Recent Submissions

  • Factors associated with psychological distress for couples facing head and neck cancer: A systematic literature review

    Tickle, Anna C.; Biswas, Sanchia (2021)
    Objectives: Cancer patients in supportive relationships display improved health and survival outcomes. Identifying factors that might respond to intervention for Head and Neck Cancer (HNC) dyads is important as HNC patients and their partners experience heightened distress. This article systematically reviewed and evaluated the research findings and methodological quality of studies which identified factors influencing psychological distress for couples facing HNC. Methods: PsycINFO, Medline, and CINAHL were searched. Studies were included if they used validated psychological distress measures and quantitative data collection methods. Eleven studies satisfied inclusion criteria. Results: Studies identified factors associated with the psychological distress experienced by couples facing HNC, with substantial effect size variation. These factors included clinical, sociodemographic, relational, and psychological variables. Factors associated with increased psychological distress included disease burden, reduced social contact, perception of reduced relationship quality, and less adaptive/assimilative coping although the effect sizes displayed considerable heterogeneity. Overall, studies possessed good methodological quality but generally could have been improved by minimising the risk of non-response bias and fully reporting relational characteristics. Conclusions: The implications of these results for clinical practice and future research are discussed. Further research is recommended to report effect sizes more consistently for both dyad members to gain greater insight into couple-level distress and to perform moderator analyses to identify which variables influence the magnitude of psychological distress.
  • Reducing dropout in acceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy for chronic pain and cancer patients using motivational interviewing

    Malins, Samuel; Biswas, Sanchia; Rathbone, James; Vogt, William; Pye, Naomi; Levene, Jo (2020)
    OBJECTIVEAcceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy are types of cognitive-behavioural therapy (CBT) group that improve physical and mental health in chronic pain or cancer. However, dropout is high due to group demands alongside physical impairments. Motivational interviewing (MI) is a well-evidenced means of enhancing treatment adherence. Few studies have investigated MI as an adjunct to CBT in cancer or chronic pain, and none have established the minimum MI duration required for adherence improvement. This study evaluated minimal-duration MI to improve adherence in three CBT group types for cancer and chronic pain.METHODSIn a cohort study of 99 cancer and chronic pain patients, 47 were given a 10- to 15-min structured MI telephone intervention (MI-call) after the first session. The remaining 52 received a CBT group without MI (no-MI).RESULTSOdds of completing group CBTs were five times greater for patients in the MI-call cohort versus no-MI. Effects remained when controlling for age, gender, diagnosis, group type, and baseline quality of life. The MI-call cohort attended one extra session per patient compared to no-MI, controlling for age, gender, and diagnosis.CONCLUSIONSA brief MI telephone intervention may improve adherence to group CBTs in cancer and chronic pain.PRACTITIONER POINTSA brief motivational interviewing (MI) telephone intervention may reduce dropout from group cognitive-behavioural therapies (CBTs) for cancer and chronic pain patients when administered after the first group session in routine care. Recipients of this intervention were five times more likely to complete a group CBT programme than those who did not receive it. Therefore, a minimal-dose MI intervention can have clinically important effects on dropout in group CBTs for patients with long-term conditions. It is unclear whether this intervention would also result in greater outcome improvements.
  • Brief training in psychological assessment and interventions skills for cancer care staff: A mixed methods evaluation of deliberate practice techniques

    Malins, Samuel; Levene, Jo; Biswas, Sanchia (2020)
    OBJECTIVE: Unaddressed anxiety and depression is common among cancer patients and has significant adverse consequences. Cancer staff training is recommended for psychological assessment and interventions to address depression and anxiety, to increase access to psychosocial oncology care. However, psychological skills training has a poor track-record for improving clinical effectiveness. "Deliberate practice", receiving feedback on therapeutic micro-skills and rehearsing modifications, can enhance clinical effectiveness. This study applied deliberate practice to maximise benefits of brief psychological skills training for cancer care staff. METHOD: Seventeen one-day training workshops were provided to 263 cancer care staff, aiming to improve confidence in assessing anxiety and depression, and delivering problem-solving therapy. Training used deliberate practice methods at the expense of didactic lecturing. Staff confidence was assessed in key teaching domains using pre-post confidence ratings. Anonymous comments from 152 training attendees were examined using thematic analysis. RESULTS: One-day psychological skills training significantly improved cancer staff confidence in assessment of anxiety and depression, and delivery of brief psychological interventions. Thematic analysis indicated that focusing on practical skills was valued by participants and contributed to staff commitments to change practice. However, some participants felt the one-day training was over-filled and would be better delivered over more days. CONCLUSION: Similar results can be achieved by providing psychological skills training on a single-day, as compared to an established five-day programme, by abbreviating didactic teaching and focusing time on deliberate practice of skills. Training may increase the likelihood of changes in practice, but more training time may be required for maximum benefit. This article is protected by copyright. All rights reserved.
  • Using smart-messaging to enhance mindfulness-based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation

