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Objective: Low and middle income countries of Africa account for a disproportionate amount of the global health burden of cancer. Providing patients access to psychosocial oncology and palliative care through policy structures such as the National Cancer Control Plans (NCCP) is essential to improving the care provided to patients and their families. The first phase of this study sought to determine the extent to which palliative care and psychosocial oncology were integrated in NCCPs in African countries. Methods: A qualitative thematic analysis of the plans was used using Nvivo, with two‐raters coding and continuous team discussions. Data were organized into an infographic map showing the coverage of themes across African countries. Results: Fifty‐eight NCCPs and NCD plans were analyzed in the 54 countries in Africa. The findings illustrate a lack of standardization across countries' NCCPs in addressing psychosocial oncology and palliative care themes. Certain areas presented good coverage across several plans, such as barriers to access, education, awareness, and health behaviors, coordination of care, families, caregivers and community involvement, and palliative care. Other themes presented low coverage, such as doctor‐patient communication, mental health, bereavement, psychosocial care, survivorship care, and traditional medicine. Conclusions: One may consider further developing NCCP areas as they pertain to psychosocial oncology and palliative care to ensure their proper place on the policy agenda for a healthier Africa. [ABSTRACT FROM AUTHOR]

Background: Issues relating to certification of the Psycho‐oncology profession require clarification in order to provide high quality comprehensive psychosocial care within oncology. We conducted a survey identifying existing training, professional registration requirements and accreditation programs, at national levels, for the specialty of psycho‐oncology as well as the mandatory presence of this specialist in cancer teams. Methods: This survey was conducted within the International Psycho‐Oncology Society Federation of psycho‐oncology societies and included representatives of each national federated society and some countries not belonging to the Federation. Survey questions were emailed requesting specific details, from the registered contact person, for each country, about psycho‐oncology training, professional registration and accreditation. Results: Of 43 countries contacted (34 Federated and 9 non‐federated members), 39 replied and answered the questionnaire (90, 7%). Disparities were reported between countries, with details indicating differences from having no national program, to quite detailed and legally accredited requirements. The majority of countries had no formally recognized profession of "Psycho‐oncologist," while some countries reported that it is mandatory (or recommended to have) a specialist in psycho‐oncology in cancer centers and, thus, that an accredited, nationally recognized and certified training in this specialty exists. Conclusions: The study underlines the need to create a curriculum for the specialty (certification and accreditation) for the profession of psycho‐oncology. Given the lack of internationally recognized core standards, ideas and proposals for minimum standards of good care and the training required to deliver this, are explored to clarify who may use the designation "Clinical Psycho‐oncologist." [ABSTRACT FROM AUTHOR]

The primary purpose of this study was to investigate the contribution of genetic predispositions to depression and inflammation, as measured through polygenic risk scores, on symptom burden (physical and psychological) in patients with head and neck cancer in the immediate post-treatment period (i.e., at three months post-diagnosis), as well as on 3-, 6-, 12-, 24- and 36-month survival. Prospective longitudinal study of 223 adults (72 % participation) newly diagnosed with a first occurrence of primary head and neck cancer, paired with genetic data (Illumina PsychArray), validated psychometric measures, Structured Clinical Interviews for DSM Disorders (SCID-I), and medical chart reviews. Symptom burden at 3 months was predicted by (R2 adj. = 0.38, p < 0.001): a baseline SCID-I Anxiety Disorder (b = 1.69, B = 0.23, 95%CI = 0.43–2.94; p = 0.009), baseline levels of HADS anxiety (b = 0.20, B = 0.29, 95%CI = 0.07–0.34; p = 0.003), the polygenic risk score (PRS) for depression (b = 0.66, B = 0.18, 95%CI = 0.003–1.32; p = 0.049), and cumulated dose of radiotherapy (b = 0.002, B = 0.46, 95%CI = 0.001–0.003; p < 0.001). When controlling for factors known to be associated with cancer survival, patients with a higher PRS associated with depression and inflammation, respectively, presented higher risk of death within 36 months (b = 1.75, Exp(B) = 5.75, 95%CI = 1.55–21.27, p = 0.009 and b = 0.14, Exp(B) = 1.15, 95%CI = 1.01–1.30, p = 0.03). Our results outline three potential pathways of symptom burden in patients with head and neck cancer: a genetic predisposition towards depression; an initial anxiety disorder upon being diagnosed with cancer or high levels of anxiety upon diagnosis; and a dose-related response to radiotherapy. One may want to investigate early interventions in these areas to alleviate symptom burden in patients faced with a life-threatening disease, as well as consider targeting genetic predisposition towards depression and inflammation implicated in survival. The high prevalence of distress in patients with head and neck cancer is an opportunity to study genetic predispositions, which could potentially be broadly generalized to other cancers and diseases. • Our results outline three pathways of symptom burden in head and neck cancer: a genetic predisposition towards depression; an initial anxiety disorder upon cancer diagnosis or high anxiety levels upon diagnosis; and a dose-related response to radiotherapy. • A genetic predisposition for depression significantly predicts 3-year survival in head and neck cancer. • One warrants investigating early interventions in these areas to alleviate symptom burden in patients faced with a life-threatening disease, as well as consider targeting genetic predisposition towards depression and inflammation implicated in survival. [ABSTRACT FROM AUTHOR]

