| 1. |
- Glimelius, B, et al.
(författare)
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Improved care of patients with small cell lung cancer. Nutritional and quality of life aspects.
- 1992
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 31:8, s. 823-31
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Tidskriftsartikel (refereegranskat)abstract
- A comprehensive cancer care project was carried out in Uppsala with the aim of improving the overall situation for patients treated with intensive chemotherapy with curative intent. This report gives the results in 58 patients with small cell lung cancer (SCLC), focusing on the nutritional aspects of the care and chemotherapy-related adverse effects. Responses, survival and simple nutritional parameters were compared with a historical control group (n = 81), and quality-of-life parameters with a pre-project group (n = 22). Groups were comparable with respect to pre-treatment characteristics. In contrast to the historical control group, weight, body mass index and S-albumin did not decrease during treatment in patients diagnosed during the project period. Yet, food intake in the study group was low, and for most patients below what is recommended. Survival, proportion of responses and response duration did not differ from those of the control group. Compared with the pre-project quality-of-life controls, a number of scores were more favourable for study patients (n = 36) interviewed in association with the 8th treatment course by a Swedish version of the Cancer Inventory of Problem Situations (CIPS). The global score was lower in the study group than in the pre-project group (0.80 vs 1.20, p < 0.001). Significant differences in a favourable direction were also seen in several higher order factors and miscellaneous subscales constituting the CIPS. On individual items, the study group expressed less problems with appetite/food taste in hospital, nervousness before chemotherapy and worry about adverse effects. The greatest differences in positive direction for the study group were seen within areas where the project focused on caring activities. We therefore conclude that a cancer care project with the present goals and means of intervention can improve the quality of life in patients with SCLC treated with intensive chemotherapy.
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| 2. |
- Nordin, Karin, et al.
(författare)
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Anxiety, depression and worry in gastrointestinal cancer patients attending medical follow-up control visits
- 1996
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 35:4, s. 411-416
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Tidskriftsartikel (refereegranskat)abstract
- Anxiety, depression and worry were assessed in 141 consecutive gastrointestinal cancer patients scheduled for follow-up control visits. Participants completed two questionnaires, one including the Hospital Anxiety and Depression Scale (HAD) in conjunction with the visit and one completed after. The overall levels of anxiety before, during and after the visit were low. There were no differences between those who were considered cured and those who were not. Anxiety levels after the visit were higher for those patients for whom less than one year had passed since diagnosis. Mean HAD scores for anxiety and depression were 4.2 and 4.3 respectively. Women reported a higher degree of anxiety than men. Using a score of 8 or more for 'borderline-possible cases', 15% fell into these categories on the anxiety scale and 12% on the depression scale. About 30% of the patients worried about seeing a new physician and 25% about what the examination or tests would show. It is concluded that regular, scheduled control visits pose a significant threat to the psychological well-being of only a minority of gastrointestinal cancer patients.
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| 3. |
- Nordin, Karin, et al.
(författare)
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Predicting delayed anxiety and depression in patients with gastrointestinal cancer
- 1999
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 79:3-4, s. 525-9
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine the possibility of predicting anxiety and depression 6 months after a cancer diagnosis on the basis of measures of anxiety, depression, coping and subjective distress associated with the diagnosis and to explore the possibility of identifying individual patients with high levels of delayed anxiety and depression associated with the diagnosis. A consecutive series of 159 patients with gastrointestinal cancer were interviewed in connection with the diagnosis, 3 months (non-cured patients only) and 6 months later. The interviews utilized structured questionnaires assessing anxiety and depression [Hospital Anxiety and Depression (HAD) scale], coping [Mental Adjustment to Cancer (MAC) scale] and subjective distress [Impact of Event (IES) scale]. Patient anxiety and depression close to the diagnosis were found to explain approximately 35% of the variance in anxiety and depression that was found 6 months later. The addition of coping and subjective distress measures did little to improve that prediction. A model using (standardized) cut-off scores of moderate to high anxiety, depression (HAD) and intrusive thoughts (IES subscale) close to the diagnosis to identify patients at risk for delayed anxiety and depression achieved a sensitivity of 75% and a specificity of 98%. Levels of anxiety and depression at diagnosis predicted a similar status 6 months later. The results also indicated that the HAD scale in combination with the IES intrusion subscale may be used as a tool for detecting patients at risk of delayed anxiety and depression.
