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Depression: HELP
Articles by William F. Pirl
Based on 32 articles published since 2010
(Why 32 articles?)
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Between 2010 and 2020, W. Pirl wrote the following 32 articles about Depression.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Psychological Considerations in Hematopoietic Stem Cell Transplantation. 2019

Amonoo, Hermioni L / Massey, Christina N / Freedman, Melanie E / El-Jawahri, Areej / Vitagliano, Halyna L / Pirl, William F / Huffman, Jeff C. ·Dana Farber Cancer Institute, Department of Psychosocial Oncology, Brookline, MA; Brigham and Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA. Electronic address: Hermioni_lokko@dfci.harard.edu. · Massachusetts General Hospital, Department of Psychiatry, Boston, MA. · Massachusetts General Hospital, Department of Hematology/Oncology, Boston, MA. · Dana Farber Cancer Institute, Department of Psychosocial Oncology, Brookline, MA; Department of Psychiatry, Harvard Medical School, Boston, MA. · Department of Psychiatry, Harvard Medical School, Boston, MA; Massachusetts General Hospital, Department of Psychiatry, Boston, MA. ·Psychosomatics · Pubmed #31072626.

ABSTRACT: BACKGROUND: In recent decades, advances in transplantation medicine, and improved posttransplant care have reduced morbidity and mortality from hematopoietic stem cell transplantations (HSCTs). However, patients undergoing HSCT report a high prevalence of psychological distress, which can negatively impact recovery, function, and health outcomes, including mortality and higher risk of graft vs. host disease. Appropriate assessment and management of these psychological symptoms lead to better engagement with treatment and a variety of superior health outcomes. OBJECTIVE: We provide a narrative review of the psychological challenges that accompany HSCT and suggest management approaches to equip psychiatric consultants involved in the care of this patient population. METHODS: We reviewed published work in PubMed, PsycInfo, and Scopus electronic databases on the common psychological challenges in HSCT, their vulnerability factors, as well as practical interventions for managing these challenges. RESULTS: We outline the phases of the HSCT hospitalization and discuss common psychological challenges, such as depression, delirium, and post-traumatic stress reactions that accompany HSCT. We suggest an approach to psychiatric consults during the HSCT hospitalization and discuss practical interventions for managing psychological challenges in this population. CONCLUSIONS: Though pharmacological and behavioral interventions have been successfully used to treat psychosocial challenges in HSCT, further research is needed to understand the optimal psychiatric assessment tools, treatment strategies, and the long-term psychiatric care needed to address psychiatric comorbidities in this growing patient population.

2 Review Psychological distress associated with cancer screening: A systematic review. 2017

Chad-Friedman, Emma / Coleman, Sarah / Traeger, Lara N / Pirl, William F / Goldman, Roberta / Atlas, Steven J / Park, Elyse R. ·Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts. · Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. · Partners In Health, Boston, Massachusetts. · Massachusetts General Hospital Cancer Center, Boston, Massachusetts. · Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts. · Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts. ·Cancer · Pubmed #28833054.

ABSTRACT: BACKGROUND: Current national cancer screening recommendations include the potential risk of psychological harm related to screening. However, data on the relation of psychological distress to cancer screening is limited. The authors conducted a systematic review to assess psychological distress associated with cancer screening procedures. METHODS: Studies that administered measures of psychological distress between 2 weeks before and 1 month after the screening procedure were included. RESULTS: In total, 22 eligible studies met criteria for review, including 13 observational trials and 9 randomized controlled trials. Eligible studies used a broad range of validated and unvalidated measures. Anxiety was the most commonly assessed construct and was measured using the State Trait Anxiety Inventory. Studies included breast, colorectal, prostate, lung, and cervical screening procedures. Distress was low across procedures, with the exception of colorectal screening. Distress did not vary according to the time at which distress was measured. None of the studies were conducted exclusively with the intention of assessing distress at the time of screening. CONCLUSIONS: Evidence of low distress during the time of cancer screening suggests that distress might not be a widespread barrier to screening among adults who undergo screening. However, more studies are needed using validated measures of distress to further understand the extent to which screening may elicit psychological distress and impede adherence to national screening recommendations. Cancer 2017;123:3882-94. © 2017 American Cancer Society.

3 Review Recommendations for the implementation of distress screening programs in cancer centers: report from the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force. 2014

Pirl, William F / Fann, Jesse R / Greer, Joseph A / Braun, Ilana / Deshields, Teresa / Fulcher, Caryl / Harvey, Elizabeth / Holland, Jimmie / Kennedy, Vicki / Lazenby, Mark / Wagner, Lynne / Underhill, Meghan / Walker, Deborah K / Zabora, James / Zebrack, Bradley / Bardwell, Wayne A. ·Center for Psychiatric Oncology and Behavioral Sciences at Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. ·Cancer · Pubmed #24798107.

ABSTRACT: In 2015, the American College of Surgeons (ACoS) Commission on Cancer will require cancer centers to implement screening programs for psychosocial distress as a new criterion for accreditation. A joint task force from the American Psychosocial Oncology Society, the Association of Oncology Social Work, and the Oncology Nursing Society developed consensus-based recommendations to guide the implementation of this requirement. In this review, the authors provide recommendations regarding each of the 6 components necessary to meet the ACoS standard: 1) inclusion of psychosocial representation on the cancer committee, 2) timing of screening, 3) method/mode of screening, 4) tools for screening, 5) assessment and referral, and 6) documentation.

4 Clinical Trial Prognostic understanding, quality of life and mood in patients undergoing hematopoietic stem cell transplantation. 2015

El-Jawahri, A / Traeger, L / Kuzmuk, K / Eusebio, J / Vandusen, H / Keenan, T / Shin, J / Gallagher, E R / Greer, J A / Pirl, W F / Jackson, V A / Ballen, K K / Spitzer, T R / Graubert, T A / McAfee, S / Dey, B / Chen, Y-B A / Temel, J S. ·1] Department of Hematology Oncology-Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA [2] Harvard Medical School, Boston, MA, USA. · Department of Hematology Oncology-Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA. ·Bone Marrow Transplant · Pubmed #25961772.

ABSTRACT: Little is known about how patients undergoing hematopoietic stem cell transplantation (HCT) and their family caregivers (FC) perceive their prognosis. We examined prognostic understanding in patients undergoing HCT and their FC and its relationship with quality of life (QOL) and mood. We conducted a longitudinal study of patients (and FC) hospitalized for HCT. We used a questionnaire to measure participants' prognostic understanding and asked the oncologists to estimate patients' prognosis prior to HCT. We assessed QOL and mood weekly and evaluated the relationship between prognostic understanding, and QOL and mood using multivariable linear mixed models. We enrolled 90 patients undergoing (autologous (n=30), myeloablative (n=30) or reduced intensity allogeneic (n=30)) HCT. About 88.9% of patients and 87.1% of FC reported it is 'extremely' or 'very' important to know about prognosis. However, 77.6% of patients and 71.7% of FC reported a discordance and more optimistic prognostic perception compared to the oncologist (P<0.0001). Patients with a concordant prognostic understanding with their oncologists reported worse QOL (β=-9.4, P=0.01) and greater depression at baseline (β=1.7, P=0.02) and over time ((β=1.2, P<0.0001). Therefore, Interventions are needed to improve prognostic understanding, while providing patients with adequate psychological support.

