Symptoms of posttraumatic stress disorder among hospitalized patients with cancer

Nipp, Ryan David; El‐Jawahri, Areej; DʼArpino, Sara; Chan, Adrienne S.; Fuh, Charn‐Xin; Johnson, Patrick Connor; Lage, Daniel E; Wong, Risa Liang; Pirl, William F.; Traeger, Lara; Cashavelly, Barbara J.; Jackson, Vicki A.; Ryan, David P.; Hochberg, Ephraim P.; Temel, Jennifer S.; Greer, Joseph A.

doi:10.1002/cncr.31576

Cited by 37 publications

(38 citation statements)

References 50 publications

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“…This may be because of the fact that we recruited patients suffering from different kinds of cancer, while most of the previously conducted studies restricted to certain types of cancer, for instance breast cancer . Another study by Nip et al, which recently investigated the prevalence of PTSD symptoms in a similar cohort also found a rate of PTSD that was higher than previously suspected …”

Section: Discussionsupporting

confidence: 77%

“…These results provide further evidence for the remarkably high prevalence of PTSD and distress in female cancer patients. One explanation could be that women are more likely to perceive and articulate symptoms of emotional stress, and thus, it can be hypothesized that male patients underreport symptoms of psychological distress, resulting in underdiagnosis and undertreatment of psychiatric comorbidities . This potential lack of diagnosis and treatment might contribute to a lower quality of life and a worse outcome in female and male cancer patients.…”

Section: Discussionmentioning

confidence: 99%

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Screening for post‐traumatic stress disorders in 1017 cancer patients and correlation with anxiety, depression, and distress

et al. 2019

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ObjectivePost‐traumatic stress disorder (PTSD) is a severe psychiatric disorder, which might develop after a traumatic event, like cancer diagnosis, and threatens the patient's psychological and/or physiological integrity. Anxiety, depression, and mental distress are known to be common in cancer patients; however, the frequency of PTSD was not investigated thoroughly in this patient group so far. Here, we aim to screen cancer patients for PTSD symptoms and determine a possible correlation with anxiety, depression, and distress.MethodsThe study was performed at the Divisions of Hematology and Oncology of the Medical University of Vienna from 2010 to 2018. Following written consent, patients were asked to fill out the validated self‐assessment questionnaire for PTSS‐10 and HADS. The study was approved by the institutional ethics committee of the Medical University of Vienna (EC Nr: 2255/2016).ResultsA total of 1017 adult cancer patients (513 male, 504 female) were included in a cross‐sectional single‐center study. Mean age was 57.6 years (SD 14.4 years); 31.7%, 14.6%, 13.2%, and 27.4% of patients outscored the predefined thresholds for self‐assessed cases of PTSD, anxiety, depression, and distress, respectively. Compared with men, women showed a higher prevalence of symptoms for PTSD (38.9% vs 24.5%; P < .001) and anxiety (20.4% vs 8.6%; P < .001). The scores of HADS‐A, HADS‐D, and the combined HADS score (distress) were significantly correlated with PTSS‐10 scores (P < .01). No differences in age were observed among the different score groups.ConclusionThe study shows a significant prevalence as well as a correlation of PTSD symptoms with anxiety, depression, and distress among cancer patients. Findings underscore the necessity of a serious screening for psychiatric disorders, especially in female patients. In order to enable multidisciplinary care for cancer patients and to reduce the burden for psychiatric disorders, interdisciplinary screening and treatment concepts, which take into account gender aspects, are urged.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Screening for post‐traumatic stress disorders in 1017 cancer patients and correlation with anxiety, depression, and distress

et al. 2019

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“…We also included diarrhea and constipation because these symptoms are highly prevalent among patients with cancer. [23][24][25] Each individual symptom is scored on a scale of 0 to 10 (with 0 reflecting absence of the symptom and 10 reflecting the worst possible severity). We categorized the severity of ESAS-r scores as none (0), mild (1-3), moderate (4-6), and severe (7-10), consistent with prior research.…”

Section: Physical and Psychological Symptom Burdenmentioning

confidence: 99%

“…We categorized the severity of ESAS-r scores as none (0), mild (1-3), moderate (4-6), and severe (7-10), consistent with prior research. [24][25][26] Also consistent with prior work, we computed composite ESAS-r physical and ESAS-r total symptom variables, which included summed scores of patients' physical and total symptoms. [22][23][24][25][26] We used the Geriatric Depression Scale (GDS-15) to assess depression symptoms.…”

Section: Physical and Psychological Symptom Burdenmentioning

confidence: 99%

“…Consistent with prior work, we investigated time to first unplanned hospitalization within 90 days and time to first unplanned emergency department (ED) visit within 90 days. [23][24][25] We used the 90-day time frame to account for mortality, because patients who die may have less time at risk for hospitalizations and ED visits. We defined time to first unplanned hospitalization as the number of days from study enrollment to first unplanned hospitalization within 90 days.…”