    Malins, Samuel; Biswas, Sanchia; Sweeney, Timothy; Levene, Jo (2019)
    OBJECTIVE Depression and anxiety lead to reduced treatment adherence, poorer quality of life, and increased care costs amongst cancer patients. Mindfulness-Based Cognitive Therapy (MBCT) is an effective treatment, but dropout reduces potential benefits. Smart-message reminders can prevent dropout and improve effectiveness. However, smart-messaging is untested for MBCT in cancer. This study evaluates smart-messaging to reduce dropout and improve effectiveness in MBCT for cancer patients with depression or anxiety. METHODS Fifty-one cancer patients attending MBCT in a psycho-oncology service were offered a smart-messaging intervention, which reminded them of prescribed between-session activities. Thirty patients accepted smart-messaging and 21 did not. Assessments of depression and anxiety were taken at baseline, session-by-session and one-month follow-up. Logistic regression and multilevel modelling compared the groups on treatment completion and clinical effectiveness. Fifteen post-treatment patient interviews explored smart-messaging use. RESULTS The odds of programme completion were eight times greater for patients using smart-messaging compared with non-users, controlling for age, gender, baseline depression, and baseline anxiety (OR = 7.79, 95% CI 1.75 to 34.58, p = .007). Smart-messaging users also reported greater improvement in depression over the programme (B = -2.33, SEB = .78, p = .004), when controlling for baseline severity, change over time, age, and number of sessions attended. There was no difference between groups in anxiety improvement (B = -1.46, SEB = .86, p = .097). In interviews, smart-messaging was described as a motivating reminder and source of personal connection. CONCLUSIONS Smart-messaging may be an easily integrated telehealth intervention to improve MBCT for cancer patients.
  • How patients adjust psychologically to the experience of head and neck cancer: A grounded theory

    Biswas, Sanchia; Tickle, Anna C. (2019)
    Numerous physical and psychological challenges are recognised as consequences of head and neck cancer and its treatment, but little is known about how patients adjust psychologically to these experiences. This study aimed to develop a theoretical understanding of the processes patients engage in when adjusting to head and neck cancer. Twelve patients participated in semi-structured interviews conducted individually and transcribed verbatim. Data were analysed using grounded theory methodology. Analysis generated a core category of "modifying my relationship to the changes cancer brings," which encompassed 11 processes patients engaged in throughout their adjustment: "survive mode," "instrumental support from others," "making a choice," "developing own understanding," "acceptance," "talking with others," "making changes," "redefining or regaining normality," "managing emotions/distressing thoughts," "putting things into perspective" and "barriers to progress." Contrasting findings are discussed, and a model of psychological adjustment to head and neck cancer is proposed. The study found that patients engage in a series of processes throughout adjustment to head and neck cancer, which broadly map on to the cancer treatment trajectory, though these processes did not appear to be specific to head and neck cancer. The proposed model may be used as a framework to guide psychological interventions.
  • Challenges related to the cancer care role

    Fathers, Dean (2019)
    Background: Cancer caregiving occurs across all the settings in which care is delivered and often involves interacting with numerous providers, back and forth transitions from hospital to home, and eventually end-of-life care. The journey is nonlinear and each phase of the care process brings with it new challenges for the carers. Family members make a vital, hidden contribution to the health and well-being of the nation, however their care roles and needs remain largely unaddressed, and are omitted from conversations with healthcare providers. Aim(s): In line with the NCRI research priorities announced in November 2018, the aim of this study was to gain insight about carers' experienced challenges while providing support to a close one diagnosed with cancer at main transition points in the journey. Method(s): Data were collected through in-depth interviews and two focus groups with carers residing in the East Midlands of England. Data were thematically analysed. Result(s): Twenty four participants took part in the study (4 males; 20 females; age range 37-76; 4 HCPs). Themes emerged from the data explained aspects related to (1) specialist services (lack of access to facilities, lack of timely and right information about treatment sideeffects, follow-up care, and use of medical devices, undignified care, and service discontinuity) and (2) patient's diagnosis and decisions (comorbidities, treatment discontinuity, and refusal to communicate). Conclusion(s): This study has identified carers' challenges related to their roles and responsibilities. It highlights the need of coordinated and family oriented services to empower carers to manage the illness throughout the diagnostic and treatment journey.
  • Lung cancer screening: does pulmonary nodule detection affect a range of smoking behaviours?