5 Article Depression and inflammation among epidermal growth factor receptor (EGFR) mutant nonsmall cell lung cancer patients. 2019

McFarland, Daniel C / Jutagir, Devika R / Rosenfeld, Barry / Pirl, William / Miller, Andrew H / Breitbart, William / Nelson, Christian. ·Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York. · Department of Psychology, Fordham University, Bronx, New York. · Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts. · Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. ·Psychooncology · Pubmed #31022775.

ABSTRACT: OBJECTIVE: Depression is highly prevalent in nonsmall cell lung cancer (NSCLC) and is associated with elevated inflammation. However, certain subtypes of driver mutation-associated NSCLC such as epidermal growth factor receptor (EGFR)-mutated NSCLC may be associated with less depression given the differences in their underlying biology and disease trajectories. Biological variables such as inflammation, measured by C-reactive protein (CRP), may provide insight into depression variability in EGFR mutant NSCLC. METHODS: Patients with EGFR mutant and wild-type metastatic NSCLC were evaluated for depression using the Hospital Anxiety and Depression Scale (HADS) on a continuous scale and meeting depression screening criteria (HADS ≥ 8). Inflammation was measured using CRP. A mediation model was created to understand how inflammation mediates EGFR wild-type associated depression. RESULTS: One hundred out of 120 patients with NSCLC were recruited (83.3% response rate). The 20 participants with EGFR mutant NSCLC had less depression (HADS-D 3.0 versus 5.4) (P < .001), met depression screening criteria less often (P = .047), and exhibited less inflammation (CRP = 0.23 mg/mL versus 2.71 mg/mL) (P < .001) in comparison with EGFR wild-type NSCLC. Multivariate linear regression model revealed that only CRP predicted depression (P = .015) while controlling for age and sex. Mediation analysis found that lower CRP partially mediated less depression in EGFR mutant NSCLC. CONCLUSIONS: EGFR mutant NSCLC is associated with less depression but the relationship is partially mediated by lower CRP-related inflammation, which is a stronger predictor of depression than EGFR status. Depression in lung cancer varies by subtype and is significantly related to inflammation.

6 Article Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer. 2019

Wong, Risa L / El-Jawahri, Areej / D'Arpino, Sara M / Fuh, Charn-Xin / Johnson, P Connor / Lage, Daniel E / Irwin, Kelly E / Pirl, William F / Traeger, Lara / Cashavelly, Barbara J / Jackson, Vicki A / Greer, Joseph A / Ryan, David P / Hochberg, Ephraim P / Temel, Jennifer S / Nipp, Ryan D. ·Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA risawong@uw.edu. · Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. · Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. · Department of Psychiatry, Sylvester Comprehensive Cancer Center and University of Miami, Miami, Florida, USA. · Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. ·Oncologist · Pubmed #30082486.

ABSTRACT: BACKGROUND: Among patients with cancer, depressive symptoms are associated with worse clinical outcomes, including greater health care utilization. As use of antidepressant medications can improve depressive symptoms, we sought to examine relationships among depressive symptoms, antidepressant medications, and hospital length of stay (LOS) in patients with advanced cancer. MATERIALS AND METHODS: From September 2014 to May 2016, we prospectively enrolled patients with advanced cancer who had an unplanned hospitalization. We performed chart review to obtain information regarding documented depressive symptoms in the 3 months prior to admission and use of antidepressant medications at the time of admission. We compared differences in hospital LOS by presence or absence of depressive symptoms and used adjusted linear regression to examine if antidepressant medications moderated these outcomes. RESULTS: Of 1,036 patients, 126 (12.2%) had depressive symptoms documented prior to admission, and 288 (27.8%) were taking antidepressant medications at the time of admission. Patients with depressive symptoms experienced longer hospital LOS (7.25 vs. 6.13 days; CONCLUSION: Documented depressive symptoms prior to hospital admission were associated with longer hospital LOS. This effect was restricted to patients not on antidepressant medications. Future studies are needed to investigate if use of antidepressant medications decreases LOS for patients hospitalized with advanced cancer and the mechanisms by which this may occur. IMPLICATIONS FOR PRACTICE: This study investigated the prevalence of documented depressive symptoms in patients with advanced cancer in the 3 months prior to an unplanned hospitalization and the prevalence of use of antidepressant medications at time of hospital admission. The relationship of these variables with hospital length of stay was also examined, and it was found that documented depressive symptoms were associated with prolonged hospital length of stay. Interestingly, antidepressant medications moderated the relationship between depressive symptoms and hospital length of stay. These findings support the need to recognize and address depressive symptoms among patients with advanced cancer, with potential implications for optimizing health care utilization.

7 Article Differential effects of early palliative care based on the age and sex of patients with advanced cancer from a randomized controlled trial. 2018

Nipp, Ryan D / El-Jawahri, Areej / Traeger, Lara / Jacobs, Jamie M / Gallagher, Emily R / Park, Elyse R / Jackson, Vicki A / Pirl, William F / Temel, Jennifer S / Greer, Joseph A. ·1 Division of Hematology & Oncology, Department of Medicine, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · 2 Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · 3 Division of Palliative Care & Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · 4 Department of Psychiatry, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA. ·Palliat Med · Pubmed #29323617.

ABSTRACT: BACKGROUND: Early palliative care interventions enhance patient outcomes, including quality of life, mood, and coping, but it remains unclear whether certain subgroups of patients are more likely to benefit from early palliative care. We explored whether age and sex moderate the improved outcomes seen with early palliative care. METHODS: We performed a secondary analysis of data from a randomized trial of 350 patients with advanced lung and non-colorectal gastrointestinal cancer. Patients received an early palliative care intervention integrated with oncology care or usual oncology care alone. We used linear regression to determine if age (older or younger than 65) and sex moderated the effects of the intervention on quality of life (Functional Assessment of Cancer Therapy-General (FACT-G)), depression symptoms (Patient Health Questionnaire 9 (PHQ-9)), and coping (Brief COPE) within lung and gastrointestinal subgroups. RESULTS: At 24 weeks, younger patients with lung cancer receiving early palliative care reported increased use of active coping ( B = 1.74; p = 0.02) and decreased use of avoidant coping ( B = -0.97; p = 0.02), but the effects of early palliative care on these outcomes were not significant for older patients. Male patients with lung cancer assigned to early palliative care reported better quality of life (FACT-G: B = 9.31; p = 0.01) and lower depression scores (PHQ-9: B = -2.82; p = 0.02), but the effects of early palliative care on these outcomes were not significant for female patients. At 24 weeks, we found no age or sex moderation effects within the gastrointestinal cancer subgroup. CONCLUSION: Age and sex moderate the effects of early palliative care for patients with advanced lung cancer. Early palliative care may need to be tailored to individuals' unique sociodemographic and clinical characteristics.

