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Spouse caregivers of patients with advanced cancer are a high-risk population for depression. Subjective caregiving burden and relational variables, such as caregivers' attachment orientations and marital dissatisfaction, are important predictors of caregiver depression.

Disordered eating behavior is common and persistent in young women with IDDM and is associated with impaired metabolic control and a higher risk of diabetic retinopathy.

Interpretation: There is a strong stigma attached to palliative care, which may persist even after positive experiences with an early palliative care intervention. Education of the public, patients and health care providers is paramount if early integration of palliative care is to be successful. AbstractCMAJ Podcasts: author interview at

PurposeIndividuals with advanced cancer experience substantial distress in response to disease burden and impending mortality. Managing Cancer And Living Meaningfully (CALM) is a novel, brief, manualized psychotherapeutic intervention intended to treat and prevent depression and end-of-life distress in patients with advanced cancer. We conducted a randomized controlled trial to compare CALM with usual care (UC) in this population.MethodsPatients with advanced cancer were recruited from outpatient oncology clinics at a comprehensive cancer center into an unblinded randomized controlled trial. Permuted block randomization stratified by Patient Health Questionnaire-9 depression score allocated participants to CALM plus UC or to UC alone. Assessments of depressive symptoms (primary outcome), death-related distress, and other secondary outcomes were conducted at baseline, 3 months (primary end point), and 6 months (trial end point). Analyses were by intention to treat. Analysis of covariance was used to test for outcome differences between groups at follow-up, controlling for baseline. Mixed-model results are reported.ResultsParticipants (n = 305) were recruited between February 3, 2012, and March 4, 2016, and randomly assigned to CALM (n = 151) or UC (n = 154). CALM participants reported less-severe depressive symptoms than UC participants at 3 months (Δ = 1.09; P = .04; Cohen’s d = 0.23; 95% CI, 0.04 to 2.13) and at 6 months (Δ = 1.29; P = .02; d = 0.29; 95% CI, 0.24 to 2.35). Significant findings for greater end-of-life preparation at 6 months also favored CALM versus UC. No adverse effects were identified.ConclusionFindings suggest that CALM is an effective intervention that provides a systematic approach to alleviating depressive symptoms in patients with advanced cancer and addresses the predictable challenges these patients face.

OBJECTIVE -To compare the prevalence of eating disturbances in preteen and early teenage girls with type 1 diabetes to their nondiabetic peers. RESEARCH DESIGN AND METHODS-A cross-sectional, case-controlled study of 101 girls with type 1 diabetes, ages 9 -14 years, and 303 age-matched, female nondiabetic control subjects was conducted. Participants completed a Children's Eating Disorder Examination interview. Socioeconomic status, BMI, and diabetes-related variables were assessed. Groups were compared using 2 analyses.RESULTS -Binge eating; the use of intense, excessive exercise for weight control; the combination of two disturbed eating-related behaviors; and subthreshold eating disorders were all more common in girls with type 1 diabetes. Metabolic control was not related to eating behavior in this study population.CONCLUSIONS -Eating disturbances, though mostly mild, were significantly more common in preteen and early teenage girls with type 1 diabetes. Screening and prevention programs for this high-risk group should begin in the preteen years. Diabetes Care 27:1654 -1659, 2004E ating disorders, including anorexia nervosa and bulimia nervosa and their milder variants (eating disorder not otherwise specified [ED-NOS] and subthreshold disorders), are a group of psychiatric disorders unified by highly disturbed eating behavior and a constellation of psychological traits and symptoms. The eating behaviors can include fasting and dieting; binge eating; selfinduced vomiting; the abuse of laxatives, diet pills, diuretics, and other medications; and the use of intense, excessive exercise for weight control. The psychological traits and symptoms include preoccupation with body weight and shape, distortions of body image, and severely disturbed attitudes toward food, calories, and eating (1). Eating disorders have high medical and psychiatric comorbidity and the highest mortality rate of the psychiatric disorders, mostly by suicide (2-4).The etiology of eating disorders appears to be complex and multifactorial, involving individual, familial, and environmental vulnerability factors (5). Living with type 1 diabetes may be one such risk factor, although the nature and specificity of this association has been debated since the first published reports of eating disorders among diabetic individuals in the 1970s (6). Most published studies have found an absolute, if not always statistically significant, increase in the risk of eating disorders among female patients with type 1 diabetes compared with their nondiabetic peers. Nielsen's 2002 metaanalysis of the work to date (7) concluded that bulimia nervosa, ED-NOS, and subthreshold eating disorders are all more common in female patients with type 1 diabetes.Disturbed eating behavior is very common among teenage girls and young women with type 1 diabetes, with binge eating reported by 45-80% and deliberate induction of glycosuria by reducing the insulin dosage or omitting insulin to promote weight loss reported by 12-40% (8 -10). Eating disorders and milder disturbed eating b...

Depressive symptoms in advanced cancer patients are relatively common and may arise as a final common pathway of distress in response to psychosocial vulnerabilities, physical suffering, and proximity to death. These findings support the need for an integrated approach to address emotional and physical distress in this population and to determine whether early intervention may prevent depression at the end of life.

CALM may be a feasible intervention to benefit patients with advanced cancer. The results are encouraging, despite attrition and small effect sizes, and support further study.