    das Nair, Roshan (2018)
    Background: Lung cancer screening can reduce lung cancer mortality by 20%. Screen-detected abnormalities may provide teachable moments for smoking cessation. This study assesses impact of pulmonary nodule detection on smoking behaviours within the first UK trial of a novel auto-antibody test, followed by chest x-ray and serial CT scanning for early detection of lung cancer (Early Cancer Detection Test-Lung Cancer Scotland Study). Methods: Test-positive participants completed questionnaires on smoking behaviours at baseline, 1, 3 and 6 months. Logistic regression compared outcomes between nodule (n = 95) and normal CT groups (n = 174) at 3 and 6 months follow-up. Results: No significant differences were found between the nodule and normal CT groups for any smoking behaviours and odds ratios comparing the nodule and normal CT groups did not vary significantly between 3 and 6 months. There was some evidence the nodule group were more likely to report significant others wanted them to stop smoking than the normal CT group (OR across 3- and 6-month time points: 3.04, 95% CI: 0.95, 9.73; P = 0.06). Conclusion: Pulmonary nodule detection during lung cancer screening has little impact on smoking behaviours. Further work should explore whether lung cancer screening can impact on perceived social pressure and promote smoking cessation.
  • Lung cancer CT screening: Psychological responses in the presence and absence of pulmonary nodules

    das Nair, Roshan (2018)
    Pulmonary nodules are commonly found on CT scans screening for lung cancer (LC). Some non-UK studies show negative psychological impacts of pulmonary nodule diagnosis. We explored psychological impacts of nodule diagnosis during LC screening in the UK. There was little impact on affect, health anxiety, worry, illness perception or risk perception. There were fewer short-term avoidance symptoms in those diagnosed with nodules.
  • Within and between day repeatability of the incremental shuttle walking test in patients with thoracic cancer

    Taylor, Vicky (2018)
    Background Breathlessness is common in patients with thoracic cancer but difficult to manage. The Incremental Shuttle Walking Test (ISWT) can help assess new treatments, but its repeatability has not been described in this group. Aim To examine within and between day repeatability of the ISWT in this setting. Methods Patients with incurable thoracic cancer were recruited from outpatient clinics at a University Hospital. Two ISWTs were completed one hour apart on two consecutive days, with the first test for familiarization purposes only. Repeatability of distance walked was examined using Bland and Altman plots and assessed as the single determination (within subject) standard deviation of the difference between tests and its 95% range. Results Forty-one patients participated and completed all tests. Mean (SD) distance walked was 333 (134), 349 (129) and 353 (130) m over the three tests, with the mean difference significantly different from zero between days (16 m, 95% CI 8–24 m, P = 0.043) but not within days (5 m, 95% CI –2 to 12 m, P = 0.47). Within and between day single determination SD and 95% ranges were 30 (−31 to 91) m and 36 (−37 to 109) m respectively. Conclusions These data help inform the design of studies making use of the ISWT and the interpretation of their findings.
  • The effect of psychological interventions on quality of life in patients with head and neck cancer: A systematic review and meta-analysis

    Calver, Louise; Tickle, Anna C.; Biswas, Sanchia (2017)
    This systematic review and meta-analysis aimed to evaluate the effectiveness of psychological interventions in improving quality of life for head and neck cancer patients. Five databases were systematically searched in July 2016. Studies were included if they reported original empirical data from intervention studies utilising psychological approaches (excluding psychoeducational-only interventions) and provided data on quality of life outcomes. Six studies, involving 185 participants, fulfilled eligibility criteria. Study designs included a case study, single-group designs, non-randomised controlled trials and one randomised controlled trial. Meta-analysis of two studies did not provide support for the effectiveness of psychological intervention improving total quality of life scores (or subscales) compared to control groups at end of intervention. Intervention studies evaluating psychological interventions for patients with head and neck cancer have produced insufficient data to support their effectiveness for improving quality of life. This review further highlights the limited evidence base within this area. Existing studies are based on small samples and are inconsistent regarding: intervention type, duration and intensity; follow-up measurement periods; and methodological quality. Further research, addressing these limitations, is required for more definitive conclusions to be drawn about the effectiveness of psychological interventions with this population.
  • The relationship between coping style and psychological distress in people with head and neck cancer: A systematic review

