Psychological Distress and Pain Significantly Increase Before Death in Metastatic Breast Cancer Patients

Abstract

Results suggest that specialized end-stage clinical interventions are particularly needed for cancer patients as they approach death. Moreover, intervention studies for patients with deteriorating illnesses may need to take this "spike" in psychological distress and pain proximal to death into account to avoid Type II errors in evaluations of psychological outcomes.

A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer

“…Nonmetastatic breast cancer patients have pain prevalence rates of 33% to 52%; the rate increases to 56% -68% among women with metastatic breast cancer (McGuire & Sheidler, 1992). Pain is a primary symptom of breast cancer when there is bone metastasis (Dow, Ferrell, Leigh, Ly , & Gulasekaram, 1996), and may increase over the course of metastatic illness, particularly in the period prior to death (Butler et al, 2003). Sleep disturbances are almost universal for people with chronic pain (McCracken & Iverson, 2002).…”

“…Therefore, we included the baseline intercept of the sleep variables as a covariate in each multiple regression analysis because the intercept is the best estimate of the true baseline value of the variable. Previous research has shown that women with metastatic breast cancer report a significant increase in distress and pain prior to dying (Butler et al, 2003;Classen, Butler, Koopman, Miller, DiMiceli, Giese-Davis, Fobair et al, 2001). Consequently, we dropped assessment that was proximal to death (within 12 months) and recalculated the slopes based on the remaining points.…”

Gruppenpsychotherapie f�r Brustkrebspatientinnen

“…Genau das erwartet man auch von einer supportiv-expressiven Gruppenintervention, da sie die Konfrontation mit den existenziellen Herausforderungen und die Verbesserung der emotionalen Expressivität fördert (Butler et al 2003;Classen et al 2001). Diese Art der Intervention führt zu signifikanten Verschiebungen in der emotionalen Regulation, die sich in signifikanten Verbesserungen der emotionalen Expressivität zeigen: Die Unterdrückung von negativem Affekt wird reduziert, einhergehend mit verbesserter Selbstkontrolle im Ausdruck von Feindseligkeit, antagonistischen und sozial entfremdenden Verhaltensweisen (Giese-Davis et al 2002).…”

“…Zugleich scheint es unklug, Kurz-Zeit-Gruppen in der Pflege von schwer kranken und sterbenden Patientinnen einzurichten. Stattdessen sollte man weiter die Möglichkeit von "Openend-Behandlungen" untersuchen mit speziell ausgearbeiteten Interventionen für Frauen, deren Tod naht (Butler et al 2003). …”

Prospective replication study implicates the catechol-O-methyltransferase Val158Met polymorphism as a biomarker for the response to morphine in patients with cancer

“…Pain is a feared and common complication in patients with cancer (1,2), which increases in prevalence and intensity with disease progression (3,4), and influences multiple aspects of quality of life (5)(6)(7)(8). Pharmacogenetic, pharmacokinetic and pharmacodynamic variations among individuals result in a wide variety of responses to pain sensation and analgesics; therefore, investigations of biomarkers for opioid treatment have been performed to improve the efficacy of morphine treatment (9).…”