8 Article Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood. 2018

Greer, Joseph A / Jacobs, Jamie M / El-Jawahri, Areej / Nipp, Ryan D / Gallagher, Emily R / Pirl, William F / Park, Elyse R / Muzikansky, Alona / Jacobsen, Juliet C / Jackson, Vicki A / Temel, Jennifer S. ·Joseph A. Greer, Jamie M. Jacobs, Areej El-Jawahri, Ryan D. Nipp, Emily R. Gallagher, Elyse R. Park, Alona Muzikansky, Juliet C. Jacobsen, Vicki A. Jackson, and Jennifer S. Temel, Massachusetts General Hospital and Harvard Medical School, Boston, MA · and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL. ·J Clin Oncol · Pubmed #29140772.

ABSTRACT: Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients' coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and coping (Brief COPE) at baseline and 24 weeks. We used linear regression to test intervention effects on use of coping strategies and mediation regression models with bias-corrected bootstrapping to examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes. Results Compared with usual oncology care, EIPC significantly increased patient use of approach-oriented coping strategies ( B = 1.09; SE = 0.44; P = .01) and slightly reduced use of avoidant strategies ( B = -0.44; SE = 0.23; P = .06) from baseline to 24 weeks. Also, the increased use of approach-oriented coping and reduction in avoidant coping were associated with higher QOL and lower depressive symptoms at 24 weeks. The positive changes in approach-oriented coping, but not avoidant coping, significantly mediated the effects of EIPC on QOL (indirect effect, 1.27; 95% CI, 0.33 to 2.86) and depressive symptoms (indirect effect, -0.39; 95% CI, -0.87 to -0.08). Conclusion Patients with incurable cancer who received EIPC showed increased use of approach-oriented coping, which was associated with higher QOL and reduced depressive symptoms. Palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness.

9 Article Effects of Early Integrated Palliative Care on Caregivers of Patients with Lung and Gastrointestinal Cancer: A Randomized Clinical Trial. 2017

El-Jawahri, Areej / Greer, Joseph A / Pirl, William F / Park, Elyse R / Jackson, Vicki A / Back, Anthony L / Kamdar, Mihir / Jacobsen, Juliet / Chittenden, Eva H / Rinaldi, Simone P / Gallagher, Emily R / Eusebio, Justin R / Fishman, Sarah / VanDusen, Harry / Li, Zhigang / Muzikansky, Alona / Temel, Jennifer S. ·Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA ael-jawahri@partners.org. · Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA. · Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. · Division of Oncology, Department of Medicine, University of Washington Seattle, Seattle, Washington, USA. · Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA. ·Oncologist · Pubmed #28894017.

ABSTRACT: BACKGROUND: The family and friends (caregivers) of patients with advanced cancer often experience tremendous distress. Although early integrated palliative care (PC) has been shown to improve patient-reported quality of life (QOL) and mood, its effects on caregivers' outcomes is currently unknown. MATERIALS AND METHODS: We conducted a randomized trial of early PC integrated with oncology care versus oncology care alone for patients who were newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers and their caregivers. The early PC intervention focused on addressing the needs of both patients and their caregivers. Eligible caregivers were family or friends who would likely accompany patients to clinic visits. The intervention entailed at least monthly patient visits with PC from the time of diagnosis. Caregivers were encouraged, but not required, to attend the palliative care visits. We used the Hospital Anxiety and Depression Scale (HADS) and Medical Health Outcomes Survey Short-Form to assess caregiver mood and QOL. RESULTS: Two hundred seventy-five caregivers (intervention CONCLUSION: Early involvement of PC for patients with newly diagnosed lung and gastrointestinal cancers leads to improvement in caregivers' psychological symptoms. This work demonstrates that the benefits of early, integrated PC models in oncology care extend beyond patient outcomes and positively impact the experience of caregivers. IMPLICATIONS FOR PRACTICE: Early involvement of palliative care for patients with newly diagnosed lung and gastrointestinal cancers leads to improvement in caregivers' psychological symptoms. The findings of this trial demonstrate that the benefits of the early, integrated palliative care model in oncology care extend beyond patient outcomes and positively impact the experience of caregivers. These findings contribute novel data to the growing evidence base supporting the benefits of integrating palliative care earlier in the course of disease for patients with advanced cancer and their caregivers.

10 Article Depression, inflammation, and epidermal growth factor receptor (EGFR) status in metastatic non-small cell lung cancer: A pilot study. 2017

Jacobs, Jamie M / Traeger, Lara / Eusebio, Justin / Simon, Naomi M / Sequist, Lecia V / Greer, Joseph A / Temel, Jennifer S / Pirl, William F. ·Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States. Electronic address: jjacobs@mgh.harvard.edu. · Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States. · Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 6th floor, Boston, MA 02114, United States. · Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 7B, Boston, MA 02114, United States. ·J Psychosom Res · Pubmed #28712427.

ABSTRACT: OBJECTIVE: Patients with stage IV non-small cell lung cancer (NSCLC) have high risk for depressive symptoms and major depressive disorder (MDD); however, those with epidermal growth factor receptor (EGFR) mutations may have decreased risk. The biological underpinning of this relationship is unknown. We examined differences in depression severity and MDD in patients with newly diagnosed stage IV NSCLC based on EGFR mutation status, and examined proinflammatory cytokines and growth factors known to play a role in cancer progression and depression. METHODS: Fifty-five patients with newly diagnosed stage IV NSCLC completed self-report and clinician-administered depression assessments prior to receiving results of tumor genotyping. We measured serum levels of circulating biological markers of inflammation: IL-1β, IL-6, TGF-α, and TNF-α. We examined differences in depression severity, MDD, and inflammatory biomarkers in patients with and without EGFR mutations. RESULTS: Patients with EGFR mutations (n=10) had lower depression severity (t[43]=2.38, p=0.03) than those without EGFR mutations (n=38) and fewer patients with EGFR mutations had concurrent MDD (2.08%) relative to those without mutations (27.08%). Patients with MDD had higher levels of TNF-α than those without MDD (t[40]=2.95, p=0.005). Those with EGFR mutations exhibited higher levels of TNF-α relative to those without EGFR mutations (t[35]=2.17, p=0.04). CONCLUSIONS: Patients with stage IV NSCLC harboring an EGFR mutation exhibited elevated proinflammatory marker TNF-α, yet had lower depression severity than patients without EGFR mutations. More work is warranted to examine the interaction between tumor genotyping and inflammatory cytokines in the context of depression.