    Morris, Nicole; Tickle, Anna C.; Biswas, Sanchia (2017)
    OBJECTIVE: Individuals diagnosed with head and neck cancer (HNC) are at an elevated risk of experiencing psychological distress and a reduced quality of life. The aim of this review was to systematically examine and assess the quality of empirical evidence on the associations between coping mechanisms and psychological distress among people with HNC. METHODS: CINAHL, MEDLINE, PsycINFO, EMBASE and Web of Science were accessed to conduct this review. Studies were included if they used reliable and valid measures to investigate the relationship between coping style and psychological distress. Study quality was assessed and rated according to pre-set criteria, and showed variability in relation to selection methods. RESULTS: 12 studies (nine cross-sectional and three prospective designs) involving 1281 patients were reviewed. There was considerable heterogeneity in study samples and coping measures. Moderate to large associations between disengagement coping mechanisms (e.g. avoidance) and psychological distress were observed. Engagement coping strategies (e.g. direct action) were not consistently associated with psychological distress across studies. CONCLUSIONS: Several studies observed a significant relationship between coping styles aimed at disengaging and distancing from cancer and increased psychological distress. To understand directionality of these associations and further develop an understanding of temporal features of the relationship between coping styles and distress, longitudinal designs could be used in future research.
  • A large scale pragmatic validation of the HADS for major depression in an ethnically diverse cancer population

    Baker-Glenn, Elena A. (2010)
    OBJECTIVES: There is considerable interest in the accuracy of the Hospital Anxiety and Depression Scale in cancer. The HADS is the single most commonly applied tool for depression, tested to date in 22 analyses against major depressive disorder (MDD). However, only one previous study had a sample size over 300 (Walker et al. 2007 J Psychosom Res 63: 83-91). METHOD: We analysed data collected from Leicester Cancer Centre from 2007-2009 involving approximately 1000 people approached by a research nurse, research physician and two therapeutic radiographers. The researcher applied DSMIV criteria of major depressive disorder (MDD). We collated full data on 690 patient assessments of whom 12.9% had MDD, 121 were palliative and 115 (16.7%) were from ethnic minorities (largely British South Asian of India descent). RESULTS: Sensitivity and specificity were as follows HADS-A 87.6%/72.3; HADS-D 86.5%/80.1% and HADS-T 95.5%/76.3%. The AUC was highest for HADS-T > HADS-D > HADS-A. In ethnic minorities sensitivity and specificity were as follows HADS-A 93.1%/66.3%; HADS-D 86.2%/65.1% and HADS-T 96.6%/66.3%. AUC was poor for the HADS-D from the ethnic group and HADS-A/HADS-T were preferred. There was no difference by cancer stage. CONCLUSIONS: This is the largest validation study of the HADS in cancer and suggests that in an ethnically diverse population the HADS-T may be the optimal version based on accuracy alone; regardless of cancer stage. The HADS-D may have weaker validity in patients from ethnic minority populations.
  • Desire for psychological support in cancer patients with depression or distress: Validation of a simple help question

    Baker-Glenn, Elena A.; Park, Bert G. (2011)
    Objectives: Despite documented high rates of psychological distress, it is not clear how to identify those who are willing to accept help. The aim of this study was to investigate whether asking patients receiving chemotherapy if they want help with emotional problems is valuable and to investigate the type of help they want.; Methods: Patients attending a chemotherapy suite were asked to complete the Hospital Anxiety and Depression Scale, the Brief Patient Health Questionnaire (PHQ) and the Emotion Thermometers tools. Results were compared with a single question on desire for help.; Results: In this study, 128 patients completed questionnaires for distress, depression, anxiety and desire for help at initial interview. Only one in five unselected patients had a perceived need for help, and in distressed patients only 36% expressed a desire for help. The addition of the help question to the two questions (PHQ-2) about mood and interest improved the ability to rule-in depression by increasing the specificity. However, by addition of this question, sensitivity was significantly reduced. Desire for help was modestly associated with severity of distress, anxiety and depression.; Conclusions: The addition of a help question appears to have limited value in screening for psychological symptoms, but it may highlight those who are willing to accept addition support. Clinicians should attempt to offer a range of psychosocial interventions that will be acceptable to patients with distress.; Copyright © 2010 John Wiley & Sons, Ltd.
  • Jo's story: The journey of one woman's experience of having cancer and a 'learning disability'

    Martean, Melissa H. (2014)
    With increasing longevity amongst people with learning disabilities, it is not surprising that prevalence and incidence rates of cancer are growing at a significant rate. Much of the research undertaken in the area of psycho-oncology has focused on the 'general population', and over the last decade, there has been increasing interest in using a narrative approach to explore the lived experiences of people who have had cancer. Traditionally, research into cancer amongst people with learning disabilities has focused upon epidemiology or palliative care. However, the present article uses a narrative analysis to explore the lived and told experience of a person with a learning disability, who has been given a diagnosis of cancer. This article highlights the need and provides justification, for more qualitative research to be undertaken in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Breast reconstruction following cancer: Its impact on patients' and partners' sexual functioning

