A research study review of effectiveness of treatments for psychiatric conditions common to end-stage cancer patients: needs assessment for future research and an impassioned plea

Abstract

BackgroundRates of psychiatric conditions common to end-stage cancer patients (delirium, depression, anxiety disorders) remain unchanged. However, patient numbers have increased as the population has aged; indeed, cancer is a chief cause of mortality and morbidity in older populations. Effectiveness of psychiatric interventions and research to evaluate, inform, and improve interventions is critical to these patients’ care. This article’s intent is to report results from a recent review study on the effectiveness of interventions for psychiatric conditions common to end-stage cancer patients; the review study assessed the state of research regarding treatment effectiveness. Unlike previous review studies, this one included non-traditional/alternative therapies and spirituality interventions that have undergone scientific inquiry.MethodsA five-phase systematic strategy and a theoretic grounded iterative methodology were used to identify studies for inclusion and to craft an integrated, synthesized, comprehensive, and reasonably current end-product.ResultsPsychiatric medication therapies undoubtedly are the most powerful treatments. Among them, the most effective (i.e., “best practices benchmarks”) are: (1) for delirium, typical antipsychotics—though there is no difference between typical vs. atypical and other antipsychotics, except for different side-effect profiles, (2) for depression, if patient life expectancy is ≥4–6 weeks, then a selective serotonin reuptake inhibitor (SSRI), and if < 3 weeks, then psychostimulants or ketamine, and these generally are useful anytime in the cancer disease course, and (3) for anxiety disorders, bio-diazepams (BDZs) are most used and most effective. A universal consensus suggests that psychosocial (i.e., talk) therapy and spirituality interventions fortify the therapeutic alliance and psychiatric medication protocols. However, trial studies have had mixed results regarding effectiveness in reducing psychiatric symptoms, even for touted psychotherapies.ConclusionsThis study’s findings prompted a testable linear conceptual model of co-factors and their importance for providing effective psychiatric care for end-stage cancer patients. The complicated and tricky part is negotiating patients’ diagnoses while articulating internal intricacies within and between each of the model’s co-factors. There is a relative absence of scientifically derived information and need for more large-scale, diverse scientific inquiry. Thus, this article is an impassioned plea for accelerated study and better care for end-stage cancer patients’ psychiatric conditions.

A Research Study Review of Effectiveness of Treatments for Psychiatric Conditions Common to End-Stage Cancer Patients: Needs Assessment for Future Research and an Impassioned Plea - A Commentary and Controversy

“…The study was systematic, evidence-based and thematically grounded. This study's results suggest administrative and policy recommendations for the most effective use of treatments for psychiatric conditions common to end-stage cancer patients ( Figure 1 for pictorial definition of where end-stage cancer care lies on the continuum of cancer care) [1][2][3][4][5].…”

“…Johnson reports on a comprehensive 5-phase iterative needs assessment study [1]. The study was systematic, evidence-based and thematically grounded.…”

“…(2) To report results from a current comprehensive evidence-based investigation and analyses that intended to assess the state of research regarding treatment effectiveness and the need for future research [1]. This review study drew on previous seminal studies as well as a few on-going studies regarding psychiatric treatment effectiveness for end-stage cancer patients.…”

“…But few, if any, studies (until this one) have provided a reasonably current, comprehensive detailed review of effectiveness of psychiatric treatments for the range of end-stage cancer patient psychiatric treatments with an eye toward the state of research and need for future research. Hence, the article described herein also reports scientific examinations of newer and even non-traditional/alternative treatments [1]. The ultimate goal was to provide a compendium of "pearls" of best practices for endstage cancer patients' mental health care, so as to help oncologists, mental health practitioners and researchers, and policymaker's better address emotional and psychiatric suffering and improve quality of life for these patients.…”

“…Second, in collecting research articles and answering the challenge of integrating descriptive data, this article reports on the use of an evidence-based, 5-phase systematic strategy [1]. The focus of this strategy was a fortuitous grounded qualitative methodology employed iteratively to generate and assign themes (i.e., code), until "thematic saturation" was reached [35,36].…”