Objective: Head and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse. Methods: Two hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model. Results: Sixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism. Conclusion: This longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions. [ABSTRACT FROM AUTHOR]

Objectives: Human papillomavirus (HPV) has prompted a need to further investigate how this new biomarker changes the head and neck cancer (HNC) psychosocial landscape. This study aimed to: (a) characterize the sociodemographic, psychological, and social profiles of patients with HPV-positive versus -negative squamous cell carcinoma of the head and neck; and (b) identify how HPV status contributes to anxiety and depression (primary outcome), quality of life (QoL), and sexuality needs.Methods: We conducted a prospective longitudinal study of 146 patients newly diagnosed with oral, oropharyngeal, nasopharyngeal, and hypopharyngeal cancer. Seventy-nine patients were HPV-positive and 67 HPV-negative. Patients completed self-administered psychometric measures upon HNC and 3-month follow-up, and Structured Clinical Interviews for DSM Diagnoses.Results: Patients with HPV-negative tumors generally presented with higher anxiety and depression and lower QoL immediately post-HNC diagnosis (<2 weeks) compared to HPV-positive cancers. A Major Depressive Disorder (MDD) immediately post-HNC diagnosis negatively affected patients' anxiety and depression and QoL levels upon diagnosis only when the cancer was HPV-positive. Immediately posttreatment, HPV status was not associated with outcomes. A previous history of suicidal ideation, and upon cancer diagnosis cigarette smoking, anxiety and depression, and feeling close to one's partner were instead explanatory.Conclusion: While patients with HPV-positive HNC generally present with initially lower psychological distress, their vulnerability immediately posttreatment indicates an equal need for support. Head and neck clinics may need to better address MDD, anxiety and depression, a prior history of suicidal ideation, health behavior change, and quality of relationships. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to: (1) determine the contribution of pre‐cancer psychosocial vulnerability as an independent predictor of anxiety disorder (AD) onset immediately post‐treatment in patients diagnosed with a first occurrence of head and neck cancer (HNC), controlling for sociodemographics and medical variables; and (2) estimate prevalence of AD and identify trajectories from the moment of diagnosis to the immediate post‐treatment (i.e., over a period of 3 months) in this population. Methods: Two‐hundred twenty‐four consecutive patients (participation rate = 72%) newly diagnosed with a primary HNC were assessed with a structured clinical interview for a mental disorder, validated psychometric measures, and medical chart reviews. Results: Twenty‐five percent of patients presented a lifetime AD, 19.4% within 2 weeks of HNC diagnosis, and 16.6% immediately post‐treatment; representing 26.7% of patients with AD at any timepoint from the moment of diagnosis to immediately post‐treatment. Patients were more likely to present an AD immediately post‐treatment when they: were diagnosed with advanced‐stage cancer (OR = 3.40, p = 0.006), presented a upon cancer diagnosis AD (OR = 2.45, p = 0.008) and/or experienced childhood abuse (OR = 1.96, p = 0.03). Conclusions: Several AD trajectories may arise when patients are diagnosed with primary HNC. Health professionals should address AD and screen for risk factors (i.e., advanced stage cancer, AD upon cancer diagnosis, history of childhood abuse) as early as possible to assure optimal mental health care in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: This study aimed at examining predictors of clinical anxiety and depressive symptoms in patients with head and neck cancer (HNC) at 3, 6, and 12 months post‐diagnosis, with a particular interest in contextual and historical factors. Methods: Prospective longitudinal study of 219 consecutive patients newly diagnosed with a first occurrence of primary HNC, including psychometric measures, Structured Clinical Interview for DSM‐IV Diagnoses (SCID), and medical chart reviews. Results: Point prevalence of clinical anxiety symptoms (Hospital Anxiety and Depression Scale‐Anxiety subscale) was 32.0%, 21.9%, 12.1%, and 12.6% at baseline, 3, 6, and 12 months; and clinical depressive symptoms on the Depression Subscale was 19.4%, 21.9%, 13.5%, and 9.2%, respectively. Predictors of anxiety and depressive symptoms included upon diagnosis SCID major depressive or anxiety disorder, stressful life events in previous year, neuroticism, and levels of anxiety and depressive symptoms upon cancer diagnosis. Conclusions: This study emphasizes the predictive contribution of broader personal contextual and historical factors that increase psychological vulnerability in HNC and merit consideration. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine, within the first-year post-head and neck cancer (HNC) diagnosis, the contribution of past and upon HNC psychiatric diagnoses (ie, substance use disorder, major depressive disorder, and anxiety disorder) to the extent (ie, cumulated dose) of opioid prescription.Methods: Prospective longitudinal study of 223 consecutive adults (on 313 approached; 72% participation) newly diagnosed (<2 weeks) with a first occurrence of primary HNC, including Structured Clinical Interviews for DSM-IV disorders, validated psychometric measures, and medical chart reviews. Opioid doses were translated into standardized morphine milligram equivalents (MME) using CDC guidelines. A model of variables was tested using multiple linear regression.Results: Fifty-five percent (123/223) of patients received opioids at some point during the first 12 months post-HNC diagnosis, 37.7% (84/223) upon HNC diagnosis (pre-treatment), 40.8% (91/223) during treatments, and 31.4% (70/223) post-treatment. The multiple linear regression indicated that an AD (P = 0.04) upon HNC diagnosis in early stage contributes to cumulated MME dose in the first year post-HNC diagnosis.Conclusion: This study underlines how anxiety has important repercussions on the management of pain and illustrates the importance of screening for AD upon HNC diagnosis to allow for early prophylactic treatment and support. [ABSTRACT FROM AUTHOR]

