Emotional Distress Prior to Chemoradiation for Rectal or Anal Cancer

Background/Aim: Breast cancer patients receiving radiation therapy (RT) may experience considerable distress. We investigated the course of distress during an RT-course for breast cancer. Patients and Methods: Three-hundred-andthirty breast cancer patients completed Distress Thermometers before and directly after RT. Distress was evaluated in the entire cohort and different groups of age, sex, Karnofsky performance score (KPS), intent of RT, and previous RT. Results: Mean change of distress scores was -0.4 points, which was significantly associated with KPS. Decrease of distress was more pronounced in patients with KPS ≤80 or age <64 years. Deterioration (yes vs. no) was non-significantly associated with no previous RT. In patients with pre-RT distress scores ≤5 points, mean score increased by +0.5 points; no significant associations between characteristics and investigated endpoints were found. Conclusion: Psychological assistance should be offered to all patients irradiated for breast cancer, particularly to those with risk factors, regardless of the pre-RT distress score.Breast cancer is the most common primary tumor type among women in Western countries (1). Many of these patients receive radiation therapy (RT), either as loco-regional treatment following breast surgery or for metastatic disease. Anticipated treatment may induce considerable distress for the corresponding patients. In a previous study of breast cancer patients assigned to adjuvant RT following breastconserving surgery or mastectomy, 46% of patients reported fears prior to the start of RT, 38% worry, 29% sadness, and 29% nervousness (2). These emotional problems are part of the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT) (3). In the study of Mose et al., 48% of patients assigned to adjuvant RT of early-stage breast cancer reported distress related to the upcoming RT (4). In addition, Goldschmidt Mertz et al. found that 43% of patients with newly diagnosed breast cancer felt distressed, when a cut-off value of 7 points on the NCCN-DT (points range between 0 and 10, with 10 points indicating maximum distress) was used (5). When using a cut-off value of 3 points, even 77% of the patients were considered distressed. The highest rates were observed for worry and nervousness (5). Luutonen et al. found depressive symptoms and distress in 32% and 28% of breast cancer patients treated with adjuvant RT (6). Moreover, Browall et al. have shown that emotional functioning is positively correlated with the quality of life of patients receiving adjuvant RT for breast cancer (7).Current literature demonstrates that emotional and psychological distress are common in breast cancer patients assigned to RT. However, little is known regarding the course of distress scores during an RT-series. In a previous study including different types of malignancy, the change of distress during the RT-course was significantly associated with the primary tumor type (8). Therefore, it was considered reasonable to perform separate studies for the most com...

Section: Discussionsupporting

confidence: 68%

Development of Distress During a Radiotherapy Course in Patients Irradiated for Breast Cancer

DELIKANLI,

JANSSEN,

et al. 2023

“…When summarizing the data regarding emotional distress prior to RT for prostate cancer, the prevalence at baseline was lower than that in patients undergoing RT for other in vivo 37: 2173-2177 (2023) 2174 malignant diseases (12)(13)(14)(15)(16). For example, the prevalence of specific emotional problems was 12-46% in patients irradiated for breast cancer, 11-47% in patients irradiated for head-and-neck cancers, 16-57% in patients irradiated for gynecological cancers, 11-47% in patients irradiated for rectal or anal cancer, and 23-63% in patients irradiated for malignant gliomas, respectively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Distress Scores Before and After Radiotherapy for Prostate Cancer

JANSSEN,

DELIKANLI,

et al. 2023

Background/Aim: Prostate cancer patients undergoing radiotherapy (RT) may experience distress. This study evaluated the course of distress during RT. Patients and Methods: Four distress characteristics were analyzed for change of distress in 136 patients irradiated for prostate cancer, including age, Karnofsky performance score, intent of RT, and previous RT. Results: Mean distress scores were 4.3 (±2.9) at baseline and 4.2 (±2.7) at the end of RT.Associations with increased distress were found for KPS >80 (p<0.001) and curative intent RT (p=0.072). When evaluating increased distress as binary variable (yes vs. no), KPS >80 was significant on univariable (p<0.001) and multivariable (p=0.016) analyses. In patients with baseline scores ≤5 points, KPS >80 was associated with mean change of distress (p=0.009) and increased distress (p=0.029). Conclusion: Many patients receiving RT for prostate cancer do not experience increased distress during their treatment course. Patients at higher risk of increased distress may require early psychological assistance.

“…A considerable proportion of cancer patients assigned to a course of RT experience significant distress due to the upcoming treatment (1)(2)(3)(4)(5)(22)(23)(24). Distress can lead to sleep disorders and decreased quality of life (1,(25)(26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Distress Scores in Elderly Cancer Patients During Radiotherapy

RADES,

DELIKANLI,

et al. 2023

Background/Aim: When assigned to radiotherapy (RT), elderly patients may experience distress. We investigated distress during RT and potential risk factors in these patients. Patients and Methods: Six-hundred-andnineteen patients completed pre-RT and post-RT distress thermometers. Seven characteristics were investigated including age, sex, Karnofsky performance score (KPS), grouped KPS, tumor type, intent of RT, and previous RT. Additional analyses were performed in 358 patients with pre-RT scores ≤5. Results: Mean change of distress was -0.5 (±2.7) points and associated with KPS (p=0.005) and grouped KPS (p<0.001). Male sex (p=0.035), KPS 90-100 (p=0.001), and curative intent (p=0.037) were associated with increased distress on univariable analyses, and KPS 90-100 (odds ratio=1.92, p=0.004) on multivariable analysis. In patients with baseline scores ≤5, mean change was +0.5 (±2.5) points and associated with KPS (p=0.040) and grouped KPS (p=0.025). Conclusion: Psychological assistance should be considered for all patients including those with baseline scores ≤5 and KPS 90-100. Patients with risk factors for increased distress would especially benefit.Many cancer patients assigned to a course of radiotherapy (RT) experience significant distress (1-5). However, little is known about the development of distress during the course of . The levels of distress may decrease due to habituation with the daily sessions of RT or increase, for example due to symptoms caused by RT-related adverse events or a treatment effect below the patient's expectations. In our pilot study including 200 patients receiving RT, the mean distress score decreased in the majority of patients ( 8). These results were confirmed in our recent study of 927 patients (9). Both studies included patients of any age and did not focus on elderly or very elderly patients (8).As patients continue to live longer, outcomes in the elderly population require particular attention (10-12). Due to comorbidities, many elderly patients are unable to tolerate aggressive standard therapies. According to the Organization for Economic Co-operation and Development (OECD), the elderly population is defined as aged ≥65 years (13). Moreover, very elderly patients are defined as aged ≥80 years in several studies (14-18). Our present study focused on elderly patients and additionally considered very elderly patients irradiated for a malignant disease. We investigated the course of distress during RT and aimed to identify risk factors for increased distress. High-risk patients may particularly benefit from psychological assistance before and during their course of RT.