11 Article Coping and Prognostic Awareness in Patients With Advanced Cancer. 2017

Nipp, Ryan D / Greer, Joseph A / El-Jawahri, Areej / Moran, Samantha M / Traeger, Lara / Jacobs, Jamie M / Jacobsen, Juliet C / Gallagher, Emily R / Park, Elyse R / Ryan, David P / Jackson, Vicki A / Pirl, William F / Temel, Jennifer S. ·All authors: Harvard Medical School, Massachusetts General Hospital, Boston, MA. ·J Clin Oncol · Pubmed #28574777.

ABSTRACT: Purpose Patients' understanding of their illness is key for making informed treatment decisions, yet studies suggest an association between prognostic awareness and worse quality of life (QOL) and mood among patients with advanced cancer. We sought to explore the relationships among prognostic awareness, coping, QOL, and mood in patients with newly diagnosed, incurable cancer. Methods We assessed patients' self-reported health status and treatment goal (Prognosis and Treatment Perceptions Questionnaire), coping (Brief COPE), QOL (Functional Assessment of Cancer Therapy-General), and mood (Hospital Anxiety and Depression Scale) within 8 weeks of incurable lung or GI cancer diagnosis. We used linear regression to examine associations and interaction effects among patients' health status and treatment goal, coping strategies, QOL, and mood. Results Patients who reported a terminally ill health status had worse QOL (unstandardized coefficient [B] = -6.88; P < .001), depression (B = 1.60; P < .001), and anxiety (B = 1.17; P = .007). Patients who reported their oncologist's treatment goal was "to cure my cancer" had better QOL (B = 4.33; P = .03) and less anxiety (B = -1.39; P = .007). We observed interaction effects between self-reported health status and treatment goal and certain coping strategies. Specifically, subgroup analyses showed that greater use of positive reframing was related to better QOL (B = 2.61; P < .001) and less depression (B = -0.78; P < .001) among patients who reported a terminally ill health status. Active coping was associated with better QOL (B = 3.50; P < .001) and less depression (B = -1.01; P < .001) among patients who acknowledged their oncologist's treatment goal was not "to cure my cancer." Conclusion Prognostic awareness is related to worse QOL and mood in patients with newly diagnosed, incurable cancer; however, the use of certain coping strategies may buffer these relationships. Interventions to improve patients' prognostic awareness should seek to cultivate more adaptive coping strategies in order to enhance QOL and mood.

12 Article Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers. 2017

Jacobs, Jamie M / Shaffer, Kelly M / Nipp, Ryan D / Fishbein, Joel N / MacDonald, James / El-Jawahri, Areej / Pirl, William F / Jackson, Vicki A / Park, Elyse R / Temel, Jennifer S / Greer, Joseph A. ·Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 10B, Boston, MA, 02114, USA. jjacobs@mgh.harvard.edu. · Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA. jjacobs@mgh.harvard.edu. · Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA. · Department of Psychology, University of Miami, Coral Gables, FL, USA. · Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA. · Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 10B, Boston, MA, 02114, USA. · Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA. · Department of Medicine, Division of Palliative Care, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA. ·Ann Behav Med · Pubmed #28097515.

ABSTRACT: BACKGROUND: Individuals with advanced, incurable cancer often experience high physical and psychological symptom burden. Family and friend caregivers are at risk for emotional distress. PURPOSE: The aim of the study is to investigate the interrelationship of distress in patient-caregiver dyads at the time of newly diagnosed incurable cancer. METHODS: From May 2011 to July 2015, within 8 weeks of diagnosis of advanced lung or noncolorectal gastrointestinal cancer, 350 patients and 275 family caregivers were enrolled in a randomized controlled trial of early palliative care. Actor-partner interdependence modeling was used to examine relationships between dyad's self-reported anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale at baseline. RESULTS: Comparing patients with caregivers, patients reported more depressive symptoms (M CONCLUSIONS: In the context of newly diagnosed incurable cancer, caregivers experience more pronounced anxiety, while patients report greater depressive symptoms. Findings indicate that anxiety and depressive symptoms are interrelated among dyads facing newly diagnosed incurable disease. Results emphasize the importance of addressing distress in both patients and caregivers. Future research should discern when dyadic versus individual psychosocial interventions would be optimal. TRIAL REGISTRATION NUMBER: The trial was registered with the ClinicalTrials.gov database (NCT02349412) https://clinicaltrials.gov/ct2/show/NCT02349412 .

13 Article Effects of Early Integrated Palliative Care in Patients With Lung and GI Cancer: A Randomized Clinical Trial. 2017

Temel, Jennifer S / Greer, Joseph A / El-Jawahri, Areej / Pirl, William F / Park, Elyse R / Jackson, Vicki A / Back, Anthony L / Kamdar, Mihir / Jacobsen, Juliet / Chittenden, Eva H / Rinaldi, Simone P / Gallagher, Emily R / Eusebio, Justin R / Li, Zhigang / Muzikansky, Alona / Ryan, David P. ·Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital · Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA · Anthony L. Back, University of Washington, Seattle, WA · and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH. ·J Clin Oncol · Pubmed #28029308.

ABSTRACT: Purpose We evaluated the impact of early integrated palliative care (PC) in patients with newly diagnosed lung and GI cancer. Patients and Methods We randomly assigned patients with newly diagnosed incurable lung or noncolorectal GI cancer to receive either early integrated PC and oncology care (n = 175) or usual care (n = 175) between May 2011 and July 2015. Patients who were assigned to the intervention met with a PC clinician at least once per month until death, whereas those who received usual care consulted a PC clinician upon request. The primary end point was change in quality of life (QOL) from baseline to week 12, per scoring by the Functional Assessment of Cancer Therapy-General scale. Secondary end points included change in QOL from baseline to week 24, change in depression per the Patient Health Questionnaire-9, and differences in end-of-life communication. Results Intervention patients ( v usual care) reported greater improvement in QOL from baseline to week 24 (1.59 v -3.40; P = .010) but not week 12 (0.39 v -1.13; P = .339). Intervention patients also reported lower depression at week 24, controlling for baseline scores (adjusted mean difference, -1.17; 95% CI, -2.33 to -0.01; P = .048). Intervention effects varied by cancer type, such that intervention patients with lung cancer reported improvements in QOL and depression at 12 and 24 weeks, whereas usual care patients with lung cancer reported deterioration. Patients with GI cancers in both study groups reported improvements in QOL and mood by week 12. Intervention patients versus usual care patients were more likely to discuss their wishes with their oncologist if they were dying (30.2% v 14.5%; P = .004). Conclusion For patients with newly diagnosed incurable cancers, early integrated PC improved QOL and other salient outcomes, with differential effects by cancer type. Early integrated PC may be most effective if targeted to the specific needs of each patient population.