Objective: The primary purpose of this study was to identify predictors of Major Depressive Disorder in head and neck cancer (HNC) patients in the immediate post-treatment period (ie, at 3 months post-diagnosis), with a focus on previously unexamined historical and contextual factors.Methods: Prospective longitudinal study of 223 consecutive adults (72% participation) newly diagnosed with a first occurrence of primary HNC, including validated psychometric measures, Structured Clinical Interviews for DSM Disorders, and medical chart reviews.Results: The 3-month period prevalence of Major Depressive Disorder was 20.4%; with point prevalences of 6.8% upon HNC diagnosis, 14.2% at 3 months, and 22.6% lifetime. Patients most susceptible to developing Major Depressive Disorder in the immediate post-treatment period: were diagnosed with advanced-stage cancer rather than early-stage cancer (O.R. = 4.94, P = 0.04), received surgery only (O.R. = 8.73, P = 0.04), presented a lifetime history of Anxiety Disorder on SCID-I (O.R. = 6.62; P = 0.01), and indicated higher pre-treatment levels of anxiety on the HADS (O.R. = 0.45, P = 0.05).Conclusions: Our results outline the predominant role of anxiety upon diagnosis as a precursor to post-treatment Major Depressive Disorder, suggesting the need for identification and prophylactic treatment of anxiety upon diagnosis in head and neck cancer patients. Further investigation into pathways by which pre-treatment anxiety predisposes to post-treatment Major Depressive Disorder in this population is warranted. [ABSTRACT FROM AUTHOR]

