostly female (64.9%) and White (86.2%). Correlations were found between FH and depressive symptoms (r = 0.310) and anxiety (r = 0.289). A predictive relationship was observed between FH and depressive symptoms, with baseline and 6-month depressive symptom levels predicting later FH (baseline β = .079, P = .070; 6-month β = .072, P = .081) and 9-month FH significantly predicting 12-month depressive symptoms (β = .083, P = .025), even after accounting for health care charges and out-of-pocket costs. Baseline and 9-month anxiety showed a predictive relationship with subsequent FH (baseline β = .097, P = .023; 9-month β = .071, P = .068).

Conclusion:
FH emerged as a prominent issue, with nearly half of participants experiencing some level of FH. Depressive symptoms and anxiety were related to FH. These findings underscore the need for a comprehensive approach in cancer care that concurrently addresses anxiety, depressive symptoms, and FH, recognizing their interconnected impact.

Annotation

The finding:
Yanez et al. evaluated the longitudinal associations between depression, anxiety, and financial hardship and found a bidirectional relationship between depression and financial hardship. Additionally, they identified anxiety as a predictor of experiencing financial hardship.

Strength and weaknesses:
Strengths of this study include longitudinal design with detailed statistical analysis, identification of demographic characteristics that may be at risk and mixed patient population especially regarding treatment status. Limitations include conducting the study at a single site, limiting the generalizability of the results, using an outcome measure assessed by a single item question from a larger scale, and only a small portion of patients experiencing financial hardship at the beginning of the study.

Relevance:
In the last few years, financial hardship has been the assessed more closely in oncology. Results may be helpful to inform psycho-oncology clinicians how they can adjust their practice and how policy makers may consider integration of screening processes to identify and possible treat early.

PUBLICATION #2 — Psychooncology

Body mass index and risk of over 100 cancer forms and subtypes in 4.1 million individuals in Sweden: The Obesity and Disease Development Sweden (ODDS) pooled cohort study.

E Birch, C Williams, J Hunter, M C Lapa.

Abstract: J Pediatr Ophthalmol Strabismus10.3928/0191-3913-19970701-08.

Background:
Obesity, assessed by body mass index (BMI), is an established risk factor for 13 cancers. We aimed to identify further potential obesity-related cancers and to quantify their association with BMI relative to that of established obesity-related cancers.

Methods:
Using Cox regression models on 4,142,349 individuals in Sweden (mean age 27.1 years at weight measurement), we calculated hazard ratios (HRs) for the association between BMI and the risk of 122 cancers and cancer subtypes, grouped by topography and morphology. Cancers with a positive association (i.e., HR >1) at an α-level of 0.05 for obesity (BMI ≥30 kg/m2) vs. normal weight (BMI 18.5–24.9 kg/m2) or per 5 kg/m2 higher BMI, for which obesity is not an established risk factor, were considered potentially obesity related.

Findings:
After 100.2 million person-years of follow-up, 332,501 incident cancer cases were recorded. We identified 15 cancers in men and 16 in women as potentially obesity related. These were cancers of the head and neck, gastrointestinal tract, malignant melanoma, genital organs, endocrine organs, connective tissue, and haematological malignancies. Among these, there was evidence of differential associations with BMI between subtypes of gastric cancer, small intestine cancer, cervical cancer, and lymphoid neoplasms (P values for heterogeneity in HRs <0.05). The HR (95% confidence interval) per 5 kg/m2 higher BMI was 1.17 (1.15–1.20) in men and 1.13 (1.11–1.15) in women for potential obesity-related cancers (51,690 cases), and 1.24 (1.22–1.26) in men and 1.12 (1.11–1.13) in women for established obesity-related cancers (84,384 cases).

Interpretation:
This study suggests a large number of potential obesity-related cancers could be added to already established ones. Importantly, the magnitudes of the associations were largely comparable to those of the already established obesity-related cancers. We also provide evidence of specific cancer subtypes driving some associations with BMI. Studies accounting for cancer-specific confounders are needed to confirm these findings.

Annotation

The finding:
Sun et al., identified 18 types of cancer as potential obesity-related cancers.

Strength and weaknesses:
Strengths include a strong cohort study with a large sample size, prolonged follow up and detailed cancer categorization. Limitations include lack of control for confounding variables like diet, alcohol, physical activity, viral infection history, among others. Type I error is a possibility in the context of exploring 122 cancers.

Relevance:
As the evidence between BMI and several types of cancers increases in robustness, including a conversation relating obesity between CL psychiatrists and their patients becomes increasingly relevant. Having a proper weight management plan is particularly important in the context of individuals taking medications that have weight gain as a potential side effect.

PUBLICATION #3 — Psychooncology

The effect of mindfulness-based interventions on biomarkers in cancer patients and survivors: A systematic review.

Alessio Matiz, Bruna Scaggiante, Ciro Conversano, Angelo Gemignani, Gaetano Pascoletti, Franco Fabbro, Cristiano Crescentini.

Abstract: Stress Health. 2024 Aug;40(4):e3375. doi: 10.1002/smi.3375. Epub 2024 Jan 23.

Various reviews and meta-analyses have shown the positive effects of mindfulness-based interventions (MBIs) on the mental health of cancer patients and survivors. Some studies have also investigated the impact of MBIs on physiological markers of health in oncology, but a systematic review has not been conducted in this field. The current paper aims to fill this gap in the literature. Following preferred reporting items for systematic reviews and meta-analyses 2020 guidelines, data were obtained from the databases of Pubmed, Scopus, Web of Science in May 2022. Twenty-five studies were included. Globally, 35 biomarkers were employed in these studies and were categorized 8 groups (cortisol; blood pressure (BP), heart rate, and respiratory rate; C-reactive protein; telomere length and telomerase activity (TA); genetic signature; cytokines and hormones; leucocyte activation; leucocyte count and cell subpopulation analysis). In seven of these categories of biomarkers, positive effects of MBIs were observed. The most promising results were obtained for cortisol, BP, TA and pro-inflammatory gene expression. However, the generally low number of studies per single biomarker limits the possibility to draw reliable conclusions. The present review presents a comprehensive state-of-the-art for MBIs in oncology on biomarkers, confirming MBIs’ potential for improving physiological health in cancer patients and survivors besides those already shown in literature on psychological well-being.

Annotation

The finding:
This systematic review rigorously studied biological measures captured during mindfulness-based interventions (MBI). It offers a comprehensive overview of the cancer types involved in these studies, primarily breast cancer, and the types of biological measures collected. These include a wide range of biological markers. There is significant heterogeneity present.

Strength and weaknesses:
Overall, this analysis is descriptive and provides insight into various gaps in research. It is difficult to compare across studies that do not align in terms of collected biomarkers or cancer setting (active treatment versus survivorship etc.). Reliability across laboratory assessment is another issue. The strength of the paper is its identification of this heterogeneity. The paper is rather voluminous in terms of presenting relevant data. A weakness is the lack of data synthesis. However, this may not be possible given the heterogeneity of studies collected.

Relevance:
Mindfulness based intervention are an important therapeutic modality that impacts physiology. This area of research warrants further study, as the biological correlates may lead to actionable outcomes.