14 Article Coping in Patients With Incurable Lung and Gastrointestinal Cancers: A Validation Study of the Brief COPE. 2017

Hagan, Teresa L / Fishbein, Joel N / Nipp, Ryan D / Jacobs, Jamie M / Traeger, Lara / Irwin, Kelly E / Pirl, William F / Greer, Joseph A / Park, Elyse R / Jackson, Vicki A / Temel, Jennifer S. ·Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: tlh42@pitt.edu. · Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. ·J Pain Symptom Manage · Pubmed #27725249.

ABSTRACT: CONTEXT: Patients with incurable cancer engage in several coping styles to manage the impact of cancer and its treatment. The Brief COPE is a widely used measure intended to capture multiple and distinct types of coping. The Brief COPE has not been validated among patients with incurable cancer. OBJECTIVES: We sought to validate seven subscales of the Brief COPE in a large sample of patients newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers (N = 350). METHODS: Participants completed the Brief COPE and measures assessing quality of life (QOL) (Functional Assessment of Cancer Therapy-General) and psychological distress (Hospital Anxiety and Depression Scale) within eight weeks of diagnosis of incurable cancer. We evaluated the psychometric properties of the Brief COPE using a confirmatory factor analysis and tests of correlation with the QOL and distress scales. RESULTS: The Brief COPE factors were consistent with the original subscales, although the Behavioral Disengagement Scale had low internal consistency. Factors showed anticipated relationships with QOL and distress measures, except emotional support coping, which was correlated with increased depression and anxiety. We also conducted an exploratory high-order factor analysis to determine if subscales' score variances grouped together. The high-order factor analysis resulted in two factors, with active, emotional support, positive reframing, and acceptance loading onto one factor and denial and self-blame loading onto the second. CONCLUSION: The selected subscales of the Brief COPE are appropriate measures of coping among individuals newly diagnosed with incurable lung and gastrointestinal cancers.

15 Article Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial. 2016

El-Jawahri, Areej / LeBlanc, Thomas / VanDusen, Harry / Traeger, Lara / Greer, Joseph A / Pirl, William F / Jackson, Vicki A / Telles, Jason / Rhodes, Alison / Spitzer, Thomas R / McAfee, Steven / Chen, Yi-Bin A / Lee, Stephanie S / Temel, Jennifer S. ·Massachusetts General Hospital, Boston2Harvard Medical School, Boston, Massachusetts. · Duke University School of Medicine, Durham, North Carolina. · Fred Hutchinson Cancer Research Center, Seattle, Washington. ·JAMA · Pubmed #27893130.

ABSTRACT: Importance: During hospitalization for hematopoietic stem cell transplantation (HCT), patients receive high-dose chemotherapy before transplantation and experience significant physical and psychological symptoms and poor quality of life (QOL). Objective: To assess the effect of inpatient palliative care on patient- and caregiver-reported outcomes during hospitalization for HCT and 3 months after transplantation. Design, Setting, and Participants: Nonblinded randomized clinical trial among 160 adults with hematologic malignancies undergoing autologous/allogeneic HCT and their caregivers (n = 94). The study was conducted from August 2014 to January 2016 in a Boston hospital; follow-up was completed in May 2016. Interventions: Patients assigned to the intervention (n=81) were seen by palliative care clinicians at least twice a week during HCT hospitalization; the palliative intervention was focused on management of physical and psychological symptoms. Patients assigned to standard transplant care (n=79) could be seen by palliative care clinicians on request. Main Outcomes and Measures: Primary: change in patient QOL from baseline to week 2; secondary: patient-assessed mood, fatigue, and symptom burden scores at baseline, 2 weeks, and 3 months after HCT and caregiver-assessed QOL and mood at baseline and 2 weeks after HCT. Results: Among 160 enrolled patients (mean age, 60 [SD, 13.3] years; 91 women [56.9%]; median hospital stay, 21 days) and 94 caregivers, 157 (98.1%) and 89 (94.7%), respectively, completed 2-week follow-up, and 149 patients (93.1%) completed 3-month follow-up. Patients in the intervention group reported a smaller decrease in QOL from baseline to week 2 (mean baseline score, 110.26; week 2 score, 95.46; mean change, -14.72) compared with patients in the control group (mean baseline score, 106.83; week 2 score, 85.42; mean change, -21.54; difference between groups, -6.82; 95% CI, -13.48 to -0.16; P = .045). Among the secondary outcomes, from baseline to week 2, patients in the intervention group vs those in the control group had less increase in depression (mean, 2.43 vs 3.94; mean difference, 1.52; 95% CI, 0.23-2.81; P = .02), lower anxiety (mean, -0.80 vs 1.12; mean difference, 1.92; 95% CI, 0.83-3.01; P < .001), no difference in fatigue (mean, -10.30 vs -13.65; mean difference, -3.34; 95% CI, -7.25 to 0.56; P = .09), and less increase in symptom burden (mean, 17.35 vs 23.14; mean difference, 5.80; 95% CI, 0.49-11.10; P = .03). At 3 months after HCT, intervention patients vs control patients had higher QOL scores (mean, 112.00 vs 106.66; mean difference, 5.34; 95% CI, 0.04-10.65; P = .048) and less depression symptoms (mean, 3.49 vs 5.19; mean difference, -1.70; 95% CI, -2.75 to -0.65; P = .002) but no significant differences in anxiety, fatigue, or symptom burden. From baseline to week 2 after HCT, caregivers of patients in the intervention group vs caregivers of patients in the control group reported no significant differences in QOL or anxiety but had a smaller increase in depression (mean, 0.25 vs 1.80; mean difference, 1.55; 95% CI, 0.14-2.96; P = .03). Conclusions and Relevance: Among adults at a single institution undergoing HCT for hematologic malignancy, the use of inpatient palliative care compared with standard transplant care resulted in a smaller decrease in QOL 2 weeks after transplantation. Further research is needed for replication and to assess longer-term outcomes and cost implications. Trial Registration: clinicaltrials.gov Identifier: NCT02207322.

16 Article Factors associated with depression and anxiety symptoms in family caregivers of patients with incurable cancer. 2016

Nipp, R D / El-Jawahri, A / Fishbein, J N / Gallagher, E R / Stagl, J M / Park, E R / Jackson, V A / Pirl, W F / Greer, J A / Temel, J S. ·Department of Medicine, Division of Hematology and Oncology rnipp@mgh.harvard.edu. · Department of Medicine, Division of Hematology and Oncology. · Department of Psychiatry. · Department of Medicine, Division of Palliative Care, Massachusetts General Hospital and Harvard Medical School, Boston, USA. ·Ann Oncol · Pubmed #27177859.