Background: Thyroid cancer (ThyCa) is generally associated with a favorable prognosis and excellent surgical outcomes. Consequently, its treatment is medically focused and current guidelines recommend interdisciplinary care including access to a nurse for complex cases alone. To date, no studies have evaluated the need for and impact of an Interdisciplinary Team-based Care Approach (ITCA-ThyCa) for general thyroid cancer patients, including a dedicated nurse as part of a larger interdisciplinary team, as well as patient-reported outcomes, as is recommended worldwide in cancer care. Our aim was to evaluate such a program.Methods: The ITCA-ThyCa was evaluated within a quasi-experimental design using the Centers for Disease Control Framework for Program Evaluation, including process and outcome measures. Patients eligible were adults with a biopsy indicating confirmed or highly suspicious ThyCa (TNM-Classification + Bethesda score of V/VI). The intervention group (IG) received ITCA-ThyCa and the comparison group (CG), usual care alone.Results: In our sample comprised of 200 participants (122 IG; 78 CG), ITCA-ThyCa patients appeared to show significantly better outcomes than CG patients, namely, higher levels of overall well-being (P = .001) and fewer physical (P = .003) and practical (P = .003) issues and concerns. More satisfied with their overall care (P = .028), including care coordination (P = .049), they reported their health care provider as more approachable (P = .007), respectful (P = .005), and trustworthy (P = .077; trend) and were more likely to recommend their hospital (P = .02). Ninety-eight percent of IG patients recommended ITCA-ThyCa.Conclusion: Data from our program illustrates that hospital resources should not be allocated based on medical trajectory alone and challenges the idea that ThyCa is "straightforward." ThyCa patients seem to experience symptom distress at a level comparable to-or exceeding-that of general oncological patients despite their promising medical outcomes, indicating that better integrated care and support are in order. [ABSTRACT FROM AUTHOR]

The search for meaning in bereavement is a topic of increasing scholarly interest. Nonetheless, literature has not yet appeared that examines the intersections of diverse theories of meaning, corresponding empirical findings, and clinical implications for counseling psychologists engaged in cancer-related bereavement psychotherapy. Meaning theories drawn from several domains of scholarship including existential, spirituality, stress, and bereavement are surveyed followed by a review of related empirical trends in the scholarship. A hypothetical case vignette is then presented to highlight potential strategies for counseling psychologists to integrate a broadened meaning-based approach to bereavement psychotherapy related to the loss of a loved one from cancer. The article concludes by identifying limitations of a meaning-based approach, as well as directions for further research. [ABSTRACT FROM AUTHOR]

Background: Cancer occurs during one in 1000-5000 of the approximately 6 million yearly US pregnancies identified by the American Pregnancy Association. Although a newly diagnosed cancer is associated with substantial distress, little is known about cancer's emotional impact on women when diagnosed during pregnancy, and no studies have been conducted on the subject. Objective: The Cancer and Pregnancy Registry was developed by Elyce H. Cardonick MD, specialist in Maternal and Fetal Medicine and Associate Professor of Obstetrics and Gynecology at Robert Wood Johnson Medical School, to examine the consequences of maternal cancer diagnosis and treatment during pregnancy on maternal, fetal, and neonatal outcomes, including the impact of in utero exposure to chemotherapy. Methods: Participants were asked to complete questionnaires, including measures of psychological distress, permitting the examination of variables associated with long-term psychological distress in women following a cancer diagnosis in pregnancy. Results: Seventy-four women completed the Brief Symptom Inventory-18 and Impact of Event Scale on average 3.8 years (SD 2.5) following their cancer diagnosis. Potential variables related to distress included information on: sociodemographics, disease, pregnancy, birth, cancer treatment, and health status. Multiple regression analyses revealed that women were at higher risk of long-term distress if they had not received fertility assistance, had been advised to terminate the pregnancy, had had a preterm baby, had had a cesarean delivery, had not produced sufficient milk to breastfeed, had been experiencing a recurrence, and/or had undergone surgery post-pregnancy. Conclusion: Results are discussed in light of our current knowledge of the normal developmental phase of pregnancy and motherhood. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]