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| 4. |
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| 5. |
- Nordin, Karin
(författare)
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Psychological responses to gastrointestinal cancer
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present thesis is to gain knowledge about psychological distress and adjustment in gastrointestinal cancer patients (colon, rectum, gastric, pancreatic or biliary) at various phases of their disease.Reactions to the diagnosis, anxiety, depression and coping were investigated in newly diagnosed patients (n=139). Repeated assessments were performed throughout the fast year after the diagnosis. Only a limited group reported high levels of anxiety (17%) and depression (21%) close to the diagnosis. Patients with colon or rectal cancer, most of whom were potentially cured, had a more confronting attitude to their diagnosis and reported more 'Fighting Spirit' than patients with gastric and pancreatic/biliary cancer. These responses were associated with better emotional well-being. The former group also reported less `Hopeless/helplessness' and 'Anxious preoccupation', which were related to higher levels of psychological distress. There were no changes over time in mean levels of anxiety and depression and virtually no changes in mean values of the coping subscales. In a separate group (n=141), overall levels of anxiety, depression and worry were low in conjunction to a medical follow-up control visit approximately two years after diagnosis.Levels of anxiety and depression at diagnosis predicted a similar status six months later. A model based on standardised cut-off scores of moderate or high levels of anxiety or depression and intrusive thoughts close to the diagnosis was used to identity patients with prolonged psychological distress.A psychometric analysis was performed of the Mental Adjustment to Cancer (MAC) scale (n=868 patients with various cancers). The reliability of the original subscales was satisfying. A confirmatory factor analysis revealed a factor structure including 28 of the original 40 items in four factors. Both versions of the MAC confound coping efforts and emotional outcomes, preventing analyses of coping-outcome relations.The main conclusion is that a majority of gastrointestinal cancer patients cope well with their disease in the short as well as in the long run.
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| 6. |
- Nordin, Karin, et al.
(författare)
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Reactions to gastrointestinal cancer : variation in mental adjustment and emotional well-being over time in patients with different prognoses
- 1998
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Ingår i: Psycho-Oncology. - 1057-9249 .- 1099-1611. ; 7:5, s. 413-423
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Tidskriftsartikel (refereegranskat)abstract
- The relation between mental adjustment, often referred to as coping strategies, and emotional well-being and their changes over time were studied in 139 consecutive, newly diagnosed gastrointestinal cancer patients. Sixty-six patients were potentially cured since all known disease could be removed by surgery, whereas in 73 patients, this was not possible. A more confronting reaction to the diagnosis was associated with better emotional well-being whereas avoidance of reminders of, and intrusive thoughts about the disease were associated with more distress. In agreement with other studies, we found that the coping strategy 'Fighting Spirit' was associated with better emotional well-being while the reverse was true for the strategies 'Hopeless/Helplessness' and 'Anxious Preoccupation'. There were only minor changes over time in the average values of emotional well-being and coping strategies, particularly among patients who at diagnosis were considered incurable. In analyses of each individual's changes of predominant coping style and whether they were categorized as cases/doubtful cases on the HAD anxiety and depression scale, marked changes were, however, seen in several patients. The analyses of mean values give an impression of stability, whereas analyses of the number of patients with a specific predominant coping strategy and how they change, give another. The question of whether coping strategies and emotional well-being change through the course of the disease has no simple and obvious answer. Whether some of the investigated coping strategies should be conceptualized in terms of coping, or whether they are an outcome of the coping efforts, are discussed.
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| 7. |
- Nordin, Karin, et al.
(författare)
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The Mental Adjustment to Cancer Scale : a psychometric analysis and the concept of coping
- 1999
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Ingår i: Psycho-Oncology. - 1057-9249 .- 1099-1611. ; 8:3, s. 250-259
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Tidskriftsartikel (refereegranskat)abstract
- A psychometric analysis of the Mental Adjustment to Cancer (MAC) scale was performed in a heterogeneous Swedish sample of cancer patients (n = 868). The homogeneity of the original subscales proved to be satisfactory (alpha coefficients 0.61-0.81). The sample was randomly split into two subgroups, and a factor analysis was carried out in one of them using the LISREL 8.20 procedure. This yielded four factors called 'Hopeless', 'Positive', 'Anxious' and 'Avoidant' including 28 of the 40 original items (alpha coefficients 0.58-0.81). The novel factor structure was cross-validated and confirmed in the second subgroup. In contrast to the original scale (one item), 'Avoidance', was indexed by three items. The distinction between mental adjustment and coping is discussed. It is concluded that both versions of the MAC scale are measures of mental adjustment including emotional reactions as well as coping.
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