ABSTRACT: BACKGROUND: Family caregivers (FCs) are critically important for patients with cancer, yet they may experience psychological distress related to caregiving demands. We sought to describe rates of depression and anxiety in FCs of patients with incurable cancer and identify factors associated with these symptoms to determine those at greatest risk for psychological distress. PATIENTS AND METHODS: We performed a cross-sectional analysis of baseline data from a randomized trial of early palliative care. We assessed depression and anxiety using the Hospital Anxiety and Depression Scale in patients within 8 weeks of diagnosis of incurable lung or gastrointestinal cancer and their FCs. We also assessed patients' quality of life (Functional Assessment of Cancer Therapy-General), coping strategies (Brief COPE), and their report of the primary goal of their cancer treatment. We used linear regression with purposeful selection of covariates to identify factors associated with FC depression and anxiety symptoms. RESULTS: We enrolled 78.6% (n = 275) of potentially eligible FCs. The majority were female (69.1%) and married to the patient (66.2%). While the proportion of FCs and patients reporting depression did not differ (16.4% versus 21.5%, P = 0.13), FCs were more likely to report anxiety compared with patients (42.2% versus 28.4%, P < 0.001). Patients' use of acceptance coping was associated with lower FC depression (B = -0.42, P < 0.001), while emotional support coping was associated with higher FC depression (B = 0.69, P = 0.001) and lower FC anxiety (B = -0.70, P < 0.001). Patient report that their primary goal of their treatment was to 'cure my cancer' was associated with higher FC depression (B = 0.72, P = 0.03). CONCLUSIONS: Patients with incurable cancer and their FCs report high levels of depression and anxiety symptoms. We demonstrated that patients' coping strategies and prognostic understanding were associated with FC depression and anxiety symptoms, underscoring the importance of targeting these risk factors when seeking to address the psychological distress experienced by FCs.

17 Article The relationship between coping strategies, quality of life, and mood in patients with incurable cancer. 2016

Nipp, Ryan D / El-Jawahri, Areej / Fishbein, Joel N / Eusebio, Justin / Stagl, Jamie M / Gallagher, Emily R / Park, Elyse R / Jackson, Vicki A / Pirl, William F / Greer, Joseph A / Temel, Jennifer S. ·Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts. · Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. ·Cancer · Pubmed #27089045.

ABSTRACT: BACKGROUND: Patients with incurable cancer face many physical and emotional stressors, yet little is known about their coping strategies or the relationship between their coping strategies, quality of life (QOL), and mood. METHODS: As part of a randomized trial of palliative care, this study assessed baseline QOL (Functional Assessment of Cancer Therapy-General), mood (Hospital Anxiety and Depression Scale), and coping (Brief COPE) in patients within 8 weeks of a diagnosis of incurable lung or gastrointestinal cancer and before randomization. To examine associations between coping strategies, QOL, and mood, we used linear regression, adjusting for patients' age, sex, marital status, and cancer type. RESULTS: There were 350 participants (mean age, 64.9 years), and the majority were male (54.0%), were married (70.0%), and had lung cancer (54.6%). Most reported high utilization of emotional support coping (77.0%), whereas fewer reported high utilization of acceptance (44.8%), self-blame (37.9%), and denial (28.2%). Emotional support (QOL: β = 2.65, P < .01; depression: β = -0.56, P = .02) and acceptance (QOL: β = 1.55, P < .01; depression: β = -0.37, P = .01; anxiety: β = -0.34, P = .02) correlated with better QOL and mood. Denial (QOL: β = -1.97, P < .01; depression: β = 0.36, P = .01; anxiety: β = 0.61, P < .01) and self-blame (QOL: β = -2.31, P < .01; depression: β = 0.58, P < .01; anxiety: β = 0.66, P < .01) correlated with worse QOL and mood. CONCLUSIONS: Patients with newly diagnosed, incurable cancer use a variety of coping strategies. The use of emotional support and acceptance coping strategies correlated with better QOL and mood, whereas the use of denial and self-blame negatively correlated with these outcomes. Interventions to improve patients' QOL and mood should seek to cultivate the use of adaptive coping strategies. Cancer 2016;122:2110-6. © 2016 American Cancer Society.

18 Article Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. 2016

El-Jawahri, Areej R / Vandusen, Harry B / Traeger, Lara N / Fishbein, Joel N / Keenan, Tanya / Gallagher, Emily R / Greer, Joseph A / Pirl, William F / Jackson, Vicki A / Spitzer, Thomas R / Chen, Yi-Bin A / Temel, Jennifer S. ·Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts. · Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. · Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts. · Palliative Care Department, Massachusetts General Hospital, Boston, Massachusetts. · Department of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts. ·Cancer · Pubmed #26650840.

ABSTRACT: BACKGROUND: During hospitalization for hematopoietic stem cell transplantation (HCT), patients experience a steep deterioration in quality of life (QOL) and mood. To our knowledge, the impact of this deterioration on patients' QOL and posttraumatic stress disorder (PTSD) symptoms after HCT is unknown. METHODS: We conducted a prospective longitudinal study of patients hospitalized for HCT. They assessed QOL using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) and depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at the time of admission for HCT, during hospitalization, and 6 months after HCT. We also used the Hospital Anxiety and Depression Scale (HADS) to measure patients' anxiety and depression symptoms at baseline and during HCT hospitalization. The PTSD Checklist was used to assess for PTSD symptoms. Multivariable linear regression models were used to identify predictors of QOL and PTSD symptoms at 6 months. RESULTS: We enrolled 90 of 93 consecutively eligible patients (97%) undergoing autologous and allogeneic HCT. Data at 6 months were available for 67 participants. At 6 months, 28.4% of participants met the criteria for PTSD and 43.3% had clinically significant depression. On multivariable regression analyses adjusting for significant covariates, changes in QOL and depression scores from week 2 of HCT hospitalization to baseline predicted worse QOL (changes in scores between week 2 and baseline [Δ] QOL: β, 0.94 [P<.0001] and Δ PHQ-9: β, -2.59 [P = 0.001]) and PTSD symptoms (Δ QOL: β, -0.40 [P<.0001] and Δ PHQ-9: β, 1.26 [P<.0001]) at 6 months after HCT. CONCLUSIONS: Six months after HCT, a significant percentage of patients met the criteria for PTSD and depression. A decline in QOL and an increase in depressive symptoms during hospitalization for HCT were found to be the most important predictors of 6-month QOL impairment and PTSD symptoms. Therefore, managing symptoms of depression and QOL deterioration during HCT hospitalization may be critical to improving QOL at 6 months and reducing the risk of PTSD. Cancer 2016;122:806-812. © 2015 American Cancer Society.

19 Article Pilot Study of a Brief Behavioral Intervention for Dyspnea in Patients With Advanced Lung Cancer. 2015

Greer, Joseph A / MacDonald, James J / Vaughn, Jeanne / Viscosi, Elene / Traeger, Lara / McDonnell, Theresa / Pirl, William F / Temel, Jennifer S. ·Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA. Electronic address: jgreer2@mgh.harvard.edu. · Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA. ·J Pain Symptom Manage · Pubmed #26166181.