    Marshall, Catherine (2005)
    Previous literature lacks a theoretical conceptualisation of breast reconstruction and its impact on patients' and partners' sexual functioning. The aims of the present study were to identify factors that impact on the sexual relationship, to explore coping strategies used by patients and partners, and to highlight service needs. In total, 12 women who had undergone breast reconstructive surgery within the last three years and their partners (10 men) took part in the study. Grounded theory methodology was used to analyse the data and identify key categories for both patients and partners. Patients' key categories included anxiety and worry, influencing factors, self-image and sexual changes. All women experienced some degree of sexual change and sexual anxiety, and a minority reported a loss of sexual self. Partners' key categories included anxiety and stress, influencing factors and negotiating sexual changes. The majority of partners reported that initially, their priority was their partner's survival rather than sexual concerns; however the majority of men acknowledged some degree of sexual anxiety. The study highlighted the lack of information and discussion about sexual issues for both patients and partners, and the timing of such information if it were to be provided. It also stresses the need for services to include partners throughout the process.
  • Can the Distress Thermometer be improved by additional mood domains? Part II. What is the optimal combination of Emotion Thermometers?

    Baker-Glenn, Elena A.; Park, Bert G. (2010)
    Purpose: To examine the added value of an algorithmic combination of visual-analogue thermometers compared with the Distress Thermometer (DT) when attempting to detect depression, anxiety or distress in early cancer. Methods: We report Classification and Regression Tree and logistic regression analyses of the new five-domain Emotion Thermometers tool. This is a combination of five visual-analogue scales in the form of four mood domains (distress, anxiety, depression, anger) as well as need for help. 130 patients attending for their first chemotherapy treatment were assessed. We calculated optimal accuracy for each domain alone and in combination against several criterion standards. Results: When attempting to diagnose depression the Depression Thermometer (DepT) used alone was the optimal approach, but when attempting to detect broadly defined distress or anxiety then a combination of thermometers was most accurate. The DepT was significantly more accurate in detecting depression than the DT. For broadly defined distress a combination of depression, anger and help thermometers was more accurate than the DT alone. For anxiety, while the anxiety thermometer (AnxT) improves upon the DT alone, a combination of the DepT and AnxT are optimal. In each case the optimal strategy allowed the detection of at least an additional 9%, of individuals. However, combinations are more laborious to score. In settings where the simplest possible option is preferred the most accurate single thermometer might be preferable as a first stage assessment. Conclusion: The DT can be improved by specific combinations of simple thermometers that incorporate depression, anxiety, anger and help. Copyright (C) 2009 John Wiley & Sons, Ltd.
  • A large scale validation of the emotion thermometers as a screening tool for distress in an ethnically diverse cancer population

    Baker-Glenn, Elena A. (2010)
    OBJECTIVES: We previously reported initial validation of the Emotion Thermometers, a simple 5-domain visual analogue scale inspired by the Distress Thermometer (Psychooncology. 2009 Mar 18; Epub), against depression. Here we aimed to report a definitive validation in a large ethnically diverse sample against Hospital Anxiety and Depression Scale (HADS) defined distress. METHOD: We analysed data collected from Leicester Cancer Centre from 2007-2009 involving approximately 1000 people approached by a research nurse, research physician and two therapeutic radiographers. The researcher applied the HADS and used a HADS-T \gt 14 to signify distress. We collated full data on 660 patient assessments of whom 12.9% had MDD and 14.8 were from ethnic minorities (largely British South Asian of India descent). RESULTS: In the parent sample of 660, sensitivity, specificity and AUC were as follows: DT - 71.9%; 78.4%; 0.814; cut point = 4 AnxT -75.7%; 73.4%; 0.821; cut point = 5 DepT - 77.6%; 82.2%; 0.855; cut point = 3 AngT - 77.5%; 77.6%; 0.823; cut point = 2 HelpT -69.1%; 80.8%; 0.809; cut point = 3. Thus DepT was optimal and has superior sensitivity and specificity to the DT. There was no significant difference by ethnicity. CONCLUSIONS: In this large scale validation of the ET against cancer related distress (on the HADS-T) the DepT may be the optimal thermometer. The optimal cut-point appears to be= >3. The DepT also performs well in those in an ethnic minority namely British South Asian patients.