Section: Healthcare Use and Overall Survivalmentioning

confidence: 99%

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Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Nipp

Thompson

Temel

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Oncologists often struggle with managing the complex issues unique to older adults with cancer, and research is needed to identify patients at risk for poor outcomes. Methods: This study enrolled patients aged ≥70 years within 8 weeks of a diagnosis of incurable gastrointestinal cancer. Patient-reported surveys were used to assess vulnerability (Vulnerable Elders Survey [scores ≥3 indicate a positive screen for vulnerability]), quality of life (QoL; EORTC Quality of Life of Cancer Patients questionnaire [higher scores indicate better QoL]), and symptoms (Edmonton Symptom Assessment System [ESAS; higher scores indicate greater symptom burden] and Geriatric Depression Scale [higher scores indicate greater depression symptoms]). Unplanned hospital visits within 90 days of enrollment and overall survival were evaluated. We used regression models to examine associations among vulnerability, QoL, symptom burden, hospitalizations, and overall survival. Results: Of 132 patients approached, 102 (77.3%) were enrolled (mean [M] ± SD age, 77.25 ± 5.75 years). Nearly half (45.1%) screened positive for vulnerability, and these patients were older (M, 79.45 vs 75.44 years; P=.001) and had more comorbid conditions (M, 2.13 vs 1.34; P=.017) compared with nonvulnerable patients. Vulnerable patients reported worse QoL across all domains (global QoL: M, 53.26 vs 66.82; P=.041; physical QoL: M, 58.95 vs 88.24; P<.001; role QoL: M, 53.99 vs 82.12; P=.001; emotional QoL: M, 73.19 vs 85.76; P=.007; cognitive QoL: M, 79.35 vs 92.73; P=.011; social QoL: M, 59.42 vs 82.42; P<.001), higher symptom burden (ESAS total: M, 31.05 vs 15.00; P<.001), and worse depression score (M, 4.74 vs 2.25; P<.001). Vulnerable patients had a higher risk of unplanned hospitalizations (hazard ratio, 2.38; 95% CI, 1.08–5.27; P=.032) and worse overall survival (hazard ratio, 2.26; 95% CI, 1.14–4.48; P=.020). Conclusions: Older adults with cancer who screen positive as vulnerable experience a higher symptom burden, greater healthcare use, and worse survival. Screening tools to identify vulnerable patients should be integrated into practice to guide clinical care.

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Symptom burden in patients with cancer who are experiencing unplanned hospitalization

Newcomb

Nipp

Waldman

et al. 2020

Cancer

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Background Inpatient supportive care programs often target patients with advanced solid tumors. To the authors' knowledge, few studies to date have characterized symptom burden in hospitalized patients with potentially curable cancers. The objective of the current study was to compare symptom burden, palliative care consultation, and readmission rates in hospitalized patients by cancer type and treatment intent. Methods The authors conducted a single‐center study of hospitalized patients with cancer between 2014 and 2017. They assessed physical symptoms using the Edmonton Symptom Assessment System and psychological distress using the Patient Health Questionnaire‐4 and the Primary Care PTSD (Posttraumatic Stress Disorder) Screen. Multivariate linear regression models were used to assess symptom burden, logistic regression was used to assess palliative care use, and competing risk regression was used to compare 90‐day readmission risk. Results A total of 1549 patients were enrolled and surveyed. The majority of patients reported moderate to severe fatigue, poor well‐being, and drowsiness with no significant differences noted by cancer type and treatment intent. Compared with other groups, patients with incurable solid cancer reported higher physical symptoms (beta coefficient [B], 4.73; P < .01) and symptoms of depression (B, 0.44; P < .01) and anxiety (B, 0.39; P < .01), but no difference in posttraumatic stress disorder. Among patients in the top quartile symptom burden according to the Edmonton Symptom Assessment System, the palliative care service was consulted in 14.7%, 7.9%, 25.0%, and 49.6%, respectively, of patients with potentially curable hematologic, potentially curable solid, incurable hematologic, and incurable solid cancers (P < .001). Compared with patients with potentially curable solid cancer, patients in each group experienced a higher risk of readmission within 90 days. Conclusions Hospitalized patients with cancer experience substantial physical and psychological symptoms. Palliative care rarely is consulted for highly symptomatic patients with potentially curable cancers. Supportive care interventions should target the needs of symptomatic patients regardless of treatment intent.

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Symptoms of posttraumatic stress disorder among hospitalized patients with cancer

Cited by 37 publications

References 50 publications

Screening for post‐traumatic stress disorders in 1017 cancer patients and correlation with anxiety, depression, and distress

Screening for post‐traumatic stress disorders in 1017 cancer patients and correlation with anxiety, depression, and distress

Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Symptom burden in patients with cancer who are experiencing unplanned hospitalization

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