ABSTRACT: CONTEXT: Dyspnea is a common symptom in patients with advanced cancer that interferes with functional ability and quality of life (QOL). Although few evidence-based treatments for dyspnea exist, prior studies show support for nonpharmacological interventions that include elements of cognitive-behavioral therapy. OBJECTIVES: To examine the feasibility and utility of delivering a brief behavioral intervention for dyspnea in patients with lung cancer. METHODS: For this single-group pilot study, eligible patients included those with advanced lung cancer (Stage III or IV non-small cell or extensive-stage small cell lung cancer) receiving outpatient cancer treatment who reported at least moderate breathlessness. The manualized intervention consisted of two sessions in which nurse practitioners taught participants breathing and relaxation techniques within the infusion clinic and encouraged home practice. Participants completed measures of breathlessness (Modified Medical Research Council Dyspnea Scale), QOL (Functional Assessment of Cancer Therapy-Lung Trial Outcome Index), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale) at baseline and within six weeks after enrollment. RESULTS: Of the 32 patients enrolled in the study (56.3% females; mean age 63.34 [SD] = 7.96 years), 84.4% (N = 27) completed all study procedures. Comparing the baseline to postassessments, we found significant improvements in Modified Medical Research Council Dyspnea Scale (P < 0.001), Functional Assessment of Cancer Therapy-Lung Trial Outcome Index (P = 0.01), and Hospital Anxiety and Depression Scale-depression subscale (P < 0.001) scores. CONCLUSION: In this sample of patients with advanced lung cancer and dyspnea, we observed a high completion rate for the two-session behavioral intervention. Patients also reported improvements in dyspnea, QOL, and mood. Follow-up randomized controlled trials are needed to examine the efficacy of brief behavioral interventions for cancer-related dyspnea.

20 Article Parenting changes in adults with cancer. 2015

Moore, Cynthia W / Rauch, Paula K / Baer, Lee / Pirl, William F / Muriel, Anna C. ·Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. · Division of Pediatric Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. ·Cancer · Pubmed #26094587.

ABSTRACT: BACKGROUND: Children whose parents have cancer are at risk for psychosocial difficulties; however, the mechanisms are not well understood. This cross-sectional study sought support for a model connecting parental cancer to child distress through its impact on parenting self-efficacy beliefs and parenting behaviors by examining relations among parental illness, quality of life/parent functioning, parenting efficacy beliefs, and concerns about children's emotional distress. METHODS: One hundred ninety-four adult oncology outpatients with children who were 18 years old or younger completed questionnaires assessing their health-related quality of life (Functional Assessment of Cancer Therapy-General), depression and anxiety symptoms (Hospital Anxiety and Depression Scale), overall distress (Distress Thermometer), and parenting efficacy beliefs and parenting concerns (Parenting Concerns Questionnaire). RESULTS: Parenting efficacy scores for parents and coparents declined significantly after diagnosis. This decline correlated with more visits to a medical clinic, treatment with intravenous chemotherapy in the past month, poorer health-related quality of life, and more depression and distress. Parents experiencing the most concern about the impact of mood, physical limitations, and changes in routines on their children experienced the biggest declines in their own sense of efficacy as parents and in their belief in their coparent's efficacy. Finally, declines in parenting efficacy beliefs correlated with parental concerns about children's emotional distress about aspects of the parent's illness. CONCLUSIONS: This study highlights the importance of identifying and addressing parenting concerns to alleviate patient distress, and it may help to guide future intervention efforts.

21 Article Psychological factors at early stage of treatment as predictors of receiving chemotherapy at the end of life. 2015

Fujisawa, Daisuke / Temel, Jennifer S / Traeger, Lara / Greer, Joseph A / Lennes, Inga T / Mimura, Masaru / Pirl, William F. ·Massachusetts General Hospital Cancer Center, Boston, MA, USA. · Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. ·Psychooncology · Pubmed #25959002.

ABSTRACT: INTRODUCTION: Administration of chemotherapy in the last 14 days of life is a widely recognized indicator of poor end-of-life (EOL) care. The current study aimed to investigate predictors of this outcome, focusing on patients' self-reported psychological symptoms. METHODS AND MATERIALS: This is a secondary analysis of a randomized controlled trial that examined the efficacy of early palliative care integrated with standard oncology practice in patients with metastatic non-small cell lung cancer (NSCLC). We analyzed associations between receipt of chemotherapy within 14 days of death and demographic, clinical, and quality-of-life variables in the 125 patients who received chemotherapy in the course of their illness and died during the 50-month follow-up. RESULTS: Twenty-five patients (20%) received chemotherapy within the last 14 days of their life. Among demographic and clinical variables, only route of chemotherapy was significantly associated with receipt of chemotherapy within 14 days of death (oral 34.1% vs. intravenous (i.v.) 12.3%, p < 0.05). In the subsample of participants who received i.v. chemotherapy as their last regimen, greater anxiety and depression and lower quality of life in emotional, social, and existential domains were associated with greater likelihood of receiving chemotherapy at the EOL. These associations were not observed in patients who received oral chemotherapy as their last regimen. CONCLUSION: Anxiety, depression, and worse psychological quality of life at early stage of treatment may be associated with the receipt of i.v. chemotherapy at the EOL. Further research is needed to examine how these factors might influence decision-making about the discontinuation of chemotherapy at the EOL.

22 Article Quality of life and mood of patients and family caregivers during hospitalization for hematopoietic stem cell transplantation. 2015

El-Jawahri, Areej R / Traeger, Lara N / Kuzmuk, Kailyn / Eusebio, Justin R / Vandusen, Harry B / Shin, Jennifer A / Keenan, Tanya / Gallagher, Emily R / Greer, Joseph A / Pirl, William F / Jackson, Vicki A / Ballen, Karen K / Spitzer, Thomas R / Graubert, Timothy A / McAfee, Steven L / Dey, Bimalangshu R / Chen, Yi-Bin A / Temel, Jennifer S. ·Department of Hematology Oncology, Massachusetts General Hospital, Boston, MA. ·Cancer · Pubmed #25469752.

ABSTRACT: BACKGROUND: We conducted a study to investigate the impact of hospitalization for hematopoietic stem cell transplantation (HCT) on the quality of life (QOL) and mood of patients and family caregivers (FC). METHODS: We conducted a longitudinal study of patients who were hospitalized for HCT and their FC. We assessed QOL (using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation) and mood (using the Hospital Anxiety and Depression Scale) at baseline (6 days before HCT), day +1, and day +8 of HCT. We administered the Medical Outcomes Study Health Survey Short Form-36 to examine FC QOL (Physical Component Scale and Mental Component Scale). To identify predictors of changes in QOL, we used multivariable linear mixed models. RESULTS: We enrolled 97% of eligible patients undergoing autologous (30 patients), myeloablative (30 patients), or reduced intensity (30 patients) allogeneic HCT. Patients' QOL markedly declined (mean Functional Assessment of Cancer Therapy-Bone Marrow Transplantation score, 109.6 to 96.0; P<.0001) throughout hospitalization. The percentage of patients with depression (Hospital Anxiety and Depression Scale-Depression score of >7) more than doubled from baseline to day +8 (15.6% to 37.8%; P<.0001), whereas the percentage of patients with anxiety remained stable (22.2%; P = .8). These results remained consistent when data were stratified by HCT type. Baseline depression (β, -2.24; F, 42.2 [P<.0001]) and anxiety (β, -0.63; F, 4.4 [P =.03]) were found to independently predict worse QOL throughout hospitalization. FC QOL declined during the patient's hospitalization (physical component scale: 83.1 to 79.6 [P =.03] and mental component scale: 71.6 to 67.4 [P =.04]). CONCLUSIONS: Patients undergoing HCT reported a steep deterioration in QOL and substantially worsening depression during hospitalization. Baseline anxiety and depression predicted worse QOL during hospitalization, underscoring the importance of assessing pre-HCT psychiatric morbidity.

23 Article Patterns and predictors of antidepressant use in ambulatory cancer patients with common solid tumors. 2015

Fisch, Michael J / Zhao, Fengmin / Manola, Judith / Miller, Andrew H / Pirl, William F / Wagner, Lynne I. ·The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ·Psychooncology · Pubmed #24930693.

ABSTRACT: PURPOSE: Depressive symptoms and antidepressant use are prevalent among cancer patients. We sought to identify determinants of prescribing commonly used antidepressants. PATIENTS AND METHODS: This multi-institutional study enrolled 3106 ambulatory patients with cancer of the breast, prostate, colon/rectum, or lung. Five case-finding methods were used to identify patients with depressive symptoms. Logistic models were used to examine factors that impact antidepressant use. RESULTS: Approximately, 47% of patients were defined as having depressive symptoms. Clinicians rated being sad/depressed as one of the top three priority problems for 10.5% of patients. Antidepressants were prescribed in 19% of all patients, 25% with depressive symptoms and 14% nondepressed patients. After adjusting for other covariates, these variable categories were significantly associated with greater use of antidepressants: depressive symptoms, family history of depression, concurrent medication use, cancer treatment status, and certain other clinical and demographic variables. The strongest individual predictors were concurrent use of more than 10 medications (odds ratio [OR] = 3.3), a family history of depression (OR = 2.2), sedative use (OR = 2.1), non-Hispanic white race (OR = 2.0), and anxiolytics use (OR = 2.0). CONCLUSIONS: Depressive symptoms are found in nearly half of outpatients with cancer, and one-fourth of patients with depressive symptoms are taking an antidepressant. Patients receiving antidepressants are more often those taking multiple medications, those with a depression diathesis, and those with more extensive cancer treatment. Patients who were younger, white, and female were also more likely to be taking antidepressants.

24 Article Dyspnea and panic among patients with newly diagnosed non-small cell lung cancer. 2014

Shin, Jennifer A / Kosiba, Jesse D / Traeger, Lara / Greer, Joseph A / Temel, Jennifer S / Pirl, William F. ·Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: jashin@mgh.harvard.edu. · Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA. · Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA. ·J Pain Symptom Manage · Pubmed #24766738.

ABSTRACT: CONTEXT: Among patients with lung cancer, dyspnea is associated with psychological distress, fatigue, and poor coping. Respiratory symptoms are also a common trigger for panic attacks in the general population. Minimal research has addressed the prevalence of panic disorder or the association of dyspnea with the risk of panic disorder in lung cancer. OBJECTIVES: We explored the frequency of panic disorder symptoms and the association of dyspnea with the risk of panic disorder symptoms among patients with newly diagnosed non-small cell lung cancer. METHODS: During 2006-2010, consecutive patients presenting for initial consultation at a thoracic oncology clinic completed a survey of current symptoms, including dyspnea and panic disorder symptoms. We evaluated the frequency of panic disorder symptoms. Logistic regression was used to test the association of dyspnea with the risk of panic disorder symptoms, adjusting for age, gender, disease stage, performance status, and major depression symptoms. RESULTS: Among 624 patients (mean age=63.7; standard deviation=12.1; 52.6% female), 48.1% reported that breathing was at least somewhat difficult and 11.2% endorsed panic disorder symptoms. Dyspnea was independently associated with higher risk of panic disorder symptoms (odds ratio=2.19, 95% confidence interval=1.11-4.31, P=0.02). Younger age and major depression symptoms also were associated with higher risk (P<0.01). CONCLUSION: Almost half of the patients with newly diagnosed non-small cell lung cancer reported dyspnea, and patients with dyspnea were more than twice as likely to endorse panic disorder symptoms relative to patients without dyspnea. Results highlight the need to differentiate panic disorder symptoms among patients who report dyspnea, particularly those who are younger or experiencing major depression symptoms.

25 Article Race by sex differences in depression symptoms and psychosocial service use among non-Hispanic black and white patients with lung cancer. 2014

Traeger, Lara / Cannon, Sheila / Keating, Nancy L / Pirl, William F / Lathan, Christopher / Martin, Michelle Y / He, Yulei / Park, Elyse R. ·Lara Traeger, William F. Pirl, and Elyse R. Park, Massachusetts General Hospital · Lara Traeger, Nancy L. Keating, William F. Pirl, Yulei He, and Elyse R. Park, Harvard Medical School · Sheila Cannon, University of Massachusetts Boston · Nancy L. Keating, Brigham and Women's Hospital · Christopher Lathan, Dana-Farber Cancer Institute, Boston, MA · and Michelle Y. Martin, University of Alabama at Birmingham, AL. ·J Clin Oncol · Pubmed #24323033.

ABSTRACT: PURPOSE: This study examined race by sex differences in depression symptoms and psychosocial service use (pastors, social workers, mental health workers, support groups) among patients with lung cancer. PATIENTS AND METHODS: The multiregional Cancer Care Outcomes Research and Surveillance study surveyed black and white adults with stages I to III lung cancer (n = 1,043) about depression symptoms, interest in help for mood, and psychosocial service use. Multivariable logistic regression was used to evaluate race/sex differences in depression symptoms (modified Center for Epidemiologic Studies Depression Scale ≥ 6) and psychosocial service use, independent of demographic, clinical, psychosocial, and behavioral covariates. RESULTS: A total of 18.2% screened positive for depression symptoms. This proportion was highest among black men (24.7%), followed by white women (20.6%), black women (15.8%), and white men (15.0%). In adjusted analyses, white women showed greater risk for depression symptoms relative to black women (P = .01) and white men (P = .002), with no other differences among groups. Black patients were less likely than white patients to receive desired help for mood from their doctors (P = .02), regardless of sex. Among all patients, black women were most likely to have contact with pastoral care and social work. CONCLUSION: Race and sex interacted to predict risk of depression symptoms. Covariates accounted for elevated risk among black men. White women showed greater risk than black women and white men, independent of covariates. Black patients may experience greater barriers to receiving help for mood from their doctors. Race by sex differences in contact with psychosocial services highlight potential differences in the extent to which services are available, acceptable, and/or sought by patients.

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